Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like P*

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

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
18	Fee-for-Service	1790819175	1790819175	1	2	POLLACK, RONALD D MD	6/12/2019	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	36850	-	NOT APPLICABLE	0	In state provider	None	1732 PALMA DR	SUITE 208	VENTURA	CA	93003	5749	56	06111	34.25702666	-119.2274867	Ventura County
36	Fee-for-Service	1093969115	1093969115	1	3	PLANNED PARENTHOOD OF LA	8/12/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4211 DOZIER STREET	None	LOS ANGELES	CA	90063	3422	19	06037	34.04153176	-118.1755086	Los Angeles County
49	Fee-for-Service	1093969115	1093969115	1	11	PLANNED PARENTHOOD OF LA	9/14/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8800 SAN PEDRO ST	None	LOS ANGELES	CA	90003	3541	19	06037	33.95715138	-118.2694827	Los Angeles County
53	Fee-for-Service	1023697299	1023697299	1	1	PETERSEN, LUCILLE CRNA	8/11/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
62	Fee-for-Service	1093969115	1093969115	1	25	PLANNED PARENTHOOD OF LA	1/11/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8015 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6009	19	06037	34.21656555	-118.4488095	Los Angeles County
146	Fee-for-Service	1093969115	1093969115	1	15	PLANNED PARENTHOOD OF LA	10/12/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	450 N GRAND AVE	None	LOS ANGELES	CA	90012	2123	19	06037	34.06008647	-118.2444243	Los Angeles County
147	Fee-for-Service	1093969115	1093969115	1	18	PLANNED PARENTHOOD OF LA	10/12/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	11800 TEXAS AVE	None	LOS ANGELES	CA	90025	1402	19	06037	34.0463162	-118.4604553	Los Angeles County
170	Fee-for-Service	1447382411	1447382411	1	1	PROHEALTH PARTNERS, A	9/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	MEDICAL GROUP, INC	300 REDONDO AVE	STE B	LONG BEACH	CA	90814	2651	19	06037	33.768324	-118.152404	Los Angeles County
186	Fee-for-Service	1104993047	1104993047	1	1	PATEL, PRAGNESH C MD	3/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72342	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
187	Fee-for-Service	1396041695	1396041695	1	1	PARTNERS URGENT CARE-	4/3/2012	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROSSMONT	6136 LAKE MURRAY BLVD	None	LA MESA	CA	91942	2502	37	06073	32.79089628	-117.020778	San Diego County
221	Fee-for-Service	1205956828	1205956828	1	1	PETERSON, CHERYL L LMFT	5/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 S SHEPHERD ST	STE D	SONORA	CA	95370	5076	55	06109	37.98264015	-120.3810653	Tuolumne County
237	Fee-for-Service	1013905678	1013905678	3	1	PROFESSIONAL RX INC	4/13/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NSTER	7631 WESTMINSTER	STE D	WESTMINSTER	CA	92683	3990	30	06059	33.7592463	-117.9958613	Orange County
270	Fee-for-Service	1336712918	1336712918	1	1	PSYCH SISTERS COUNSELING, IN	11/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C.	5535 SWADLY WAY	None	SACRAMENTO	CA	95835	1520	34	06067	38.677212	-121.5165375	Sacramento County
299	Fee-for-Service	1447387675	1447387675	1	1	PANGRAC, DANETTE G MFT	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	35805	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
363	Fee-for-Service	1609920016	1609920016	1	1	PHAM, KAREN THU A OD	11/12/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1812 GALINDO STREET	None	CONCORD	CA	94520	2477	07	06013	37.9754145	-122.034647	Contra Costa County
367	Fee-for-Service	1316956337	1316956337	1	1	PATEL, VISHAL J MD	3/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55703	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
406	Fee-for-Service	1083849012	1083849012	1	1	PARK, LIGAYA F DO	1/2/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	12072	07	Dermatology	0	In state provider	None	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	49	06097	38.46672	-122.720724	Sonoma County
430	Fee-for-Service	1346569191	1346569191	1	1	PRINCE, LESLEY C MD	11/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124531	41	Internal Medicine	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
431	Fee-for-Service	1932670049	1932670049	1	1	PEREZ, JORGE L DC	9/3/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2211 E LINCOLN AVE	None	ANAHEIM	CA	92806	4108	30	06059	33.83945699	-117.8858858	Orange County
437	Fee-for-Service	1093969115	1093969115	1	6	PLANNED PARENTHOOD OF LA	8/12/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4328 BELL AVE	None	BELL	CA	90201	2528	19	06037	33.97480781	-118.191409	Los Angeles County
456	Fee-for-Service	1184791600	1184791600	1	1	PLISKIN, SHERYL E LMFT	6/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 VETERANS BLVD	STE 220	REDWOOD CITY	CA	94063	1462	41	06081	37.49285785	-122.232301	San Mateo County
475	Fee-for-Service	1396041695	1396041695	1	1	PARTNERS URGENT CARE-	4/3/2012	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROSSMONT	6136 LAKE MURRAY BLVD	None	LA MESA	CA	91942	2502	37	06073	32.79089628	-117.020778	San Diego County
500	Fee-for-Service	1851803191	1851803191	1	1	PARSON, BLAKE M PT	1/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
503	Fee-for-Service	1124283700	1124283700	1	1	PATEL, SHETAL M PHD	4/13/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
558	Fee-for-Service	1881607604	1881607604	1	1	PARKS, STEPHEN	1/1/1995	207L00000X	NA	Other	026	PHYSICIANS	65543	05	Anesthesiology	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
636	Fee-for-Service	1134695935	1134695935	1	1	PHU, ALLEN L RCP	4/25/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
682	Fee-for-Service	1265905509	1265905509	1	1	PEUGH, CHARLES B LMFT INC	7/16/2018	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	49370 ROAD 426	STE B	OAKHURST	CA	93644	9052	20	06039	37.32775834	-119.647531	Madera County
696	Fee-for-Service	1770718975	1770718975	1	1	PALOMINO, MARY A MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115699	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
757	Fee-for-Service	1639852635	1639852635	1	1	PORTILLO, ALFREDO M CNP	8/17/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
762	Fee-for-Service	1427200344	1427200344	1	1	PRINCE, ERIN R DO	1/26/2011	207P00000X	NA	Other	026	PHYSICIANS	11276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
764	Fee-for-Service	1326196254	1326196254	1	1	PINPIN JOCSON, LUZVIMIND	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30154	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
768	Fee-for-Service	1942497193	1942497193	1	1	PHAM, THOMAS T DO	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9023	41	Internal Medicine	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4136	33	06065	33.97614344	-117.3797664	Riverside County
779	Fee-for-Service	1699480038	1699480038	1	1	PALMDALE URGENT CARE INC	8/8/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2270 E PALMDALE BLVD	STE F	PALMDALE	CA	93550	1334	19	06037	34.58009827	-118.0881861	Los Angeles County
820	Fee-for-Service	1952783862	1952783862	1	1	PERERA, K A MANISHA S MD	6/25/2019	207R00000X	NA	Other	026	PHYSICIANS	151920	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
848	Fee-for-Service	1649559543	1649559543	1	1	PALATIANOS-SIFAKIS, STACIE M	11/22/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LPCC	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
865	Fee-for-Service	1376595298	1376595298	1	1	POTTER, STEVEN ROE MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78750	34	Urology and Urological Surgery	0	In state provider	None	2200 W 3RD ST	None	LOS ANGELES	CA	90057	1932	19	06037	34.06329642	-118.2739484	Los Angeles County
877	Fee-for-Service	1710059522	1710059522	1	1	POVOR, LUCIA MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83990	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
911	Fee-for-Service	1104350271	1104350271	1	1	PAHK, EUGENE MD	6/24/2021	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	165964	None	None	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
936	Fee-for-Service	1093969115	1093969115	1	7	PLANNED PARENTHOOD OF LA	2/2/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	18230 KITTRIDGE ST	None	RESEDA	CA	91335	6121	19	06037	34.19022348	-118.530981	Los Angeles County
952	Fee-for-Service	1760427223	1760427223	1	1	PHAN, JOSEPH T MD	9/10/2019	207R00000X	NA	Other	026	PHYSICIANS	158474	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
980	Fee-for-Service	1306235767	1306235767	1	1	POGGI, GWENYTH M LMFT	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
981	Fee-for-Service	1144258765	1144258765	1	1	PAVLISCAK, JILL K MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104908	08	Family Practice	0	In state provider	None	225 S CABRILLO HWY	STE 100A	HALF MOON BAY	CA	94019	1738	41	06081	37.46542425	-122.4337617	San Mateo County
987	Fee-for-Service	1720016728	1720016728	1	1	PATEL, TUSHAR P MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71957	42	Nuclear Medicine	0	In state provider	None	17150 EUCLID ST	STE 101	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
1081	Fee-for-Service	1497172670	1497172670	1	1	PHUNG, THIEN P MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146227	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
1147	Fee-for-Service	1396731782	1396731782	1	1	POSNER, REBECCA A MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72689	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1169	Fee-for-Service	1477699486	1477699486	1	1	PITTS, RONALD A MD INC	1/1/1979	163WP0200X	NA	Other	026	PHYSICIANS	29377	40	Pediatrics	0	In state provider	None	1818 S WESTERN AVE	STE 201	LOS ANGELES	CA	90006	5860	19	06037	34.0412168	-118.3089894	Los Angeles County
1185	Fee-for-Service	1720014160	1720014160	1	1	PINSKI, JACEK K MD	6/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77687	78	Neoplastic Diseases/Oncology	0	In state provider	None	1355 SAN PABLO ST	# 103	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
1212	Fee-for-Service	1437225174	1437225174	1	2	PATEL, SUMAN N MD	6/8/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	36382	None	None	0	In state provider	None	15211 VANOWEN ST	STE 200	VAN NUYS	CA	91405	3626	19	06037	34.19395411	-118.4642527	Los Angeles County
1226	Fee-for-Service	1285299230	1285299230	1	1	PATERNO, FRANCESCA R MD	8/17/2023	390200000X	NA	Other	026	PHYSICIANS	176332	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
1272	Fee-for-Service	1720016728	1720016728	1	1	PATEL, TUSHAR P MD	6/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71957	30	Radiology	0	In state provider	None	17150 EUCLID ST	STE 101	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
1279	Fee-for-Service	1548817836	1548817836	1	1	PREMIER NEPHROLOGY OF ORANGE	12/2/2019	246ZN0300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COUNTY INC	5832 BEACH BLVD	SUITE 214	BUENA PARK	CA	90621	5501	30	06059	33.875469	-117.9981525	Orange County
1287	Fee-for-Service	1982766085	1982766085	1	1	PERDOMO, YVETTE L MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78583	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
1303	Fee-for-Service	1295912749	1295912749	1	1	PEDIATRIC CRITICAL CARE	4/4/2008	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP OF AMERICA INC	2801 ATLANTIC AVE	FL 3	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
1354	Fee-for-Service	1710304845	1710304845	1	1	PAULINO, MARJA K MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144027	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
1359	Fee-for-Service	1902549173	1902549173	1	1	PLECHOT, ERIQ OD	11/3/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	23521 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	3126	30	06059	33.61113028	-117.7126684	Orange County
1369	Fee-for-Service	1255487104	1255487104	1	1	PIKE, ADAM S PT	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
1375	Fee-for-Service	1003913484	1003913484	1	1	PULATIE, ELIZABETH K M CRNA	1/5/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
1451	Fee-for-Service	1487869327	1487869327	1	1	PATIL, SOWMYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
1484	Fee-for-Service	1649401043	1649401043	1	1	PENALBA, ARIANNA M LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	SUITE 206	TOLUCA LAKE	CA	91505	4047	19	06037	34.15222929	-118.3480509	Los Angeles County
1518	Fee-for-Service	1144639436	1144639436	1	1	PARENTIS HOME CARE PROVIDERS	12/18/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	24012 CALLE DE LA PLATA	STE 400A	LAGUNA HILLS	CA	92653	3621	30	06059	33.61012113	-117.7115908	Orange County
1526	Fee-for-Service	1053688945	1053688945	1	1	PATEL, YOGENDRA B MD INC	6/18/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40908	10	Gastroenterology (M.D. only)	0	In state provider	None	12980 FREDERICK STREET	SUITE J	MORENO VALLEY	CA	92553	5263	33	06065	33.931872	-117.2613835	Riverside County
1540	Fee-for-Service	1104991561	1104991561	1	3	PEREZ, JOSE A MD	1/5/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20957	08	Family Practice	0	In state provider	None	3500 WHITTIER BLVD	STE 107	LOS ANGELES	CA	90023	1746	19	06037	34.02656881	-118.1982818	Los Angeles County
1580	Fee-for-Service	1811410723	1811410723	1	1	PARK, HYUNBIN MD	7/10/2023	390200000X	NA	Other	026	PHYSICIANS	186448	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1613	Fee-for-Service	1124264049	1124264049	1	1	PATTERS, KRISTEN L MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120066	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
1652	Fee-for-Service	1275692980	1275692980	1	1	PINEDA, CLEO C NP	6/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
1678	Fee-for-Service	1780997742	1780997742	1	1	PATTERSON HYATT, KIMBERLY G	10/19/2021	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
1714	Fee-for-Service	1992969703	1992969703	1	1	PATEL, HERSH MD	12/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157200	08	Family Practice	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
1773	Fee-for-Service	1306231600	1306231600	1	1	PARK, JOSEPH DPM	5/18/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	795 E SECOND ST	SUITE 7	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
1794	Fee-for-Service	1861436008	1861436008	1	1	PACIFIC HEARING, INC	8/4/2003	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11645 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90025	6807	19	06037	34.05005135	-118.4602303	Los Angeles County
1806	Fee-for-Service	1154445351	1154445351	1	1	PRUITT, LINDSEY MSW LCSW	3/13/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DR	SUITE 102	VALENCIA	CA	91355	1224	19	06037	34.44222202	-118.5700452	Los Angeles County
1834	Fee-for-Service	1043386584	1043386584	1	1	PADUCH, MARTHA E CRNA	7/20/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
1835	Fee-for-Service	1316041833	1316041833	2	7	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	147 NORTH BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
1852	Fee-for-Service	1841456027	1841456027	1	1	PARK, MICHELLE G MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110500	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
1860	Fee-for-Service	1588698641	1588698641	1	1	PETERSON, CRAIG S PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	519 E GLENOAKS BLVD	None	GLENDALE	CA	91207	2015	19	06037	34.15836472	-118.2494227	Los Angeles County
1897	Fee-for-Service	1609116425	1609116425	1	1	PHAN, CHI K NP	10/27/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1927	Fee-for-Service	1154882678	1154882678	1	2	PHILIP S SCHAUWEKER D.P.M. P	11/22/2022	261QP1100X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ROFESSIONAL PODIATRIC ME	1043 ELM AVE	STE. 407	LONG BEACH	CA	90813	3206	19	06037	33.779655	-118.1880065	Los Angeles County
1930	Fee-for-Service	1649358326	1649358326	1	1	PAHLAVAN, NIMA MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69739	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
1949	Fee-for-Service	1558991596	1558991596	1	1	PRECISION RHEUMATOLOGY, INC	8/9/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	2050 S EUCLID ST	None	ANAHEIM	CA	92802	3111	30	06059	33.79714857	-117.941245	Orange County
1968	Fee-for-Service	1295893659	1295893659	1	1	PEDIATRIC GASTROENTEROLO	1/11/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GY MEDICAL ASSOCIATES OF	2577 SAMARITAN DR	STE 815	SAN JOSE	CA	95124	4109	43	06085	37.25246494	-121.9501879	Santa Clara County
1976	Fee-for-Service	1437861432	1437861432	1	2	PURE HEALTHCARE PROFESSIONAL	6/20/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	MEDICAL SERVICES	660 LOCUST AVE	103	FRESNO	CA	93650	1094	10	06019	36.84046023	-119.8058023	Fresno County
1980	Fee-for-Service	1801118773	1801118773	1	1	PARKER, NATHANIEL W MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103730	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
1984	Fee-for-Service	1053990614	1053990614	1	1	PHARMLINK INC	6/22/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	833 W WHITTIER BLVD	STE C	MONTEBELLO	CA	90640	4735	19	06037	34.01035039	-118.109564	Los Angeles County
2006	Fee-for-Service	1760421713	1760421713	1	1	PARK RIDGE HOSPITAL	1/1/1997	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1555 LONG POND RD	None	ROCHESTER	NY	14626	4182	00	None	43.191927	-77.705514	Monroe County
2017	Fee-for-Service	1528401965	1528401965	1	1	PEREZ, REBECCA R LMFT	3/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3420 FINNIAN WAY	UNIT 226	DUBLIN	CA	94568	4588	01	06001	37.7062995	-121.863105	Alameda County
2076	Fee-for-Service	1902842396	1902842396	1	1	PACIFIC WEST PHARMACY	1/30/1995	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4363 PACIFIC ST	None	ROCKLIN	CA	95677	2117	31	06061	38.80204639	-121.2223103	Placer County
2121	Fee-for-Service	1639239437	1639239437	1	1	PORTNOY, DMITRY MD	7/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53924	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
2158	Fee-for-Service	1417451592	1417451592	1	1	PADILLA, RICARDO MD	6/5/2021	207P00000X	NA	Other	026	PHYSICIANS	166164	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
2195	Fee-for-Service	1285165472	1285165472	1	1	PETERSON, JUSTIN D MD	6/4/2021	207R00000X	NA	Other	026	PHYSICIANS	172800	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
2201	Fee-for-Service	1205248218	1205248218	1	1	POWERS, KIMBERLY A CRNA	6/30/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	44139 MONTEREY AVE	STE B	PALM DESERT	CA	92260	4218	33	06065	33.728004	-116.3912775	Riverside County
2222	Fee-for-Service	1245945203	1245945203	1	1	PRACTICALMED INC	8/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	5405 W HILLSDALE AVE	None	VISALIA	CA	93291	5156	54	06107	36.329364	-119.3510385	Tulare County
2234	Fee-for-Service	1558991596	1558991596	1	1	PRECISION RHEUMATOLOGY, INC	10/25/2023	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	2050 S EUCLID ST	None	ANAHEIM	CA	92802	3111	30	06059	33.79714857	-117.941245	Orange County
2239	Fee-for-Service	1134219264	1134219264	1	1	PROPHETE, LIAUTAUD M DO	1/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9842	None	None	0	In state provider	None	502 WASHINGTON AVE	None	LOS BANOS	CA	93635	4649	24	06047	37.05600223	-120.8529485	Merced County
2240	Fee-for-Service	1912085747	1912085747	1	1	PLIMPTON, TIMOTHY S MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64454	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
2253	Fee-for-Service	1659378008	1659378008	1	1	PRAVEEN, VIJAYAKUMAR MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140002	40	Pediatrics	0	In state provider	None	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	19	06037	33.73875253	-118.2899475	Los Angeles County
2254	Fee-for-Service	1295893659	1295893659	1	1	PEDIATRIC GASTROENTEROLO	1/11/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	GY MEDICAL ASSOCIATES OF	2577 SAMARITAN DR	STE 815	SAN JOSE	CA	95124	4109	43	06085	37.25246494	-121.9501879	Santa Clara County
2282	Fee-for-Service	1285383984	1285383984	1	1	PATHGEN LABORATORY	7/17/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2155 CHENAULT DR	STE 410	CARROLLTON	TX	75006	5087	00	None	32.96496973	-96.84494686	Dallas County
2294	Fee-for-Service	1760421713	1760421713	1	1	PARK RIDGE HOSPITAL	7/17/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1555 LONG POND RD	None	ROCHESTER	NY	14626	4182	00	None	43.191927	-77.705514	Monroe County
2340	Fee-for-Service	1346813557	1346813557	1	1	POTTENGER, SEAN CRNA	2/25/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
2351	Fee-for-Service	1811452196	1811452196	1	1	PSYCH LAB PSYCHOLOGY, INC.	6/19/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3950 LONG BEACH BLVD	STE 101	LONG BEACH	CA	90807	5410	19	06037	33.830559	-118.1893225	Los Angeles County
2355	Fee-for-Service	1578543013	1578543013	1	1	PILCHER, DAVID W MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63459	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
2377	Fee-for-Service	1699728188	1699728188	1	1	PHYS MED A PHYSICAL THERAPY	5/21/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
2462	Fee-for-Service	1346275211	1346275211	1	1	PATEL, ANJANA B MD	4/21/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159731	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2482	Fee-for-Service	1386977536	1386977536	1	1	PENEUETA, RAMEY A	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
2483	Fee-for-Service	1437249190	1437249190	1	1	PARK, CONNIE M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S EUCLID ST	None	FULLERTON	CA	92832	3153	30	06059	33.85674633	-117.9418424	Orange County
2498	Fee-for-Service	1972731784	1972731784	1	1	PATERSON, TARA A MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 WEST JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
2512	Fee-for-Service	1730561085	1730561085	1	1	PRECIOUS LOVE HOSPICE	12/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	23800 SUNNYMEAD BLVD	SUITE C	MORENO VALLEY	CA	92553	7731	33	06065	33.93901947	-117.2473637	Riverside County
2553	Fee-for-Service	1093937708	1093937708	1	1	PUNZALAN, RUBIO R MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	66411	01	General Practice	0	In state provider	None	2256 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1243	19	06037	34.03497597	-118.2171363	Los Angeles County
2566	Fee-for-Service	1275724650	1275724650	1	1	PFANNER, DENNIS J LMFT	8/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
2568	Fee-for-Service	1366845232	1366845232	1	2	PACHECO, MOSES LMFT	10/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
2581	Fee-for-Service	1912655614	1912655614	1	1	PRIME DX LABS	7/3/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	24060 FIR AVE	STE B	MORENO VALLEY	CA	92553	2895	33	06065	33.93543049	-117.242604	Riverside County
2590	Fee-for-Service	1730596644	1730596644	1	1	PANOSSIAN SAKI, EVELINA LCS	1/28/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
2599	Fee-for-Service	1184945784	1184945784	1	1	PARK, ANDREW Y MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102451	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
2676	Fee-for-Service	1316041833	1316041833	2	36	PEDIATRIX MEDICAL GROUP OF C	11/15/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
2697	Fee-for-Service	1487819553	1487819553	1	1	PAWAR, RAHUL V MD	1/16/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
2800	Fee-for-Service	1730561085	1730561085	1	1	PRECIOUS LOVE HOSPICE	12/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	23800 SUNNYMEAD BLVD	SUITE C	MORENO VALLEY	CA	92553	7731	33	06065	33.93901947	-117.2473637	Riverside County
2817	Fee-for-Service	1598404048	1598404048	1	1	PON, MEAGAN C NP	10/24/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	319 DIABLO ROAD	SUITE 105	DANVILLE	CA	94526	3428	07	06013	37.82286935	-121.9968022	Contra Costa County
2827	Fee-for-Service	1225542947	1225542947	1	1	PETERSEN, ALEXANDRIA PT	4/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
2836	Fee-for-Service	1003983909	1003983909	1	1	PHILLIPS, JULIE M MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39709	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
2843	Fee-for-Service	1093937708	1093937708	1	1	PUNZALAN, RUBIO R MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	66411	41	Internal Medicine	0	In state provider	None	2256 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1243	19	06037	34.03497597	-118.2171363	Los Angeles County
2858	Fee-for-Service	1003079690	1003079690	1	1	PITRONE, JESSE LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
2884	Fee-for-Service	1235902735	1235902735	1	1	POLANCO, AMANDA N CNP	12/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
2885	Fee-for-Service	1831693589	1831693589	1	1	PARISH, ANTHONY MD	10/2/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	166271	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
2919	Fee-for-Service	1346348968	1346348968	1	1	PATHI, RAMA T MD	7/6/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	42515	None	None	0	In state provider	None	18145 US HIGHWAY 18	STE D	APPLE VALLEY	CA	92307	2210	36	06071	34.5404119	-117.2678454	San Bernardino County
2966	Fee-for-Service	1316041833	1316041833	2	9	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
2984	Fee-for-Service	1699728188	1699728188	1	6	PHYS MED A PHYSICAL THERAPY	5/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	4969 MCKINLEY AVE	107	FRESNO	CA	93727	1968	10	06019	36.76528751	-119.728755	Fresno County
2992	Fee-for-Service	1568038933	1568038933	1	1	PURVIANCE, MICHAEL MD	7/9/2024	207R00000X	NA	Other	026	PHYSICIANS	185488	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
3002	Fee-for-Service	1225548209	1225548209	1	1	PETTYGROVE, SOFIA E LMFT	1/21/2021	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1608 OHIO AVENUE	None	MODESTO	CA	95358	0033	50	06099	37.61863999	-121.0350087	Stanislaus County
3012	Fee-for-Service	1154414357	1154414357	1	1	PATEL, GEETA MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97439	None	None	0	In state provider	None	3650 SOUTH ST	STE 403	LAKEWOOD	CA	90712	1504	19	06037	33.86019847	-118.149255	Los Angeles County
3021	Fee-for-Service	1972793883	1972793883	1	1	PHAM, CECILIA L OD	6/14/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
3121	Fee-for-Service	1134752314	1134752314	1	1	PINNACLE HOME HEALTH &	5/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	2775 COTTAGE WAY	STE 18	SACRAMENTO	CA	95825	1220	34	06067	38.604078	-121.397769	Sacramento County
3124	Fee-for-Service	1003983909	1003983909	1	1	PHILLIPS, JULIE M MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39709	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
3139	Fee-for-Service	1154375624	1154375624	1	1	PLANNED PARENTHOOD	1/31/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1431 MCHENRY AVE	STE 100	MODESTO	CA	95350	4534	50	06099	37.664811	-120.993969	Stanislaus County
3229	Fee-for-Service	1598898462	1598898462	1	1	PROHEALTH PARTNERS A	9/1/1995	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	1760 TERMINO AVE	G18	LONG BEACH	CA	90804	2169	19	06037	33.78889871	-118.1458784	Los Angeles County
3230	Fee-for-Service	1023579513	1023579513	1	1	PARK, VALENTINA MD	3/3/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177690	36	Psychiatry	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
3243	Fee-for-Service	1972681559	1972681559	1	1	PATEL, DIVYESH M MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69112	05	Anesthesiology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
3248	Fee-for-Service	1801981618	1801981618	1	1	PADMESH, HOSAHALLI P MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	45763	02	General Surgery	0	In state provider	None	2216 N CALIFORNIA ST	STE A	STOCKTON	CA	95204	5533	39	06077	37.97386974	-121.2903465	San Joaquin County
3298	Fee-for-Service	1316041833	1316041833	2	26	PEDIATRIX MEDICAL GROUP OF C	9/30/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	27200 CALAROGA	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
3308	Fee-for-Service	1316041833	1316041833	2	42	PEDIATRIX MEDICAL GROUP OF C	8/5/2024	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
3315	Fee-for-Service	1629205745	1629205745	1	1	POOMMIPANIT, NEDA B MD	6/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95186	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
3325	Fee-for-Service	1154551026	1154551026	1	1	PIKE, LEAH M MD PROF CORP	5/13/2010	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	83814	85	Surgery-Pediatric	0	In state provider	None	1760 TERMINO AVE	#308	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
3345	Fee-for-Service	1902326697	1902326697	1	1	PATEL, ARPIT C DO	9/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18383	08	Family Practice	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
3350	Fee-for-Service	1306088463	1306088463	1	1	PATTAMPURATH, SEENA MD	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118938	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
3372	Fee-for-Service	1588771893	1588771893	1	1	PAUL, GORDON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
3409	Fee-for-Service	1134752314	1134752314	1	1	PINNACLE HOME HEALTH &	5/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	2775 COTTAGE WAY	STE 18	SACRAMENTO	CA	95825	1220	34	06067	38.604078	-121.397769	Sacramento County
3414	Fee-for-Service	1518173400	1518173400	1	1	POHL, ELIZABETH C MD	7/1/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97819	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
3432	Fee-for-Service	1245318823	1245318823	1	1	PAGNONE, LOUIS DO	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
3445	Fee-for-Service	1356549794	1356549794	1	1	PATEL, NABILA N MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62111	40	Pediatrics	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
3467	Fee-for-Service	1992162077	1992162077	1	1	PHARMACY MART INC	11/1/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4050 PHELAN RD	STE 8	PHELAN	CA	92371	4454	36	06071	34.42633349	-117.573624	San Bernardino County
3507	Fee-for-Service	1194803940	1194803940	1	1	PHUONG, LUCY O MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82030	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
3533	Fee-for-Service	1770362139	1770362139	1	1	PRESENT ACUPUNCTURE INC	10/22/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	16169 HESPERIAN BLVD	None	SAN LORENZO	CA	94580	2451	01	06001	37.67713903	-122.1254449	Alameda County
3534	Fee-for-Service	1467749614	1467749614	1	1	PHAN, JULIE A MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123501	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L STREET	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
3536	Fee-for-Service	1316041833	1316041833	2	31	PEDIATRIX MEDICAL GROUP OF C	10/23/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2121 SANTA MONICA	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
3553	Fee-for-Service	1316041833	1316041833	2	19	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	89109	2317	01	06001	37.63347961	-122.0897735	Alameda County
3567	Fee-for-Service	1669600284	1669600284	1	1	PREMIER HEALTHCARE SERVICES	3/18/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	ONE BETTERWORLD CIRCLE	SUITE #120	TEMECULA	CA	92590	3742	33	06065	33.49523489	-117.159146	Riverside County
3598	Fee-for-Service	1487803334	1487803334	1	1	PORTUGES, RAFAEL C LMFT	5/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
3603	Fee-for-Service	1629205745	1629205745	1	1	POOMMIPANIT, NEDA B MD	6/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95186	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
3612	Fee-for-Service	1467434324	1467434324	2	1	PETERS, BOBBY X MD	8/21/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
3613	Fee-for-Service	1154551026	1154551026	1	1	PIKE, LEAH M MD PROF CORP	5/13/2010	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	83814	20	Orthopedic Surgery	0	In state provider	None	1760 TERMINO AVE	#308	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
3619	Fee-for-Service	1578030359	1578030359	1	4	PM PEDIATRICS OF CALIFORNIA	10/26/2022	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	14971 HOLT AVENUE	None	TUSTIN	CA	92780	3406	30	06059	33.74650424	-117.8141329	Orange County
3630	Fee-for-Service	1134152689	1134152689	1	1	PANOUSSI, FRANK DC	2/29/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	19	06037	34.6457071	-118.155831	Los Angeles County
3633	Fee-for-Service	1245430354	1245430354	1	1	PARTIKIAN, ARTHUR MD	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85112	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
3635	Fee-for-Service	1679905996	1679905996	1	1	PIONEER HOME HEALTH CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	363 ACADEMY STREET	None	BISHOP	CA	93514	2603	14	06027	37.36314053	-118.3978575	Inyo County
3642	Fee-for-Service	1720022825	1720022825	1	1	POLLAK, RICHARD G MD INC	10/1/2000	207P00000X	NA	Other	026	PHYSICIANS	37625	66	Emergency Medicine (Urgent Care)	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
3691	Fee-for-Service	1508176777	1508176777	1	1	PHAN, KIMBERLY Y MD	5/11/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	129026	25	Physical Medicine and Rehabilitation	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
3728	Fee-for-Service	1902484280	1902484280	1	1	PHAN, JESSICA MD	10/4/2023	207R00000X	NA	Other	026	PHYSICIANS	183183	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
3817	Fee-for-Service	1578030359	1578030359	1	2	PM PEDIATRICS OF CALIFORNIA	5/16/2022	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	3849 EAST FOOTHILL BLVD	None	PASADENA	CA	91107	2204	19	06037	34.15029861	-118.0690163	Los Angeles County
3821	Fee-for-Service	1255650958	1255650958	1	1	PALACIOS, NORMA LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3331 TONIA AVE	None	ALTADENA	CA	91001	4436	19	06037	34.20093207	-118.1410054	Los Angeles County
3828	Fee-for-Service	1316041833	1316041833	2	38	PEDIATRIX MEDICAL GROUP OF C	11/5/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	393 S TUSTIN ST.	None	ORANGE	CA	92866	2501	30	06059	33.782724	-117.835713	Orange County
3829	Fee-for-Service	1306022892	1306022892	1	1	PAMATMAT, ANNAROSE V NP	7/24/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3837	Fee-for-Service	1780172288	1780172288	1	1	PERKOVICH, BRANDON T MD	8/24/2023	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	163516	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
3848	Fee-for-Service	1316041833	1316041833	2	40	PEDIATRIX MEDICAL GROUP OF C	3/8/2024	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
3854	Fee-for-Service	1992724785	1992724785	1	1	POWERS, BRADLEY C MD	12/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63910	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
3862	Fee-for-Service	1194486464	1194486464	1	1	PURE WELLNESS HOMECARE, INC	9/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	UNIT 201	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
3886	Fee-for-Service	1154734663	1154734663	1	1	PETREL EMERGENCY PHYSICIANS	9/1/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	A MEDICAL CORPORATION	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
3895	Fee-for-Service	1598802613	1598802613	1	1	PICKERSGILL, ANNE J MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	30607	41	Internal Medicine	0	In state provider	None	2500 HOSPITAL DR	STE 11	MOUNTAIN VIEW	CA	94040	4106	43	06085	37.36908	-122.081819	Santa Clara County
3909	Fee-for-Service	1578030359	1578030359	1	4	PM PEDIATRICS OF CALIFORNIA	3/24/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	14971 HOLT AVENUE	None	TUSTIN	CA	92780	3406	30	06059	33.74650424	-117.8141329	Orange County
3920	Fee-for-Service	1609296433	1609296433	1	1	PARK, DANIEL DO	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13220	01	General Practice	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
3927	Fee-for-Service	1679905996	1679905996	1	1	PIONEER HOME HEALTH CARE INC	6/1/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	363 ACADEMY STREET	None	BISHOP	CA	93514	2603	14	06027	37.36314053	-118.3978575	Inyo County
3935	Fee-for-Service	1114950789	1114950789	2	1	PHARMERICA DRUG SYSTEMS LLC	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMERICA	11205 KNOTT AVE	STE C	CYPRESS	CA	90630	5489	30	06059	33.8006025	-118.0111199	Orange County
3956	Fee-for-Service	1811563000	1811563000	1	1	POST ACUTE HOME HEALTH	2/15/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	504 N MOUNTAIN VIEW AVE	STE 308	SAN BERNARDINO	CA	92401	1208	36	06071	34.108551	-117.2874275	San Bernardino County
3958	Fee-for-Service	1437861432	1437861432	1	1	PURE HEALTHCARE PROFESSIONAL	2/19/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	MEDICAL SERVICES	151 N SUNRISE AVE	STE 1203	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
4009	Fee-for-Service	1366590341	1366590341	1	1	PENA, LORRIANE J MD	10/31/1986	207R00000X	NA	Other	026	PHYSICIANS	55985	01	General Practice	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
4016	Fee-for-Service	1215020045	1215020045	1	1	POLUKOFF,GERALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84157	0000	00	None	40.659588	-111.891798	Salt Lake County
4062	Fee-for-Service	1407990005	1407990005	1	1	PACIFICAR, ESTELLA A MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25445	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PACIFICAR WOMENS MED CTR	222 N SUNSET AVE	STE F	WEST COVINA	CA	91790	2278	19	06037	34.07397524	-117.9354429	Los Angeles County
4085	Fee-for-Service	1265963631	1265963631	1	1	PINEDA, MINERVA MD	10/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162260	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
4103	Fee-for-Service	1578030359	1578030359	1	2	PM PEDIATRICS OF CALIFORNIA	1/27/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	3849 EAST FOOTHILL BLVD	None	PASADENA	CA	91107	2204	19	06037	34.15029861	-118.0690163	Los Angeles County
4116	Fee-for-Service	1316041833	1316041833	2	35	PEDIATRIX MEDICAL GROUP OF C	7/22/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
4149	Fee-for-Service	1962428144	1962428144	1	1	PETKAR, MADHURI P MD	3/3/2006	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53923	01	General Practice	0	In state provider	None	825 N PARK AVE	None	POMONA	CA	91768	3002	19	06037	34.06627607	-117.7548673	Los Angeles County
4170	Fee-for-Service	1972765535	1972765535	1	1	PHAM, THO N MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120852	41	Internal Medicine	0	In state provider	None	4550 CALIFORNIA AVE	SUITE 500	BAKERSFIELD	CA	93309	7020	15	06029	35.367903	-119.0537145	Kern County
4181	Fee-for-Service	1598802613	1598802613	1	1	PICKERSGILL, ANNE J MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	30607	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2500 HOSPITAL DR	STE 11	MOUNTAIN VIEW	CA	94040	4106	43	06085	37.36908	-122.081819	Santa Clara County
4200	Fee-for-Service	1245663483	1245663483	1	1	PULIDO, FRANCES A	2/27/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
4213	Fee-for-Service	1184678674	1184678674	1	1	PINNEY, STEPHEN J MD	9/15/2000	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	85873	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
4218	Fee-for-Service	1902169071	1902169071	1	1	PILGRIM, ASHLEY J MD	3/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127027	66	Emergency Medicine (Urgent Care)	0	In state provider	None	ONE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
4242	Fee-for-Service	1609450758	1609450758	1	1	PURYEAR, ERIN CNP	6/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
4286	Fee-for-Service	1972800340	1972800340	1	1	PRODIGY HEALTHCARE, INC	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	701 EAST WALTER AVE	R10-11, MO	FOWLER	CA	93625	9792	10	06019	36.63082718	-119.6710954	Fresno County
4296	Fee-for-Service	1568850709	1568850709	1	1	PAZ, JESSICA E MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	153961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
4297	Fee-for-Service	1871746834	1871746834	1	1	PHAM, TUYEN T PHD	10/14/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
4298	Fee-for-Service	1366590341	1366590341	1	1	PENA, LORRIANE J MD	10/31/1986	207R00000X	NA	Other	026	PHYSICIANS	55985	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
4317	Fee-for-Service	1144463654	1144463654	1	1	PATEL, SMITTA V MD	1/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121841	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
4367	Fee-for-Service	1710290226	1710290226	1	1	PAVEZ, GERALDINE S NP	2/22/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4375	Fee-for-Service	1265963631	1265963631	1	1	PINEDA, MINERVA MD	10/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162260	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
4384	Fee-for-Service	1083167589	1083167589	1	1	PELAYO, MARITZA LCSW	1/5/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
4399	Fee-for-Service	1982645305	1982645305	1	1	PENOBSCOT BAY MEDICAL	7/19/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	6 GLEN COVE DRIVE	None	ROCKPORT	ME	04856	4240	00	None	44.144001	-69.084594	Knox County
4426	Fee-for-Service	1699728188	1699728188	1	7	PHYS MED A PHYSICAL THERAPY	5/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	1209 WHITLEY AVE	None	CORCORAN	CA	93212	2327	16	06031	36.09801547	-119.5628355	Kings County
4442	Fee-for-Service	1962428144	1962428144	1	1	PETKAR, MADHURI P MD	3/3/2006	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53923	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	825 N PARK AVE	None	POMONA	CA	91768	3002	19	06037	34.06627607	-117.7548673	Los Angeles County
4457	Fee-for-Service	1699728188	1699728188	1	2	PHYS MED A PHYSICAL THERAPY	9/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	1350 O STREET	201	FRESNO	CA	93721	1828	10	06019	36.74132042	-119.7891324	Fresno County
4531	Fee-for-Service	1730302381	1730302381	1	1	POSITIVE DIRECTIONS, INC	12/19/2000	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2224 QUINCY ST	None	DELANO	CA	93215	1226	15	06029	35.78763692	-119.2342295	Kern County
4563	Fee-for-Service	1013254846	1013254846	1	1	PUGH, NANCY L PHD	12/5/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
4597	Fee-for-Service	1922156959	1922156959	1	1	PARK, MICHELLE S MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79285	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
4603	Fee-for-Service	1750545448	1750545448	1	1	PALASKAS, NICOLAOS J MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114683	41	Internal Medicine	0	In state provider	None	9090 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1850	19	06037	34.06702873	-118.3894057	Los Angeles County
4651	Fee-for-Service	1144607680	1144607680	1	1	PAN, MICHAEL MD	11/19/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	161456	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
4654	Fee-for-Service	1578786398	1578786398	1	1	PRIMIGENIA OPTOMETRY INC	7/10/2006	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14461 MERCED AVE	STE 101	BALDWIN PARK	CA	91706	5173	19	06037	34.07249163	-117.9613001	Los Angeles County
4663	Fee-for-Service	1194091173	1194091173	1	1	PADILLA, JIMMY S MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128916	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
4665	Fee-for-Service	1386895886	1386895886	1	1	PROVIDENCE HEALTH & SERVICES	3/11/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	401 W POPLAR ST	None	WALLA WALLA	WA	99263	2846	00	None	46.06269104	-118.3437284	Walla Walla County
4683	Fee-for-Service	1982645305	1982645305	1	1	PENOBSCOT BAY MEDICAL	7/19/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	6 GLEN COVE DRIVE	None	ROCKPORT	ME	04856	4240	00	None	44.144001	-69.084594	Knox County
4690	Fee-for-Service	1316041833	1316041833	2	29	PEDIATRIX MEDICAL GROUP OF C	10/6/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
4710	Fee-for-Service	1083680847	1083680847	1	1	PENNEY, ALBERT D MD	7/2/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	174610	None	None	0	In state provider	None	9920 TALBERT	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
4725	Fee-for-Service	1962428144	1962428144	1	1	PETKAR, MADHURI P MD	3/3/2006	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53923	08	Family Practice	0	In state provider	None	825 N PARK AVE	None	POMONA	CA	91768	3002	19	06037	34.06627607	-117.7548673	Los Angeles County
4756	Fee-for-Service	1225356959	1225356959	1	1	PARK, JANICE MD	6/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119303	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
4813	Fee-for-Service	1861414716	1861414716	1	1	PULMONARY PROFESSIONALS	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61475	29	Pulmonary Diseases (M.D. only)	0	In state provider	A MEDICAL CORPORATION	18370 BURBANK BLVD	STE 211	TARZANA	CA	91356	2854	19	06037	34.17173059	-118.5331881	Los Angeles County
4845	Fee-for-Service	1285203406	1285203406	1	1	PRORX, INC.	11/30/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18399 COLIMA RD.	STE. A	ROWLAND HEIGHTS	CA	91748	2798	19	06037	33.98844297	-117.9041666	Los Angeles County
4847	Fee-for-Service	1477999290	1477999290	1	2	PEOPLES COMMUNITY CLINIC	4/2/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	540 N SAN JACINTO STREET	None	HEMET	CA	92543	3154	33	06065	33.755229	-116.9586405	Riverside County
4870	Fee-for-Service	1487180527	1487180527	1	1	PANDA, PREETI A MD	6/11/2024	207P00000X	NA	Other	026	PHYSICIANS	172801	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4872	Fee-for-Service	1457879561	1457879561	1	1	PENTA HOME HEALTH AGENCY INC	2/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7036 FOOTHILL BLVD	UNIT C	TUJUNGA	CA	91042	2715	19	06037	34.24792098	-118.2846579	Los Angeles County
4888	Fee-for-Service	1932111473	1932111473	1	1	PRECISION EYE CARE AMC	4/3/2002	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 EUCLID AVE	STE 302	NATIONAL CITY	CA	91950	2953	37	06073	32.68353398	-117.082625	San Diego County
4897	Fee-for-Service	1558529479	1558529479	1	1	PRESTON, CHARLES F MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99089	20	Orthopedic Surgery	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
4925	Fee-for-Service	1659390094	1659390094	1	1	PORTERA-CAILLIAU, CARLOS	2/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89610	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
4951	Fee-for-Service	1386895886	1386895886	1	1	PROVIDENCE HEALTH & SERVICES	3/11/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	401 W POPLAR ST	None	WALLA WALLA	WA	99263	2846	00	None	46.06269104	-118.3437284	Walla Walla County
4961	Fee-for-Service	1982728937	1982728937	1	1	PORTER, SHANEE M MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100836	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
4976	Fee-for-Service	1770535908	1770535908	1	1	PADOVA, JAMES A MD INC	2/1/1983	207RH0003X	NA	Oncology	026	PHYSICIANS	11836	01	General Practice	0	In state provider	None	18102 IRVINE BLVD	None	TUSTIN	CA	92780	3402	30	06059	33.74819092	-117.816792	Orange County
4994	Fee-for-Service	1316041833	1316041833	2	27	PEDIATRIX MEDICAL GROUP OF C	9/29/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
5065	Fee-for-Service	1750316741	1750316741	1	2	PLANNED PARENTHOOD OF THE	3/1/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2079 COMPTON AVE	SUITE 104	CORONA	CA	92881	7284	33	06065	33.848496	-117.5361745	Riverside County
5159	Fee-for-Service	1487180527	1487180527	1	1	PANDA, PREETI A MD	6/11/2024	207P00000X	NA	Other	026	PHYSICIANS	172801	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
5171	Fee-for-Service	1205311461	1205311461	1	1	PEOPLECARE MEDICAL GROUP PC	2/16/2024	261QP2300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2356 GOLD MEADOW WAY	STE 130	GOLD RIVER	CA	95670	6323	34	06067	38.622141	-121.2625395	Sacramento County
5176	Fee-for-Service	1932111473	1932111473	1	1	PRECISION EYE CARE AMC	6/15/1992	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	655 EUCLID AVE	STE 302	NATIONAL CITY	CA	91950	2953	37	06073	32.68353398	-117.082625	San Diego County
5197	Fee-for-Service	1346516143	1346516143	1	1	PHANG, SAMUEL K MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127549	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
5225	Fee-for-Service	1891146593	1891146593	1	1	PRINCETON MANOR HEALTHCARE	8/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	2124 57TH AVENUE	None	OAKLAND	CA	94621	4322	01	06001	37.76998011	-122.1959954	Alameda County
5236	Fee-for-Service	1861896805	1861896805	1	1	PALM SPRINGS OPERATING	10/1/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMPANY LP	277 S SUNRISE WAY	None	PALM SPRINGS	CA	92262	6738	33	06065	33.820092	-116.5282565	Riverside County
5248	Fee-for-Service	1801505730	1801505730	1	1	PMD WELLNESS CENTER INC	12/23/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	780 ATLANTIC AVE	None	LONG BEACH	CA	90813	4565	19	06037	33.776325	-118.1850235	Los Angeles County
5263	Fee-for-Service	1770535908	1770535908	1	1	PADOVA, JAMES A MD INC	2/1/1983	207RH0003X	NA	Oncology	026	PHYSICIANS	11836	41	Internal Medicine	0	In state provider	None	18102 IRVINE BLVD	None	TUSTIN	CA	92780	3402	30	06059	33.74819092	-117.816792	Orange County
5273	Fee-for-Service	1093761611	1093761611	1	1	PULMOCARE RESPIRATORY	12/1/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	760 SOUTH VIA LATA AVE	STE 100A	COLTON	CA	92324	4048	36	06071	34.05695188	-117.3068865	San Bernardino County
5283	Fee-for-Service	1720090632	1720090632	1	1	PARIMON, TANYALAK MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134429	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
5292	Fee-for-Service	1326245226	1326245226	1	1	PLASENCIA, CRISTINA LCSW	9/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
5310	Fee-for-Service	1902170467	1902170467	1	1	PREGO, SUSANA LMFT	11/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11110 LOS ALAMITOS BLVD	None	LOS ALAMITOS	CA	90720	3602	30	06059	33.801516	-118.0717825	Orange County
5313	Fee-for-Service	1760543375	1760543375	1	1	PHELAN, TIMOTHY E MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84901	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1621 CREEKSIDE DR	STE 102	FOLSOM	CA	95630	3493	34	06067	38.670966	-121.1476905	Sacramento County
5362	Fee-for-Service	1841558426	1841558426	1	1	PIRASTEHFAR, MOHSEN M MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138456	13	Neurology (M.D. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
5394	Fee-for-Service	1477392587	1477392587	1	1	PEPPER, ALISHA NP	3/14/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95129554	-	NOT APPLICABLE	0	In state provider	None	2403 PROFESSIONAL DRIVE	SUITE 103	SANTA ROSA	CA	95403	3007	49	06097	38.463642	-122.7245175	Sonoma County
5424	Fee-for-Service	1124082847	1124082847	1	1	PISCHEL, KENNETH MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	47007	83	Rheumatology	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
5428	Fee-for-Service	1518226232	1518226232	1	1	PRZYBYSZ, AARON J MD	10/16/2017	390200000X	NA	Other	026	PHYSICIANS	147216	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
5459	Fee-for-Service	1205311461	1205311461	1	1	PEOPLECARE MEDICAL GROUP PC	2/16/2024	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2356 GOLD MEADOW WAY	STE 130	GOLD RIVER	CA	95670	6323	34	06067	38.622141	-121.2625395	Sacramento County
5460	Fee-for-Service	1407995160	1407995160	1	1	POBLANO, ROBERT L JR	11/7/2007	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RP REHABILITATION	3100 ORO DAM BLVD	None	OROVILLE	CA	95966	5183	04	06007	39.51350071	-121.5393974	Butte County
5464	Fee-for-Service	1477999290	1477999290	1	1	PEOPLES COMMUNITY CLINIC	3/10/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	540 N SAN JACINTO STREET	SUITE Q	HEMET	CA	92543	3154	33	06065	33.755229	-116.9586405	Riverside County
5508	Fee-for-Service	1245228337	1245228337	1	1	PRATT, STEPHEN LMFT	4/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23120 ALICIA PKWY	STE 234	MISSION VIEJO	CA	92692	1210	30	06059	33.62754998	-117.6504451	Orange County
5510	Fee-for-Service	1982118816	1982118816	1	1	PERRY, KAREN LMFT	11/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
5525	Fee-for-Service	1063672178	1063672178	1	1	PINEDA, REIMARIE R MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101236	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
5568	Fee-for-Service	1720090632	1720090632	1	1	PARIMON, TANYALAK MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134429	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
5571	Fee-for-Service	1972662039	1972662039	1	2	PLANNED PARENTHOOD-NAPA	11/8/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	28	06055	38.24829023	-122.2745626	Napa County
5589	Fee-for-Service	1316041833	1316041833	2	11	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
5599	Fee-for-Service	MSS00040F	None	1	1	PARTNERS IN CARE	3/1/2001	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	732 MOTT STREET	STE 150	SAN FERNANDO	CA	91340	4241	19	06037	34.27661761	-118.4442372	Los Angeles County
5601	Fee-for-Service	1316041833	1316041833	2	8	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1150 N INDIAN CANYON DRI	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
5634	Fee-for-Service	1538530324	1538530324	1	1	PARAMOUNT SURGERY CENTER INC	7/9/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	15942 COLORADO AVE	None	PARAMOUNT	CA	90723	5008	19	06037	33.88759485	-118.1614171	Los Angeles County
5638	Fee-for-Service	1568061414	1568061414	1	1	PEACEFUL MIND HOSPICE CARE	1/24/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	725 S GLENDALE AVE	STE H	GLENDALE	CA	91205	4148	19	06037	34.13774391	-118.2513154	Los Angeles County
5655	Fee-for-Service	1528194297	1528194297	1	1	PHILEMON HEALTHCARE	2/24/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	5171 LINCOLN AVE	None	CYPRESS	CA	90630	2906	30	06059	33.83179452	-118.0427085	Orange County
5669	Fee-for-Service	1891883674	1891883674	2	1	PANSE, SWATI MD	4/27/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51794	40	Pediatrics	0	In state provider	None	621 N STATE ST	STE 1	SAN JACINTO	CA	92583	6568	33	06065	33.79501272	-116.9715035	Riverside County
5726	Fee-for-Service	1518383140	1518383140	1	1	PERKINS, TIFFANY MD	9/19/2019	208800000X	NA	Other	026	PHYSICIANS	163085	34	Urology and Urological Surgery	0	In state provider	None	2624 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57136027	-122.397513	Shasta County
5737	Fee-for-Service	1740228931	1740228931	1	1	PRATAP, ARATI MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143192	None	None	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
5754	Fee-for-Service	1194015305	1194015305	1	1	POWELL, RUSSELL T MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142292	13	Neurology (M.D. only)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
5838	Fee-for-Service	1396287488	1396287488	1	1	PHILLIPS, TAMISA LMFT	10/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
5855	Fee-for-Service	1720090632	1720090632	1	1	PARIMON, TANYALAK MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134429	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
5863	Fee-for-Service	1598804593	1598804593	1	1	PERALTA, MEL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
5864	Fee-for-Service	1548264492	1548264492	1	1	PACIFIC PHYSICAL THERAPY	5/31/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	121-A BOATYARD DR	None	FORT BRAGG	CA	95437	5751	23	06045	39.42167151	-123.8057535	Mendocino County
5866	Fee-for-Service	1134760176	1134760176	1	1	PEPE, EMILY NP	12/27/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
5912	Fee-for-Service	1174718134	1174718134	1	1	PARK, RICHARD MD	1/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111560	41	Internal Medicine	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
5917	Fee-for-Service	1184243123	1184243123	1	1	PHAN, DUY H DO	10/13/2023	208M00000X	NA	Other	026	PHYSICIANS	20750	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
5930	Fee-for-Service	1568061414	1568061414	1	1	PEACEFUL MIND HOSPICE CARE	1/24/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	725 S GLENDALE AVE	STE H	GLENDALE	CA	91205	4148	19	06037	34.13774391	-118.2513154	Los Angeles County
5964	Fee-for-Service	1760564652	1760564652	1	1	PRIVATE PEDIATRICS INC	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69540	40	Pediatrics	0	In state provider	PRIVATE PEDIATRICS INC	3031 TELEGRAPH AVE	STE 235	BERKELEY	CA	94705	2053	01	06001	37.85506766	-122.259871	Alameda County
5969	Fee-for-Service	1366845232	1366845232	1	1	PACHECO, MOSES LMFT	10/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127871	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
5981	Fee-for-Service	1043665144	1043665144	1	1	PARK, SA RA MD	3/16/2020	208M00000X	NA	Other	026	PHYSICIANS	161891	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6008	Fee-for-Service	1457659369	1457659369	1	1	PATEL, FALGOONI DO	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11160	40	Pediatrics	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
6013	Fee-for-Service	1477809127	1477809127	1	1	PALANIYANDI, NISHANDAN LCSW	8/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
6017	Fee-for-Service	1568638625	1568638625	1	1	PEREZ, SARAH J MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106084	78	Neoplastic Diseases/Oncology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
6034	Fee-for-Service	1477931186	1477931186	1	1	PARK, ELISA E DO	8/3/2020	390200000X	NA	Other	026	PHYSICIANS	16443	41	Internal Medicine	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
6041	Fee-for-Service	1275733859	1275733859	1	1	PENN, JOYCE Y LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
6159	Fee-for-Service	1073729588	1073729588	1	1	PHAN, DEREK T MD	11/10/2009	207R00000X	NA	Other	026	PHYSICIANS	99908	41	Internal Medicine	0	In state provider	None	1401 S GRAND AVE	SUITE 402	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
6177	Fee-for-Service	1275564296	1275564296	1	10	PRECISION REHABILITATION & O	10/28/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	746 G ST	None	REEDLEY	CA	93654	2622	10	06019	36.59985453	-119.4544879	Fresno County
6178	Fee-for-Service	1770876849	1770876849	1	1	PASTWICK, MICHELLE L DO	2/1/2017	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
6185	Fee-for-Service	1316041833	1316041833	2	37	PEDIATRIX MEDICAL GROUP OF C	11/15/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2101 N WATERMAN AVE.	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
6191	Fee-for-Service	1417477761	1417477761	1	1	POUVARANUKOAH, JANE OD	10/17/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
6225	Fee-for-Service	1164817037	1164817037	1	1	PHAM, TIFFANY MD	4/5/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146288	None	None	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
6232	Fee-for-Service	1700262672	1700262672	1	1	PATEL, KAVISHA B MD	6/13/2023	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169691	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
6233	Fee-for-Service	1407410731	1407410731	1	1	PEYMAN, HELYA DO	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	21137	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
6304	Fee-for-Service	1568638625	1568638625	1	1	PEREZ, SARAH J MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106084	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
6305	Fee-for-Service	1346773637	1346773637	1	1	PAYNE, KATE E LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
6309	Fee-for-Service	1780925990	1780925990	2	1	PHI HEALTH, LLC	3/13/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	801 AIRPORT WAY	STE D	MODESTO	CA	95354	3904	50	06099	37.62719812	-120.9515294	Stanislaus County
6320	Fee-for-Service	1245338409	1245338409	1	1	PARTNOW, JOSHUA L MD	4/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97818	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
6323	Fee-for-Service	1134675309	1134675309	1	1	PRICE, JOSHUA D LMFT	2/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
6337	Fee-for-Service	1548722754	1548722754	1	1	PENG, THEODORE A MD	10/24/2023	208M00000X	NA	Other	026	PHYSICIANS	178392	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6377	Fee-for-Service	1740351642	1740351642	1	1	PACE, JOANNE M MD	1/1/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	81121	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
6411	Fee-for-Service	1215014170	1215014170	1	1	PATEL, SUMER DPM	5/7/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
6438	Fee-for-Service	1518980796	1518980796	1	1	PANCHAL, MAHENDRA J MD	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	89996	30	Radiology	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
6462	Fee-for-Service	1083097760	1083097760	1	1	PANSAWIRA, IRIN OD	2/4/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
6481	Fee-for-Service	1578852109	1578852109	1	1	PHILIP, SUNNY K JR MD	1/14/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	151375	78	Neoplastic Diseases/Oncology	0	In state provider	None	801 S HAM LANE	STE S	LODI	CA	95242	7503	39	06077	38.124495	-121.2882875	San Joaquin County
6500	Fee-for-Service	1063457034	1063457034	1	1	PEDERSON, MARK N MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	33814	30	Radiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
6502	Fee-for-Service	1750316741	1750316741	1	1	PLANNED PARENTHOOD OF THE	10/28/1983	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	33	06065	33.94720849	-117.399204	Riverside County
6555	Fee-for-Service	1477968972	1477968972	1	1	PATRICK C ANDERI MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
6577	Fee-for-Service	1316199326	1316199326	1	1	PATEL, SARJAN H MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114976	None	None	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
6591	Fee-for-Service	1932534492	1932534492	1	1	PROSPER, ASHLEY E MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122944	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
6606	Fee-for-Service	1932231909	1932231909	1	1	PAK, BYONG J MD	7/28/1988	207P00000X	NA	Other	026	PHYSICIANS	35602	01	General Practice	0	In state provider	None	5740 WINDMILL WAY	STE 4	CARMICHAEL	CA	95608	1379	34	06067	38.647494	-121.330044	Sacramento County
6627	Fee-for-Service	1851849863	1851849863	1	1	PALMDALE MEDICAL CLINIC INC	3/17/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	38780 TRADE CENTER DR	SUITE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
6646	Fee-for-Service	1396841961	1396841961	1	1	PARK, VERNON G MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	32541	41	Internal Medicine	0	In state provider	None	2200 COLORADO AVE	None	TURLOCK	CA	95382	2004	50	06099	37.51276844	-120.8352605	Stanislaus County
6650	Fee-for-Service	1932824638	1932824638	1	1	PLASTIC SURGERY AND WOUND CO	1/17/2024	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	NSULTANTS	555 HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
6659	Fee-for-Service	1639932882	1639932882	1	1	PAOLILLO, EMILY W	1/31/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6663	Fee-for-Service	1740351642	1740351642	1	1	PACE, JOANNE M MD	1/1/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	81121	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
6676	Fee-for-Service	1275951311	1275951311	1	1	PALAKURTHY, NEEL DO	10/17/2018	207R00000X	NA	Other	026	PHYSICIANS	15825	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
6723	Fee-for-Service	1609182120	1609182120	1	1	PURI, LATIKA MD	4/1/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	120200	68	Hematology	0	In state provider	None	250 E CAROLINE ST	STE J	SAN BERNARDINO	CA	92408	3758	36	06071	34.0615203	-117.2793274	San Bernardino County
6750	Fee-for-Service	1184009417	1184009417	1	1	PACIFIC BREEZE HOME CARE INC	3/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	137 PLAYA DEL REY AVE	None	OCEANSIDE	CA	92058	7965	37	06073	33.24173396	-117.3272643	San Diego County
6816	Fee-for-Service	1386839306	1386839306	1	1	PHAM, SALLY T RN	4/22/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	98476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
6842	Fee-for-Service	1235458092	1235458092	1	1	PURI, TIMOTHY K MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144889	41	Internal Medicine	0	In state provider	None	450 STANYON ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
6855	Fee-for-Service	1306917133	1306917133	1	1	PALKHIWALA, SAPAN N	9/16/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24012 CALLE DE LA PLATA	#300	LAGUNA HILLS	CA	92653	7062	30	06059	33.61012113	-117.7115908	Orange County
6858	Fee-for-Service	1629376967	1629376967	1	1	PIZZEY, SARAH N	4/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	SUITE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
6867	Fee-for-Service	1235516477	1235516477	1	1	PATEL, AJAY V MD	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150753	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
6869	Fee-for-Service	1346445590	1346445590	1	1	PENA-HAAS, LUCY M LMFT	2/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39429 LOS ALAMOS RD	A	MURRIETA	CA	92563	5037	33	06065	33.57568119	-117.1769187	Riverside County
6878	Fee-for-Service	1255302287	1255302287	1	1	PAUL, JONATHAN D MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148289	18	Ophthalmology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
6914	Fee-for-Service	1922311703	1922311703	1	1	PICKETT, RASHEEDAH	2/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12281 KNOTT ST	STE 103	GARDEN GROVE	CA	92841	3939	30	06059	33.78524517	-118.0112189	Orange County
6923	Fee-for-Service	1417371287	1417371287	1	1	PENNYBAKER, STEVEN J MD	4/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157427	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
6956	Fee-for-Service	1740351642	1740351642	1	1	PACE, JOANNE M MD	1/1/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	81121	41	Internal Medicine	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
6964	Fee-for-Service	1831613975	1831613975	1	2	PAULA VANG, O.D., INC.	1/11/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	811 GRAND AVE	SUITE B	SACRAMENTO	CA	95838	3466	34	06067	38.637621	-121.4470125	Sacramento County
6982	Fee-for-Service	1194907162	1194907162	1	1	PALMER, OWEN P MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105504	02	General Surgery	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
6984	Fee-for-Service	1144512153	1144512153	1	1	POOLE, GARRETT R MD	7/15/2011	207L00000X	NA	Other	026	PHYSICIANS	108273	05	Anesthesiology	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
6999	Fee-for-Service	1457894735	1457894735	1	1	PENALOZA RAMSEY, ASHLEY T	1/6/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N MAIN ST	SUITE 945	SANTA ANA	CA	92705	6678	30	06059	33.7737545	-117.8687284	Orange County
7000	Fee-for-Service	1770072803	1770072803	1	1	PACIFIC VASCUCARE SURGERY CE	6/30/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	NTER	1660 W 3RD ST	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
7010	Fee-for-Service	1083720304	1083720304	1	1	PREMIERESCAN, APC	11/18/2008	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	798 S WINCHESTER BLVD	None	SAN JOSE	CA	95128	2928	43	06085	37.313361	-121.9499825	Santa Clara County
7012	Fee-for-Service	1609182120	1609182120	1	1	PURI, LATIKA MD	4/1/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	120200	40	Pediatrics	0	In state provider	None	250 E CAROLINE ST	STE J	SAN BERNARDINO	CA	92408	3758	36	06071	34.0615203	-117.2793274	San Bernardino County
7023	Fee-for-Service	1982675930	1982675930	1	1	PURDY, ANNELIE S PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	A PSYCHOLOGICAL CORP	433 S LINCOLN ST	None	SANTA MARIA	CA	93458	5525	42	06083	34.94857123	-120.4374742	Santa Barbara County
7041	Fee-for-Service	1225278997	1225278997	1	1	P PATEL, S DESAI, S PATEL	5/6/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1172 CADILLAC COURT	None	MILPITAS	CA	95035	3025	43	06085	37.4442397	-121.9185731	Santa Clara County
7043	Fee-for-Service	1356321491	1356321491	1	1	PORK, NROMAN O. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	941 KAMEHAMEHA HWY	STE 208	PEARL CITY	HI	96782	2516	00	None	21.39429472	-157.97183	Honolulu County
7047	Fee-for-Service	1154688000	1154688000	1	1	PRESTON, ERISA M PSYD	3/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4929 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	3800	19	06037	34.0621435	-118.3380975	Los Angeles County
7050	Fee-for-Service	1386264794	1386264794	1	1	PEARSON, KEON MD	11/27/2023	207R00000X	NA	Other	026	PHYSICIANS	184726	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
7073	Fee-for-Service	1295957728	1295957728	1	1	PEPPERMINT RIDGE	10/16/1987	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	825 MAGNOLIA AVE	BLDG A	CORONA	CA	92879	3129	33	06065	33.86004536	-117.5526662	Riverside County
7096	Fee-for-Service	1356049472	1356049472	1	1	PARKER, COURTNEY E PSYD	5/12/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
7140	Fee-for-Service	1740251818	1740251818	1	1	PUREWAL, SHARNJIT S MD	11/29/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73435	08	Family Practice	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
7145	Fee-for-Service	1790712305	1790712305	1	1	PENG, ALICE MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62712	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
7158	Fee-for-Service	1730525353	1730525353	1	1	PARIZAD HOOSHI MD INC	5/8/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	CENTER	19871 NORDHOFF ST	None	NORTHRIDGE	CA	91324	3331	19	06037	34.23190676	-118.5658922	Los Angeles County
7159	Fee-for-Service	1235316324	1235316324	1	1	PETERS, DANIELLE LMFT	10/19/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	775 SUNRISE AVE	110	ROSEVILLE	CA	95661	4523	31	06061	38.732436	-121.2720345	Placer County
7175	Fee-for-Service	1578750774	1578750774	1	1	PARK, DON Y MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102517	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
7195	Fee-for-Service	1710253596	1710253596	1	1	PACIFIC EDGE DIAGNOSTICS USA	9/22/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LTD.	1214 RESEARCH BLVD	SUITE 2000	HUMMELSTOWN	PA	17036	9196	00	None	40.26180477	-76.68790609	Dauphin County
7197	Fee-for-Service	1144494550	1144494550	1	1	PARIKH, GAURAV R MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142679	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
7219	Fee-for-Service	1982812194	1982812194	1	1	PATE & INGRAM HOMES	6/30/1999	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9613 S 11TH AVE	None	INGLEWOOD	CA	90305	3112	19	06037	33.94867425	-118.3287575	Los Angeles County
7221	Fee-for-Service	1720519010	1720519010	1	1	PAIJI, CHRISTOPHER L MD	3/28/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	170265	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
7262	Fee-for-Service	1790782191	1790782191	1	1	PONZIO, CHRISTINE C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48377	08	Family Practice	0	In state provider	None	PO BOX 646	None	GONZALES	CA	93926	0646	27	06053	0	0	None
7269	Fee-for-Service	1881056596	1881056596	1	1	PASRICHA, NEEL D MD	6/12/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	152628	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
7310	Fee-for-Service	1275564296	1275564296	1	9	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1870 CENTRAL ST	None	VISALIA	CA	93277	4418	54	06107	36.314541	-119.310201	Tulare County
7357	Fee-for-Service	1598100109	1598100109	1	1	PROACTIVE SPINE & SPORTS PHY	3/2/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CENTERS	2620 LARKSPUR LANE	SUITE T	REDDING	CA	96002	1043	45	06089	40.5690659	-122.3555361	Shasta County
7364	Fee-for-Service	1114959475	1114959475	1	1	PATHAK, MAYANK S MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76833	13	Neurology (M.D. only)	0	In state provider	None	9940 TALBERT AVENUE	SUITE 204	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166347	-117.955494	Orange County
7421	Fee-for-Service	1376653287	1376653287	1	1	PHAM, NGOC MINH	1/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34924	08	Family Practice	0	In state provider	None	2363 ULRIC ST	STE B	SAN DIEGO	CA	92111	6447	37	06073	32.78619268	-117.1693315	San Diego County
7432	Fee-for-Service	1790712305	1790712305	1	1	PENG, ALICE MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62712	45	Nephrology (Renal-Kidney)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
7447	Fee-for-Service	1639201932	1639201932	1	1	POPE, AMBER J MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112188	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
7472	Fee-for-Service	1275763633	1275763633	1	1	PARIKH, JAYNI MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116181	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
7527	Fee-for-Service	1043258825	1043258825	1	1	PAN, ALAN S DO	9/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
7564	Fee-for-Service	1366962854	1366962854	1	1	PANDYA, JANKEE B LCSW	5/13/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
7578	Fee-for-Service	1275564296	1275564296	1	2	PRECISION REHABILITATION & O	6/27/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1132 E LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.22949281	-119.3296994	Tulare County
7581	Fee-for-Service	1346930328	1346930328	1	1	PENNINGTON, EMILY CCC-SLP	8/11/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
7625	Fee-for-Service	1710690060	1710690060	1	1	PARK, JANET C NP	2/7/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
7629	Fee-for-Service	1568133411	1568133411	2	1	PRG TECHNOLOGIES, INC	9/27/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1020 S ANAHEIM BLVD	STE 106	ANAHEIM	CA	92805	5808	30	06059	33.82002206	-117.9087091	Orange County
7720	Fee-for-Service	1225198054	1225198054	1	1	PUNZ, ERWIN	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
7721	Fee-for-Service	1467764316	1467764316	1	1	PROGRESS SPEECH & LANGUAGE P	7/21/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ENTER	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
7741	Fee-for-Service	1073027413	1073027413	1	1	PECK, ANASTASIA H PT	7/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
7769	Fee-for-Service	1164588075	1164588075	1	1	PONN, ANGELA C LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
7792	Fee-for-Service	1679511059	1679511059	1	1	PANDOVE, SANDEEP MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	61019	41	Internal Medicine	0	In state provider	None	880 N STATE ST	None	HEMET	CA	92543	1459	33	06065	33.76159592	-116.9717828	Riverside County
7793	Fee-for-Service	1417143777	1417143777	1	1	PERRINE, LISA B PHD	4/1/1999	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1329 HOWE AVE	STE 201	SACRAMENTO	CA	95825	3363	34	06067	38.590191	-121.416624	Sacramento County
7844	Fee-for-Service	1578099669	1578099669	1	1	PEZESHKI, BENJAMIN B MD	1/8/2019	207R00000X	NA	Other	026	PHYSICIANS	157154	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
7846	Fee-for-Service	1104261700	1104261700	1	1	PHAN, DUNG MY MD INC	6/15/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42236	01	General Practice	0	In state provider	None	1693 FLANIGAN DR	STE 100	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
7849	Fee-for-Service	1861894909	1861894909	1	1	PETTERSSON-ROSENBUSCH,	12/2/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	KRISTINE K MFT	2220 MOUNTAIN BLVD	STE 240	OAKLAND	CA	94611	2905	01	06001	37.82318115	-122.2080468	Alameda County
7873	Fee-for-Service	1184951451	1184951451	1	1	PATEL, HEMESH M DO	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10987	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
7913	Fee-for-Service	1710976766	1710976766	1	1	PATRICK G FREDENBERG, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 THUNDERBIRD RD	None	GLENDALE	AZ	85306	0000	00	None	33.609294	-112.1797485	Maricopa County
7916	Fee-for-Service	1366885154	1366885154	1	2	PASSIONATE HEART HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15928 VENTURA BLVD	SUITE 209	ENCINO	CA	91436	4400	19	06037	34.15585301	-118.4801465	Los Angeles County
7920	Fee-for-Service	1144454489	1144454489	1	1	PURGANAN, KRISTINA M DO	9/22/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21425	None	None	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
7930	Fee-for-Service	1376513754	1376513754	1	2	PALOMAR HEALTH	1/31/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15611 POMERADO RD	STE 525	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
7962	Fee-for-Service	1093836736	1093836736	1	1	PITTS, MILLICENT L LMFT	6/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2201 F STREET	None	BAKERSFIELD	CA	93301	3850	15	06029	35.379342	-119.023506	Kern County
7995	Fee-for-Service	1750891727	1750891727	1	2	PEDIATRIC CARDIOLOGY OF SAN	7/18/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	DIEGO	5755 OBERLIN DR	STE 202	SAN DIEGO	CA	92121	4716	37	06073	32.89290908	-117.1944873	San Diego County
8001	Fee-for-Service	1497833123	1497833123	1	1	PAREEK, REKHA MD	1/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89916	45	Nephrology (Renal-Kidney)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
8007	Fee-for-Service	1467764316	1467764316	1	1	PROGRESS SPEECH & LANGUAGE P	11/12/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ENTER	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
8021	Fee-for-Service	1386908341	1386908341	1	1	PERRIN, JARED T MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142654	41	Internal Medicine	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
8022	Fee-for-Service	1063666352	1063666352	1	1	POTTER-MARTINO, KRISTINA R D	9/7/2020	207P00000X	NA	Other	026	PHYSICIANS	16150	66	Emergency Medicine (Urgent Care)	0	In state provider	O	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
8026	Fee-for-Service	1437786688	1437786688	1	1	PRICE, JORDAN D DO	9/22/2023	207R00000X	NA	Other	026	PHYSICIANS	21832	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
8054	Fee-for-Service	1588160022	1588160022	1	1	PEREZ, MARCELINA MD	8/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163515	30	Radiology	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
8062	Fee-for-Service	1225222599	1225222599	1	1	PANNAGASAYANAM DINESH, KUMAR	4/13/2023	174400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	760 GOLF VIEW DRIVE	SUITE 200	MEDFORD	OR	97504	9685	00	None	42.315228	-122.8230985	Jackson County
8121	Fee-for-Service	1063832442	1063832442	1	1	PAULSEN, MICHAEL MD	6/25/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	138218	33	Thoracic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8149	Fee-for-Service	1568533313	1568533313	1	1	PONG, ALICE MD	1/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75974	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
8192	Fee-for-Service	1699728188	1699728188	1	4	PHYS MED A PHYSICAL THERAPY	3/18/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	650 S ZEDIKER AVE	None	PARLIER	CA	93648	2666	10	06019	36.60500164	-119.5210273	Fresno County
8200	Fee-for-Service	1275564296	1275564296	1	8	PRECISION REHABILITATION & O	10/28/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2251 COUNTRY CLUB LN	None	SELMA	CA	93662	3859	10	06019	36.5662241	-119.5996308	Fresno County
8203	Fee-for-Service	1366885154	1366885154	1	2	PASSIONATE HEART HOSPICE INC	10/30/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15928 VENTURA BLVD	SUITE 209	ENCINO	CA	91436	4400	19	06037	34.15585301	-118.4801465	Los Angeles County
8243	Fee-for-Service	1548470933	1548470933	1	1	PAYNE, LENA LCSW	3/18/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8261	Fee-for-Service	1700154101	1700154101	1	1	PASSOFF, LAUREN LCSW	11/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
8281	Fee-for-Service	1467664185	1467664185	1	1	PEARSON-PLUMMER, ELIZABETH	12/16/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD A PRO PSYCH CORP	2827 PALOMINO RIDGE LANE	None	SANTA BARBARA	CA	93105	2125	42	06083	34.45404987	-119.7177486	Santa Barbara County
8296	Fee-for-Service	1467764316	1467764316	1	1	PROGRESS SPEECH & LANGUAGE P	11/12/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ENTER	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
8301	Fee-for-Service	1316982911	1316982911	1	1	PAUL CONRAD MD	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	110 S MAIN ST	None	HIAWASSEE	GA	30546	3408	00	None	34.94615716	-83.75403445	Towns County
8400	Fee-for-Service	1992899942	1992899942	1	1	PEDIATRIC & ADOLESCENT	5/25/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
8403	Fee-for-Service	1801896543	1801896543	2	1	POWELL, JERRY MD	8/18/2023	2085P0229X	NA	Other	026	PHYSICIANS	182723	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
8410	Fee-for-Service	1417919507	1417919507	1	1	PEHLEVANIAN, GARO Z MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38617	41	Internal Medicine	0	In state provider	None	5250 SANTA MONICA BLVD	STE 207	LOS ANGELES	CA	90029	1254	19	06037	34.09077051	-118.3046976	Los Angeles County
8414	Fee-for-Service	1689908683	1689908683	1	1	PAK, KAREN K	5/13/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
8430	Fee-for-Service	1285157750	1285157750	1	1	PARK, KRISTOFFER Y PHD	5/11/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
8454	Fee-for-Service	1194091983	1194091983	1	1	PETER WANG CHIROPRACTIC CORP	2/24/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	.	9939 GARVEY AVE	A	EL MONTE	CA	91733	4712	19	06037	34.06277368	-118.0516203	Los Angeles County
8458	Fee-for-Service	1770821613	1770821613	1	1	POWELL, JESSICA LAC	11/8/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY DR	SUITE 180	SCOTTS VALLEY	CA	95066	3452	44	06087	37.06204883	-122.0069319	Santa Cruz County
8466	Fee-for-Service	1225569098	1225569098	1	1	PANCHAL, RAMOLA M MD	8/1/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
8489	Fee-for-Service	1316213531	1316213531	2	2	PANTHERX SPECIALTY LLC	7/27/2022	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	24 SUMMIT PARK DRIVE	SUITE 101	PITTSBURGH	PA	15275	1104	00	None	40.45137874	-80.19249886	Allegheny County
8490	Fee-for-Service	1275564296	1275564296	1	12	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	755 N. LEMOORE AVE.	SUITE C	LEMOORE	CA	93245	9998	16	06031	36.306108	-119.780838	Kings County
8493	Fee-for-Service	1538625975	1538625975	1	2	PURPOSEFUL RESIDENTIAL CARE	9/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	809 WELLMAN WAY	None	BAKERSFIELD	CA	93312	5704	15	06029	35.36530468	-119.1360167	Kern County
8531	Fee-for-Service	1881987436	1881987436	1	1	PARKER, NATHAN H MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122594	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
8535	Fee-for-Service	1548509193	1548509193	1	1	PELLEGRINI, JENNA O CCC-SLP	12/19/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
8547	Fee-for-Service	1063621357	1063621357	1	1	PARIKH, NEETI B MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56130	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8593	Fee-for-Service	1083746630	1083746630	1	1	PARRINGTON, DONALD J MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28010	-	NOT APPLICABLE	0	In state provider	None	160 E HOLT AVENUE	None	POMONA	CA	91767	5406	19	06037	34.06239649	-117.7489613	Los Angeles County
8640	Fee-for-Service	1104997006	1104997006	1	1	PICKERING, SHELLEY D MD	9/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54751	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
8667	Fee-for-Service	1699257857	1699257857	1	1	PROREHAB PHYSICAL THERAPY AN	10/13/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS PERFORMANCE, IN	3673 EUREKA WAY	None	REDDING	CA	96001	0177	45	06089	40.58394504	-122.4258671	Shasta County
8669	Fee-for-Service	1407805484	1407805484	1	1	PETERSON, JOHNETTE L MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	41599	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
8677	Fee-for-Service	1659669885	1659669885	1	1	PARKER, KRISTA E CRNA	1/6/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
8680	Fee-for-Service	1144274861	1144274861	1	1	PATELS, SHAILESH J. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13943 N 91ST AVE	STE H101	PEORIA	AZ	85381	3689	00	None	33.610455	-112.253868	Maricopa County
8696	Fee-for-Service	1417919507	1417919507	1	1	PEHLEVANIAN, GARO Z MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	38617	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5250 SANTA MONICA BLVD	STE 207	LOS ANGELES	CA	90029	1254	19	06037	34.09077051	-118.3046976	Los Angeles County
8723	Fee-for-Service	1932144813	1932144813	1	1	PRINCE, LAWRENCE S MD	1/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89291	79	Neurology-Child	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
8734	Fee-for-Service	1427078427	1427078427	1	1	PATIL, AVINASH S MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
8742	Fee-for-Service	1194091983	1194091983	1	1	PETER WANG CHIROPRACTIC CORP	2/24/2021	111N00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	.	9939 GARVEY AVE	A	EL MONTE	CA	91733	4712	19	06037	34.06277368	-118.0516203	Los Angeles County
8754	Fee-for-Service	1467498477	1467498477	1	1	PACIFIC MEDEDGE INC	10/11/2006	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PACIFIC MEDEDGE MED SVCS	18311 S WESTERN AVE	None	GARDENA	CA	90248	3820	19	06037	33.864489	-118.3091865	Los Angeles County
8760	Fee-for-Service	1720094642	1720094642	2	1	PATEL, NAYANABEN U MD	11/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
8765	Fee-for-Service	1629731518	1629731518	1	1	PORTER, HEATHER N	11/4/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4460 BLACK AVE	STE F	PLEASANTON	CA	94566	6139	01	06001	37.67215839	-121.8770704	Alameda County
8815	Fee-for-Service	1962985572	1962985572	1	1	PEREZ, JESSICA E LCSW	12/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
8818	Fee-for-Service	1437256120	1437256120	1	1	PATEL, SWATI P MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43729	41	Internal Medicine	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
8824	Fee-for-Service	1114901378	1114901378	1	1	PEERSON, STACEY PHD	5/5/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
8849	Fee-for-Service	1508913294	1508913294	1	1	PATCHING, STEVEN C MD	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	42575	02	General Surgery	0	In state provider	None	800 HOWE AVE	STE 300	SACRAMENTO	CA	95825	3965	34	06067	38.581146	-121.4145	Sacramento County
8863	Fee-for-Service	1285752063	1285752063	1	1	PALOMAR POMERADO HEALTH	10/1/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
8872	Fee-for-Service	1891951083	1891951083	1	1	PANDYA, CHIRAG M MD	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99084	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
8875	Fee-for-Service	1871773762	1871773762	1	1	PLACENTIA-YORBA LINDA SD	3/29/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1301 E ORANGETHORPE AVE	None	PLACENTIA	CA	92870	5302	30	06059	33.870375	-117.8378505	Orange County
8884	Fee-for-Service	1275018392	1275018392	1	1	PLATINUM PROVIDERS MEDICAL G	2/24/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ROUP, INC.	6900 BROCKTON AVE	100	RIVERSIDE	CA	92506	3819	33	06065	33.94872	-117.3967215	Riverside County
8893	Fee-for-Service	1396932547	1396932547	1	1	PARRIS, DAVID L MD	1/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104426	05	Anesthesiology	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
8908	Fee-for-Service	1467764316	1467764316	1	2	PROGRESS SPEECH & LANGUAGE P	11/12/2013	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N MAIN ST	SUITE 945	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
8929	Fee-for-Service	1104997006	1104997006	1	1	PICKERING, SHELLEY D MD	9/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54751	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
8974	Fee-for-Service	1902974421	1902974421	1	1	PEPPLE, RICHARD T MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41270	41	Internal Medicine	0	In state provider	None	2644 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.570911	-122.3997975	Shasta County
8989	Fee-for-Service	1134382708	1134382708	1	1	PAWLAK, CHRISTOPHER J LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
9010	Fee-for-Service	1932144813	1932144813	1	1	PRINCE, LAWRENCE S MD	1/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89291	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
9020	Fee-for-Service	1467564534	1467564534	1	1	PLOUFF,ROBERT T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE S	None	MINNEAPOLIS	MN	55404	0000	00	None	44.95652346	-93.26250787	Hennepin County
9101	Fee-for-Service	1295944833	1295944833	1	1	PATEL, NIMESHKUMAR K DO	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11826	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
9103	Fee-for-Service	1689933715	1689933715	1	1	PRIGGE, JENNIFER M MD	4/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
9110	Fee-for-Service	1437256120	1437256120	1	1	PATEL, SWATI P MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43729	45	Nephrology (Renal-Kidney)	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
9115	Fee-for-Service	1225355720	1225355720	1	1	PATIL, AMOL A MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133973	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
9151	Fee-for-Service	1629222534	1629222534	1	1	PAREDES, MERCEDES MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108192	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9169	Fee-for-Service	1477973907	1477973907	1	1	PAUL, MATTHEW D	6/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 DRESDEN DR	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
9170	Fee-for-Service	1275018392	1275018392	1	1	PLATINUM PROVIDERS MEDICAL G	2/24/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ROUP, INC.	6900 BROCKTON AVE	100	RIVERSIDE	CA	92506	3819	33	06065	33.94872	-117.3967215	Riverside County
9185	Fee-for-Service	1124330923	1124330923	1	1	PAULSON, JESSICA M MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	146543	None	None	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
9196	Fee-for-Service	1467764316	1467764316	1	2	PROGRESS SPEECH & LANGUAGE P	7/21/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N MAIN ST	SUITE 945	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
9202	Fee-for-Service	1346256583	1346256583	1	1	PORTER, BRENDA E MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89267	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9204	Fee-for-Service	1326118761	1326118761	1	1	PARKMAN, ROBERTSON MD	6/21/2000	2080P0207X	NA	Hematology	026	PHYSICIANS	49689	08	Family Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
9217	Fee-for-Service	1447293048	1447293048	1	1	PHAM, LIEN T MD	5/15/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53375	08	Family Practice	0	In state provider	None	830 MAGNOLIA AVE	None	CORONA	CA	92879	3128	33	06065	33.86017131	-117.5520534	Riverside County
9234	Fee-for-Service	1265982359	1265982359	1	1	PROHEALTH PARTNERS A MEDICAL	5/2/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	GROUP INC	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
9243	Fee-for-Service	1528191483	1528191483	1	1	PROHEALTH PARTNERS	2/15/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	A MEDICAL GROUP IN	1045 ATLANTIC AVE	SUITE 1019	LONG BEACH	CA	90813	3413	19	06037	33.780267	-118.1850795	Los Angeles County
9244	Fee-for-Service	1164051991	1164051991	1	1	PABLO, STEPHANIE Y MD	2/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184680	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
9305	Fee-for-Service	1437220324	1437220324	1	1	PAIK, PETER S MD	4/30/1995	2086S0129X	NA	General Surgery	026	PHYSICIANS	80268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	910 S FAIRFAX AVE	None	LOS ANGELES	CA	90036	4419	19	06037	34.0597882	-118.3630234	Los Angeles County
9340	Fee-for-Service	1346346277	1346346277	1	1	PARAMOUNT CONVALESCENT	12/1/1988	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GROUP	8558 ROSECRANS AVE	None	PARAMOUNT	CA	90723	3644	19	06037	33.90365149	-118.149516	Los Angeles County
9359	Fee-for-Service	1568857142	1568857142	1	1	PARK, LISA MD	12/15/2021	208C00000X	NA	General Surgery	026	PHYSICIANS	168789	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
9363	Fee-for-Service	1295266146	1295266146	1	1	PEICHER, VALERIE MD	1/28/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	169465	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
9375	Fee-for-Service	1427210855	1427210855	1	1	POLLOCK, MAX R MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109975	30	Radiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
9386	Fee-for-Service	1053930644	1053930644	1	1	PEREZ QUINTANA, JUAN M MD	8/22/2023	207R00000X	NA	Other	026	PHYSICIANS	186249	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
9409	Fee-for-Service	1710914577	1710914577	1	1	PILE, DOUGLAS D MD	7/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	23119	08	Family Practice	0	In state provider	None	1310 PRENTICE DR	STE A	HEALDSBURG	CA	95448	5002	49	06097	38.626578	-122.8666945	Sonoma County
9470	Fee-for-Service	1083838130	1083838130	1	1	PRASANNA LAKSHMI YELAMANCHIL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	415 W COLUMBIA ST	None	EVANSVILLE	IN	47710	1656	00	None	37.98486618	-87.56985734	Vanderburgh County
9474	Fee-for-Service	1164746889	1164746889	1	1	PEKMEZCI, MELIKE MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123227	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9484	Fee-for-Service	1467764316	1467764316	1	2	PROGRESS SPEECH & LANGUAGE P	7/21/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 N MAIN ST	SUITE 945	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
9490	Fee-for-Service	1346256583	1346256583	1	1	PORTER, BRENDA E MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89267	79	Neurology-Child	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
9521	Fee-for-Service	1265982359	1265982359	1	1	PROHEALTH PARTNERS A MEDICAL	5/2/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	GROUP INC	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
9531	Fee-for-Service	1528191483	1528191483	1	1	PROHEALTH PARTNERS	2/15/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP IN	1045 ATLANTIC AVE	SUITE 1019	LONG BEACH	CA	90813	3413	19	06037	33.780267	-118.1850795	Los Angeles County
9555	Fee-for-Service	1700934775	1700934775	1	1	PARK, JENNIFER M MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62166	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
9565	Fee-for-Service	1700415338	1700415338	1	1	POLYAK, ALEXANDER MD	6/21/2023	208M00000X	NA	Other	026	PHYSICIANS	178985	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
9571	Fee-for-Service	1467406942	1467406942	1	1	PRAGER, SARAH W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	395110 C/O UWP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
9624	Fee-for-Service	1255329140	1255329140	1	1	PARIS, DAVID J DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1756 CONTINENTAL ST	None	REDDING	CA	96001	1240	45	06089	40.58266855	-122.3843989	Shasta County
9640	Fee-for-Service	1841745411	1841745411	1	1	PATRIDGE, ATREJO NP	6/7/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9653	Fee-for-Service	1649513656	1649513656	1	1	PATEL, AMISHA K MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135035	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1737	19	06037	34.07671715	-118.3799413	Los Angeles County
9664	Fee-for-Service	1295001592	1295001592	1	1	PHAN, KIM M DO	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13018	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	MER 35	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
9683	Fee-for-Service	1518045228	1518045228	1	1	PAGLIERE, EDWARD O MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33278	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
9693	Fee-for-Service	1619380706	1619380706	1	1	PETERSON, DEFNE Z	7/7/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
9696	Fee-for-Service	1275692584	1275692584	1	1	PANDYA,NAUSHIRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 S UNIVERSITY DR	None	FORT LAUDERDALE	FL	33328	0000	00	None	26.08184156	-80.25082355	Broward County
9739	Fee-for-Service	1619119997	1619119997	1	1	PITTA, HIMABINDU MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118485	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	#200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
9749	Fee-for-Service	1821173972	1821173972	1	1	PEDERSEN, ROBERT E OD	8/8/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 E WEBER AVE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
9751	Fee-for-Service	1548324767	1548324767	1	1	PUSHKIN, ROBERT S MD INC	1/2/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	28941	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1301 20TH ST	STE 100	SANTA MONICA	CA	90024	4001	19	06037	34.02976782	-118.4812493	Los Angeles County
9759	Fee-for-Service	1245307461	1245307461	1	1	PETERS, JOHN A MD	7/31/1992	204D00000X	NA	Other	026	PHYSICIANS	68239	20	Orthopedic Surgery	0	In state provider	None	944 N BRAND BLVD	None	GLENDALE	CA	91202	2905	19	06037	34.15995	-118.2550645	Los Angeles County
9766	Fee-for-Service	1780925990	1780925990	2	3	PHI HEALTH, LLC	6/30/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	471-920 JOHNSTONVILLE DR	#3	SUSANVILLE	CA	96130	8749	18	06035	40.37531547	-120.5794612	Lassen County
9798	Fee-for-Service	1487373338	1487373338	1	1	PRICE, JOHN C PT	10/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
9809	Fee-for-Service	1265982359	1265982359	1	1	PROHEALTH PARTNERS A MEDICAL	9/14/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
9820	Fee-for-Service	1154613289	1154613289	1	1	PATEL, BEJAL D MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL ST	2ND FL, BLDG 55	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
9833	Fee-for-Service	1023560612	1023560612	1	1	PETERS, MICHELLE PT	2/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 MORTON	B	PORTERVILLE	CA	93257	1940	54	06107	36.07332205	-119.0428201	Tulare County
9848	Fee-for-Service	1356380174	1356380174	1	1	PRESS, MICHAEL F MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	63073	22	Pathology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
9936	Fee-for-Service	1225376809	1225376809	1	1	PLANNED PARENTHOOD OF ORANGE	8/21/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AND SAN BERNARDINO	15403 PARK AVENUE EAST	None	VICTORVILLE	CA	92392	2482	36	06071	34.50640129	-117.3250645	San Bernardino County
9992	Fee-for-Service	1932315579	1932315579	1	1	PAN, HONGYU MD	8/4/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	107088	08	Family Practice	0	In state provider	None	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
9995	Fee-for-Service	1275911240	1275911240	1	1	PAREKH, SHALIN MD	9/13/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	152950	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10031	Fee-for-Service	1760680417	1760680417	1	1	PASTUSHENKO, GARY I MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98667	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
10099	Fee-for-Service	1265982359	1265982359	1	1	PROHEALTH PARTNERS A MEDICAL	5/2/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
10106	Fee-for-Service	1922109529	1922109529	1	1	PATEL, MEENAL S MD	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35363	05	Anesthesiology	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
10118	Fee-for-Service	1821724915	1821724915	1	1	PEREZ, JASMINE LCSW	3/9/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
10150	Fee-for-Service	1942388830	1942388830	1	1	PUTNAM, CLAIRE A MD	9/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73041	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
10182	Fee-for-Service	1821188319	1821188319	1	1	PAUL PHILLIPS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
10186	Fee-for-Service	1104252352	1104252352	1	1	PANOS, STELLA E PHD	12/17/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
10198	Fee-for-Service	1376708966	1376708966	1	1	PAE, JENNIS H MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112125	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10216	Fee-for-Service	1104465426	1104465426	1	1	PARK, MI JOUNG LMFT	9/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
10266	Fee-for-Service	1215430988	1215430988	1	1	PUNZALAN, JAYMEEH T CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
10359	Fee-for-Service	1144276288	1144276288	1	1	PERRY, VICTOR L MD	10/12/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86263	14	Neurological Surgery	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
10383	Fee-for-Service	1295772317	1295772317	1	1	PINKERTON, RONALD E	1/1/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64676	08	Family Practice	0	In state provider	None	9360 TELEGRAPH RD	None	DOWNEY	CA	90240	2425	19	06037	33.95594111	-118.1032272	Los Angeles County
10385	Fee-for-Service	1619064912	1619064912	1	1	PATEL, PARYUS B MD	4/30/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46419	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4106	19	06037	33.94909549	-118.3481595	Los Angeles County
10431	Fee-for-Service	1629175310	1629175310	1	1	PAGTALUNAN, MARIA E MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	48370	None	None	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
10463	Fee-for-Service	1184611980	1184611980	1	1	PADILLA,MARIO M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 MURCHISON	STE 100	EL PASO	TX	79902	0000	00	None	31.77875437	-106.4865444	El Paso County
10492	Fee-for-Service	1275564296	1275564296	1	6	PRECISION REHABILITATION & O	11/15/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1653 N SCHNOOR AVE	107	MADERA	CA	93637	3613	20	06039	36.972837	-120.0844225	Madera County
10495	Fee-for-Service	1801231626	1801231626	1	1	POURATI, LIORA LMFT	8/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1736 WESTWOOD BLVD	STE 202	LOS ANGELES	CA	90024	5611	19	06037	34.05108801	-118.4381032	Los Angeles County
10508	Fee-for-Service	1942361332	1942361332	2	1	PLEITEZ, NURIA F MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40248	40	Pediatrics	0	In state provider	None	430 W BADILLO ST	None	COVINA	CA	91723	1829	19	06037	34.08628272	-117.8976273	Los Angeles County
10519	Fee-for-Service	1306878020	1306878020	1	1	POPPER, MARK PHD	8/13/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1960 N GATEWAY BLVD	None	FRESNO	CA	93727	1604	10	06019	36.76842313	-119.7264558	Fresno County
10531	Fee-for-Service	1124527247	1124527247	1	1	PHILIPONIS, GENEVIEVE MD	7/30/2020	207P00000X	NA	Other	026	PHYSICIANS	169585	70	Clinic (mixed specialty)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
10594	Fee-for-Service	1780248146	1780248146	1	1	PETERSEN, MICHAEL MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	191321	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
10606	Fee-for-Service	1750574083	1750574083	1	1	PARK, BILLIE K DO	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10656	01	General Practice	0	In state provider	None	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
10622	Fee-for-Service	1730620030	1730620030	1	1	PARIKH, SONA G MD	1/5/2022	207L00000X	NA	Other	026	PHYSICIANS	157633	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
10639	Fee-for-Service	1437239852	1437239852	1	1	PEREIRA, FARIA A MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
10645	Fee-for-Service	1699792317	1699792317	1	1	PAZ-ALTSCHUL, OSCAR J MD	8/6/1994	174400000X	NA	Other	026	PHYSICIANS	43866	89	Surgery-Traumatic	0	In state provider	None	1150 N INDIAN AVE	None	PALM SPRINGS	CA	92262	4872	33	06065	33.90825494	-116.545378	Riverside County
10653	Fee-for-Service	1285221424	1285221424	1	1	PURVIS, JESSICA LCSW	1/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28441 RANCHO CALIFORNIA	105	TEMECULA	CA	92590	3618	33	06065	33.49792824	-117.1581487	Riverside County
10674	Fee-for-Service	1619064912	1619064912	1	1	PATEL, PARYUS B MD	4/30/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	46419	41	Internal Medicine	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4106	19	06037	33.94909549	-118.3481595	Los Angeles County
10725	Fee-for-Service	1366699423	1366699423	1	1	PARDO, MANUEL J MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107711	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
10746	Fee-for-Service	1245812742	1245812742	1	1	PATEL, BANSURI DO	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	22018	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
10778	Fee-for-Service	1609032986	1609032986	1	1	PATEL, MITA B MD	2/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	150310	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
10801	Fee-for-Service	1164715645	1164715645	1	1	PREMIER EMERGENCY PHYSICIANS	6/1/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA MEDICAL GR	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
10807	Fee-for-Service	1831724244	1831724244	1	1	PHARMEDQUEST PHARMACY SERVIC	6/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	325 E. 7TH STREET	ROOM 101	LOS ANGELES	CA	90014	9001	19	06037	34.04209386	-118.2486813	Los Angeles County
10808	Fee-for-Service	1013794759	1013794759	1	1	PEARL MCGINLEY ACUPUNCTURE C	3/4/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	435 MELVILLE RD	None	GARBERVILLE	CA	95542	3409	12	06023	40.09779811	-123.7946755	Humboldt County
10822	Fee-for-Service	1124527247	1124527247	1	1	PHILIPONIS, GENEVIEVE MD	7/30/2020	207P00000X	NA	Other	026	PHYSICIANS	169585	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
10825	Fee-for-Service	1497077358	1497077358	1	1	PIAO, ZHE MD	10/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101774	22	Pathology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
10840	Fee-for-Service	1063633360	1063633360	1	1	PHILLIPS, TREVOR G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST SE	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
10885	Fee-for-Service	1679513824	1679513824	1	1	PORTS, THOMAS A MD	7/30/1981	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30411	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10903	Fee-for-Service	1649203316	1649203316	1	2	PRUETT, WESLEY C MD	10/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	85876	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
10933	Fee-for-Service	1699792317	1699792317	1	1	PAZ-ALTSCHUL, OSCAR J MD	8/6/1994	174400000X	NA	Other	026	PHYSICIANS	43866	01	General Practice	0	In state provider	None	1150 N INDIAN AVE	None	PALM SPRINGS	CA	92262	4872	33	06065	33.90825494	-116.545378	Riverside County
10948	Fee-for-Service	1275668022	1275668022	1	1	PIASECKI, BROOKE E LMFT	10/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
10970	Fee-for-Service	1770757734	1770757734	1	1	PARKS, NANCY A MD	7/3/2009	208600000X	NA	General Surgery	026	PHYSICIANS	93743	02	General Surgery	0	In state provider	None	255 N HOWARD	None	FRESNO	CA	93710	0000	10	06019	36.8364201	-119.7835108	Fresno County
10994	Fee-for-Service	1619356524	1619356524	1	1	POWELSON, ANN M MD	10/5/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162011	None	None	0	In state provider	None	1735 CREEKSIDE	None	FOLSOM	CA	95630	3914	34	06067	38.672028	-121.140198	Sacramento County
11017	Fee-for-Service	1891232484	1891232484	1	1	PERSONALIZED CARE MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66851	None	None	0	In state provider	None	3010 BEARD ROAD	None	NAPA	CA	94558	3442	28	06055	38.32003352	-122.2948827	Napa County
11023	Fee-for-Service	1346826252	1346826252	1	1	PURE BLISS HOSPICE CARE INC	6/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13527 VENTURA BLVD	STE A	SHERMAN OAKS	CA	91423	6164	19	06037	34.14748205	-118.4278548	Los Angeles County
11054	Fee-for-Service	1578850988	1578850988	1	1	PARDEE, PERRIE E MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123826	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
11062	Fee-for-Service	1114087228	1114087228	2	1	PILLAI, SINDHU MD	6/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	66720	40	Pediatrics	0	In state provider	None	25485 MEDICAL CENTER DR	STE 106	MURRIETA	CA	92562	9009	33	06065	33.55785761	-117.1842222	Riverside County
11066	Fee-for-Service	1609032986	1609032986	1	1	PATEL, MITA B MD	2/28/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	150310	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
11100	Fee-for-Service	1194839035	1194839035	1	1	PERRIS FAMILY CARE CTR	3/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	33	06065	33.78658073	-117.2226438	Riverside County
11114	Fee-for-Service	1942238571	1942238571	1	1	PURI, ASHA MD	7/31/1989	174400000X	NA	Other	026	PHYSICIANS	29876	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
11122	Fee-for-Service	1649347592	1649347592	1	1	PEREZ, ROCIO MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74191	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
11125	Fee-for-Service	1396710075	1396710075	1	1	PRABHAKAR, ARUDI L MD	1/9/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31627	01	General Practice	0	In state provider	None	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
11134	Fee-for-Service	1437573946	1437573946	1	1	PALOUSE AREA CARE & TRANSPOR	8/8/2024	2278P4000X	NA	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	T, LLC	434 SOUTH JACKSON ST	None	GENESEE	ID	83832	9525	00	None	46.54707188	-116.9342731	Latah County
11145	Fee-for-Service	1649567165	1649567165	1	1	PEDOUIM, FARZIN B	1/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122634	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
11150	Fee-for-Service	1548354574	1548354574	1	1	PULITO, JOSEPH F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM ST	STE 555	PORTLAND	OR	97227	2007	00	None	45.54285348	-122.671035	Multnomah County
11160	Fee-for-Service	1588726665	1588726665	1	1	PETERS, KAREN A PHD	8/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
11162	Fee-for-Service	1205884707	1205884707	1	1	PACIFIC ALLIANCE MEDICAL	3/24/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CENTER INC	437 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3720	19	06037	34.0292709	-118.2605558	Los Angeles County
11193	Fee-for-Service	1437151826	1437151826	1	1	PREUSEN, SCOTT MD	10/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184066	None	None	0	In state provider	None	495 BIRCH ST	B	CALEXICO	CA	92231	2374	13	06025	32.6794317	-115.4928454	Imperial County
11196	Fee-for-Service	1457377202	1457377202	1	1	POWERS, BRET C DO	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9577	20	Orthopedic Surgery	0	In state provider	None	802 MAGNOLIA AVE	STE 106	CORONA	CA	92879	3125	33	06065	33.8596449	-117.5529774	Riverside County
11227	Fee-for-Service	1134656184	1134656184	1	1	PERRY, KRISTYN A DO	7/12/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
11233	Fee-for-Service	1124027172	1124027172	1	1	PAUL R KOUYOUMDJI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4 BYPASS RD	STE 101	SALEM	NJ	08079	0000	00	None	39.59604254	-75.44398059	Salem County
11271	Fee-for-Service	1205981586	1205981586	1	1	PERRO, MICHELLE D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 SUNNYHILLS DR	None	SAN ANSELMO	CA	94960	1909	21	06041	37.98269146	-122.5611947	Marin County
11272	Fee-for-Service	1316041833	1316041833	2	33	PEDIATRIX MEDICAL GROUP OF C	12/7/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2975 NORTH SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
11277	Fee-for-Service	1295813053	1295813053	1	1	PARK, RICHARD A MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72210	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
11292	Fee-for-Service	1538233929	1538233929	1	2	PRIEBE, STEVEN R PHD	7/31/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	999 ADAMS ST	SUITE 300	SAINT HELENA	CA	94574	1148	28	06055	38.5071543	-122.4685546	Napa County
11297	Fee-for-Service	1700839966	1700839966	1	1	PRABAHARAN, VELUMMYLUM MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54854	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
11298	Fee-for-Service	1710983671	1710983671	2	2	PATH LABS LLC	12/8/2011	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	999 N TUSTIN AVE	SUITES 216 & 218	SANTA ANA	CA	92705	6506	30	06059	33.754167	-117.834191	Orange County
11310	Fee-for-Service	1346826252	1346826252	1	1	PURE BLISS HOSPICE CARE INC	6/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13527 VENTURA BLVD	STE A	SHERMAN OAKS	CA	91423	6164	19	06037	34.14748205	-118.4278548	Los Angeles County
11329	Fee-for-Service	1619922911	1619922911	1	1	PITTSBURG-ANTIOCH MED GR	3/11/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPRINGHILL MEDICAL GROUP	2220 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
11379	Fee-for-Service	1659026367	1659026367	1	1	PIERSON, DAVID NP	4/9/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
11391	Fee-for-Service	1194839035	1194839035	1	1	PERRIS FAMILY CARE CTR	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	33	06065	33.78658073	-117.2226438	Riverside County
11433	Fee-for-Service	1912058561	1912058561	1	1	PATEL, VIMAL H MD	7/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153177	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
11451	Fee-for-Service	1205884707	1205884707	1	1	PACIFIC ALLIANCE MEDICAL	3/24/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTER INC	437 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3720	19	06037	34.0292709	-118.2605558	Los Angeles County
11488	Fee-for-Service	1639238256	1639238256	1	1	PARRISH, JERROLD J MD	5/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	28851	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
11493	Fee-for-Service	1558417352	1558417352	1	1	PETRUSKA, DAVID B MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	49383	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
11529	Fee-for-Service	1346480373	1346480373	1	1	PEARSON, GARYN D CRNA	9/10/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
11541	Fee-for-Service	1306067012	1306067012	1	1	PARIKH, RAJUL MD	12/1/1982	2080H0002X	NA	Pediatric Primary Care	026	PHYSICIANS	37746	40	Pediatrics	0	In state provider	None	73 W MARCH LANE	STE A	STOCKTON	CA	95207	5725	39	06077	37.99550203	-121.3068758	San Joaquin County
11547	Fee-for-Service	1609372341	1609372341	1	1	PANJIKARAN, LLOYD MD	9/6/2023	208M00000X	NA	Other	026	PHYSICIANS	185908	None	None	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
11549	Fee-for-Service	1225167919	1225167919	1	1	PHAM, HUNG T MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85913	18	Ophthalmology	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
11560	Fee-for-Service	1205981586	1205981586	1	1	PERRO, MICHELLE D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65989	40	Pediatrics	0	In state provider	None	300 SUNNYHILLS DR	None	SAN ANSELMO	CA	94960	1909	21	06041	37.98269146	-122.5611947	Marin County
11577	Fee-for-Service	1821313321	1821313321	1	1	PARADISE, KOLLEEN M CRNA	2/10/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
11586	Fee-for-Service	1598318412	1598318412	1	1	PATEL, ISHA K OD	3/9/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
11602	Fee-for-Service	1023048741	1023048741	1	1	PRATHER, TRINA D MD	1/1/2000	207R00000X	NA	Other	026	PHYSICIANS	69547	41	Internal Medicine	0	In state provider	None	8170 LAGUNA BLVD	STE 101	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
11608	Fee-for-Service	1194073213	1194073213	1	1	PATEL, TEJAL MD	11/21/2019	207R00000X	NA	Other	026	PHYSICIANS	163206	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
11623	Fee-for-Service	1639597396	1639597396	1	1	PEDERSON, JULIA C MD	1/31/2018	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	152138	40	Pediatrics	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
11635	Fee-for-Service	1598446254	1598446254	1	1	PAL, AMANDEEP NP	10/21/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	15	06029	35.356392	-119.092153	Kern County
11641	Fee-for-Service	1457572448	1457572448	1	1	PATEL, MITUL P MD	9/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95406	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
11647	Fee-for-Service	1497776603	1497776603	1	1	PALUMBO FRANK C A PROF C	1/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	30047	20	Orthopedic Surgery	0	In state provider	None	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	34	06067	38.668347	-121.3148745	Sacramento County
11658	Fee-for-Service	1487903258	1487903258	1	1	PARAMOUNT MEDICAL INC	6/22/2013	207RN0300X	NA	Nephrology	026	PHYSICIANS	105268	41	Internal Medicine	0	In state provider	None	4100 CENTRAL AVE	SUITE 101A	RIVERSIDE	CA	92506	2930	33	06065	33.95347152	-117.397278	Riverside County
11669	Fee-for-Service	1932291119	1932291119	1	1	PHATAK, SONAL V MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90261	67	Endocrinology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
11679	Fee-for-Service	1194839035	1194839035	1	1	PERRIS FAMILY CARE CTR	1/16/1997	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	33	06065	33.78658073	-117.2226438	Riverside County
11723	Fee-for-Service	1639666183	1639666183	1	1	PAPUZZA, NICOLE E MA OTR	9/23/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2665 PARK CENTER DRIVE	SUITE D	SIMI VALLEY	CA	93065	6215	56	06111	34.28449244	-118.7968424	Ventura County
11740	Fee-for-Service	1205884707	1205884707	1	1	PACIFIC ALLIANCE MEDICAL	3/24/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	CENTER INC	437 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3720	19	06037	34.0292709	-118.2605558	Los Angeles County
11756	Fee-for-Service	1174702013	1174702013	1	1	PARS MEDICAL INC	3/23/2010	193200000X	NA	Other	026	PHYSICIANS	42140	02	General Surgery	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	2300	19	06037	34.07694934	-117.7489598	Los Angeles County
11768	Fee-for-Service	1013100742	1013100742	1	1	PURCELL, ANNIE D DO	12/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10303	25	Physical Medicine and Rehabilitation	0	In state provider	None	1255 EAST STREET	SUITE 201	REDDING	CA	96001	0800	45	06089	40.58763719	-122.3893695	Shasta County
11772	Fee-for-Service	1548567068	1548567068	1	1	PANUNCIALMAN, JAYMIE F MD	12/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	07	Dermatology	1	Border provider	None	3000 BRYANT WILLIAMS DR	None	KLAMATH FALLS	OR	97601	1139	00	None	42.25179653	-121.7822714	Klamath County
11833	Fee-for-Service	1235629932	1235629932	1	1	PHAM, JENNIFER MD	7/17/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	173951	None	None	0	In state provider	None	340 FOURTH AVE	SUITE 4	CHULA VISTA	CA	91910	4414	37	06073	32.63831293	-117.0833536	San Diego County
11839	Fee-for-Service	1417960592	1417960592	1	1	PRICE, JOHN PSYD	10/31/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
11869	Fee-for-Service	1801037346	1801037346	1	1	PEREZ, ERIKA J LCSW	8/9/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
11871	Fee-for-Service	1477511178	1477511178	1	1	PAUDA, JOSE M MD INC	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75654	08	Family Practice	0	In state provider	None	631 E ALVIN DR	STE J2	SALINAS	CA	93906	3056	27	06053	36.7035675	-121.6319376	Monterey County
11872	Fee-for-Service	1518259605	1518259605	1	1	PETERSON, JAMMIE T LCSW	6/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
11887	Fee-for-Service	1427122563	1427122563	1	1	PARICA, NUBERT E	4/22/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12100 EUCLID ST	None	GARDEN GROVE	CA	92840	3304	30	06059	33.786882	-117.9410535	Orange County
11894	Fee-for-Service	1003991845	1003991845	1	1	PROVIDENCE HEALTH & SERVICES	11/23/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
11935	Fee-for-Service	1598463689	1598463689	1	1	PHILLIPS, ASHLEY LPCC	3/5/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
11946	Fee-for-Service	1487903258	1487903258	1	1	PARAMOUNT MEDICAL INC	6/22/2013	207RN0300X	NA	Nephrology	026	PHYSICIANS	105268	45	Nephrology (Renal-Kidney)	0	In state provider	None	4100 CENTRAL AVE	SUITE 101A	RIVERSIDE	CA	92506	2930	33	06065	33.95347152	-117.397278	Riverside County
11958	Fee-for-Service	1932291119	1932291119	1	1	PHATAK, SONAL V MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90261	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
11964	Fee-for-Service	1336106665	1336106665	1	1	PASCUAL, ALFRED M MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	5182	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10445 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7323	19	06037	34.259094	-118.5023365	Los Angeles County
11970	Fee-for-Service	1194839035	1194839035	1	1	PERRIS FAMILY CARE CTR	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	33	06065	33.78658073	-117.2226438	Riverside County
12005	Fee-for-Service	1548372469	1548372469	2	2	PATTERSON FAMILY PHARMACY, I	2/25/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 S DEL PUERTO AVENUE	None	PATTERSON	CA	95363	2544	50	06099	37.4693283	-121.1307196	Stanislaus County
12026	Fee-for-Service	1174545362	1174545362	1	1	PORTER,RUSSELL T MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
12030	Fee-for-Service	1285674531	1285674531	1	1	PATRICK JOHNSON MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
12067	Fee-for-Service	1164053708	1164053708	1	1	PHAM CONSULTING, LLC	6/19/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1403 N TUSTIN AVE	150	SANTA ANA	CA	92705	6857	30	06059	33.75741732	-117.8341425	Orange County
12110	Fee-for-Service	1972140036	1972140036	1	1	PAUL H. CHIU, MD, INC	3/19/2020	208VP0000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	SPECIALISTS	707 S GARFIELD AVE	304	ALHAMBRA	CA	91801	5861	19	06037	34.088688	-118.123106	Los Angeles County
12119	Fee-for-Service	1518348036	1518348036	1	1	PLATT, ANDREW W MD	10/16/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	188049	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
12120	Fee-for-Service	1497998314	1497998314	1	1	PHAM, HUY P MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151632	22	Pathology (M.D. only)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
12156	Fee-for-Service	1922240621	1922240621	1	1	PRESTON SCHNEIDER	4/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	937 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6909	00	None	45.669717	-111.020148	Gallatin County
12166	Fee-for-Service	1194880328	1194880328	1	1	PARK, KRISTEN L MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
12174	Fee-for-Service	1194087817	1194087817	1	1	PANORAMA HOSPICE INC	3/28/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6259 VAN NUYS BLVD	SUITE A	VAN NUYS	CA	91401	2711	19	06037	34.183962	-118.4487865	Los Angeles County
12177	Fee-for-Service	1326201880	1326201880	1	1	PENG, JASON H LCSW	11/19/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
12184	Fee-for-Service	1003991845	1003991845	1	1	PROVIDENCE HEALTH & SERVICES	11/23/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
12199	Fee-for-Service	1508075508	1508075508	1	1	PEPPERMINT RIDGE	12/28/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1581 HEARTLAND WAY	None	CORONA	CA	92881	4180	33	06065	33.83508485	-117.5402041	Riverside County
12216	Fee-for-Service	1184027104	1184027104	1	3	PACIFIC SKIN INSTITUTE	3/23/2021	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	550 PLAZA DRIVE	120	FOLSOM	CA	95630	4778	34	06067	38.657223	-121.172283	Sacramento County
12226	Fee-for-Service	MSS00016F	None	1	1	PASADENA HOSPITAL	7/1/1998	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATION, LTD	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
12232	Fee-for-Service	1548995541	1548995541	1	1	PROMISES GUEST VILLAGE INC	8/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1315 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	6306	30	06059	33.81599821	-117.9073421	Orange County
12237	Fee-for-Service	1932553096	1932553096	1	1	PATEL, ANISH R MD	7/10/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	162600	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
12316	Fee-for-Service	1174545362	1174545362	1	1	PORTER,RUSSELL T MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75424	08	Family Practice	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
12338	Fee-for-Service	1184906794	1184906794	1	1	PERALTA, CLAUDIA J LMFT	11/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	282 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2627	37	06073	32.64168665	-117.0812298	San Diego County
12385	Fee-for-Service	1639145634	1639145634	1	1	PRATT, JERRY W MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88313	02	General Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
12395	Fee-for-Service	1598955668	1598955668	1	1	POCH, DAVID S MD	8/25/2010	207RC0200X	NA	Other	026	PHYSICIANS	107956	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12417	Fee-for-Service	1932360492	1932360492	1	1	PATEL, PRITI I MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114503	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
12442	Fee-for-Service	1346685633	1346685633	1	1	POULSEN, DAVID M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146507	18	Ophthalmology	0	In state provider	None	1360 E HERNDON AVE	STE 201	FRESNO	CA	93720	3226	10	06019	36.83744648	-119.7646425	Fresno County
12454	Fee-for-Service	1942688528	1942688528	1	2	PROGRESSIVE HOME HEALTH AND	4/28/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1619 H STREET	STE B	MODESTO	CA	95354	1209	50	06099	37.64345951	-120.9915765	Stanislaus County
12463	Fee-for-Service	1194087817	1194087817	1	1	PANORAMA HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6259 VAN NUYS BLVD	SUITE A	VAN NUYS	CA	91401	2711	19	06037	34.183962	-118.4487865	Los Angeles County
12467	Fee-for-Service	1851473862	1851473862	2	1	PILEST, NISSAN MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30988	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
12471	Fee-for-Service	1326030024	1326030024	1	1	PENDLETON, JOHN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91072	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	STE A	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
12487	Fee-for-Service	1851310916	1851310916	1	1	PERKINS, FRASER L MD	6/30/1989	207L00000X	NA	Other	026	PHYSICIANS	29871	05	Anesthesiology	0	In state provider	None	415 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3326	19	06037	33.83819747	-118.3840178	Los Angeles County
12493	Fee-for-Service	1134486673	1134486673	1	1	PATEL, SHITAL K MD	10/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136312	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ STREET	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
12499	Fee-for-Service	1326178534	1326178534	1	1	PUGA, ANNETTE	11/6/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
12523	Fee-for-Service	1871098079	1871098079	1	1	PAPAMICHAEL, ATHENA DO	5/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17960	08	Family Practice	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
12534	Fee-for-Service	1568658086	1568658086	1	2	PROPHETE MEDICAL CORPORATION	1/14/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	502 WASHINGTON AVE	None	LOS BANOS	CA	93635	4649	24	06047	37.05600223	-120.8529485	Merced County
12575	Fee-for-Service	1871529461	1871529461	1	1	PASHA, SABIHA MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50413	None	None	0	In state provider	None	488 E VALLEY PKWY	STE 314	ESCONDIDO	CA	92025	3376	37	06073	33.12523814	-117.0769715	San Diego County
12596	Fee-for-Service	1508986738	1508986738	1	1	PRIME CARE ASSOCIATES AMC	9/4/2012	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	44729	41	Internal Medicine	0	In state provider	None	18350 ROSCOE BLVD	STE 218	NORTHRIDGE	CA	91325	4153	19	06037	34.22071855	-118.5341175	Los Angeles County
12610	Fee-for-Service	1033139043	1033139043	1	1	PAXTON, LAMONT D MD	5/31/1982	2086S0129X	NA	General Surgery	026	PHYSICIANS	47633	01	General Practice	0	In state provider	None	8665 GIBBS DR	STE 202	SAN DIEGO	CA	92123	1747	37	06073	32.81043091	-117.1419105	San Diego County
12624	Fee-for-Service	1326057746	1326057746	2	1	PEARLMAN, BARRY J MD	8/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	23387	41	Internal Medicine	0	In state provider	None	9090 WILSHIRE BLVD	STE 101	LOS ANGELES	CA	90211	1849	19	06037	34.06702873	-118.3894057	Los Angeles
12657	Fee-for-Service	1326029505	1326029505	1	1	PEREZ, RICARDO L. MD	1/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49780	None	None	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
12666	Fee-for-Service	1851575310	1851575310	1	1	PYUN, EUNICE I DO	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12683	41	Internal Medicine	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
12709	Fee-for-Service	1255420436	1255420436	1	1	PLANNED PARENTHOOD	4/24/1992	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES BURBANK CTR	916 W BURBANK BLVD	STE M	BURBANK	CA	91506	1450	19	06037	34.18397121	-118.3225966	Los Angeles County
12771	Fee-for-Service	1740251842	1740251842	1	1	PHAM, THANH OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HAYWARD OPTOMETRY	865 B ST	None	HAYWARD	CA	94541	5107	01	06001	37.67179004	-122.084486	Alameda County
12836	Fee-for-Service	1346528106	1346528106	1	1	PATHWAY SOCIETY INC	12/7/2015	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9500 MALECH ROAD	None	SAN JOSE	CA	95138	2002	43	06085	37.22005276	-121.7324415	Santa Clara County
12841	Fee-for-Service	1447317128	1447317128	1	2	POLLOCK PINES ESD	7/1/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2700 AMBER TRAIL	None	POLLOCK PINES	CA	95726	9266	09	06017	38.74822815	-120.5783371	El Dorado County
12844	Fee-for-Service	1407301468	1407301468	1	1	PRIMECARE PHARMACY LLC	1/7/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	32144 AGOURA RD	UNIT 101	WEST LAKE VILLAGE	CA	91361	4037	19	06037	34.14848408	-118.8208595	Los Angeles County
12915	Fee-for-Service	1326057746	1326057746	2	1	PEARLMAN, BARRY J MD	8/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	23387	10	Gastroenterology (M.D. only)	0	In state provider	None	9090 WILSHIRE BLVD	STE 101	LOS ANGELES	CA	90211	1849	19	06037	34.06702873	-118.3894057	Los Angeles
12976	Fee-for-Service	1730417965	1730417965	1	1	PETERS, ERIN E	6/7/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
12979	Fee-for-Service	1649667213	1649667213	1	1	PATEL, ANISH MD	5/16/2018	390200000X	NA	Other	026	PHYSICIANS	146888	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
12989	Fee-for-Service	1275564296	1275564296	1	5	PRECISION REHABILITATION & O	7/14/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	860 SEQUOIA AVE	STE A	LINDSAY	CA	93247	1425	54	06107	36.21418314	-119.096029	Tulare County
12990	Fee-for-Service	1538511399	1538511399	1	1	PATEL, KARAN K MD	11/24/2019	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	161479	08	Family Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
12992	Fee-for-Service	1811132152	1811132152	1	1	PAGE, PAUL N MD	8/12/2019	2085R0001X	NA	Other	026	PHYSICIANS	99154	32	Radiation Therapy (D.O. only)	0	In state provider	None	8100 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2353	34	06067	38.46078	-121.4177895	Sacramento County
13033	Fee-for-Service	1952780215	1952780215	1	1	PALOMERO, TIFFANY K D MD	6/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149289	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
13044	Fee-for-Service	1902453954	1902453954	1	1	PAGUD PAHED, FENELA LMFT	4/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
13052	Fee-for-Service	1881632263	1881632263	1	1	PUNJYA, RAJIV H MD	6/1/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	48705	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	415 E HARDING WAY	STE D	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
13055	Fee-for-Service	1902903180	1902903180	1	3	PRIMARY PEDIATRIC MEDICAL	3/5/2007	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3300 WEBSTER ST	STE 1202	OAKLAND	CA	94609	3126	01	06001	37.82132826	-122.2621843	Alameda County
13061	Fee-for-Service	1013941160	1013941160	1	1	PATEL, PRITI H MD	4/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75653	08	Family Practice	0	In state provider	None	1455 MONTEGO	STE 205	WALNUT CREEK	CA	94598	2957	07	06013	37.91046956	-122.0418669	Contra Costa County
13073	Fee-for-Service	1952360182	1952360182	1	1	PATTEN, DOUGLAS R OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	190 S MAAG AVENUE	SUITE G	OAKDALE	CA	95361	9622	50	06099	37.77030547	-120.8296267	Stanislaus County
13112	Fee-for-Service	1598922478	1598922478	1	1	PARK, MELISSA D LCSW	4/30/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
13139	Fee-for-Service	1619331303	1619331303	1	1	PATEL, JAY M MD	3/27/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150903	None	None	0	In state provider	None	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
13144	Fee-for-Service	1093892549	1093892549	1	1	PALMER, RICHARD J PHD	7/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
13158	Fee-for-Service	1114536208	1114536208	1	1	PATTERSON, RONALD C RCP	9/2/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
13200	Fee-for-Service	1477029866	1477029866	1	1	PARKER, AMANDA J LCSW	1/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	#100	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
13232	Fee-for-Service	1356410351	1356410351	1	3	PRIME HLTHCARE PARADISE VLY	11/7/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	610 EUCLID AVE	STE 202	NATIONAL CITY	CA	91950	2952	37	06073	32.68419388	-117.0829524	San Diego County
13256	Fee-for-Service	1457868267	1457868267	1	1	PATWA, MANORAMA RANI G NP	12/28/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
13268	Fee-for-Service	1609953736	1609953736	1	1	PACIFIC PATHOLOGY MED GR	4/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
13290	Fee-for-Service	1063411858	1063411858	1	1	PERRY, ANGELA MD	8/21/2023	207WX0200X	NA	Ophthalmology	026	PHYSICIANS	71893	None	None	0	In state provider	None	855 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1938	19	06037	34.1511692	-118.0177106	Los Angeles County
13316	Fee-for-Service	1215317821	1215317821	1	1	PHAM, LONG N MD	7/31/2020	207RR0500X	NA	Other	026	PHYSICIANS	144443	83	Rheumatology	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
13320	Fee-for-Service	1700812963	1700812963	1	1	PO, LESLEY L MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70911	08	Family Practice	0	In state provider	None	1650 S EUCLID AVE	None	ONTARIO	CA	91762	5824	36	06071	34.043571	-117.6514065	San Bernardino County
13388	Fee-for-Service	1346215290	1346215290	1	1	PACIFIC ORTHPEDIC MED	1/1/1979	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	GROUP	2621 F ST	None	BAKERSFIELD	CA	93301	1815	15	06029	35.38316921	-119.0235471	Kern County
13399	Fee-for-Service	1982834586	1982834586	1	1	PELLEGRINI, CARA N	4/2/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	86592	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13407	Fee-for-Service	1831258458	1831258458	1	1	PENROSE, JAMES R DO	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	5609	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
13463	Fee-for-Service	1245259845	1245259845	1	1	PERLADA, DAVID E MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50989	77	Infectious Disease	0	In state provider	None	5565 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5805	01	06001	37.69215143	-121.8800337	Alameda County
13526	Fee-for-Service	1710300579	1710300579	1	1	PATRIOT MEDICAL LABORATORIES	11/11/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	5330 SPECTRUM DR	STE I	FREDERICK	MD	21703	7302	00	None	39.37803134	-77.40222643	Frederick County
13539	Fee-for-Service	1194782649	1194782649	1	1	PARMAN, MARY E MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8446	09	Gynecology (D.O. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
13544	Fee-for-Service	1790729838	1790729838	1	1	PEAKE, MEREDITH L MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	57718	22	Pathology (M.D. only)	0	In state provider	None	2374 E PACIFICA PLACE	None	RANCHO DOMINGUEZ	CA	90220	6214	19	06037	33.84864797	-118.2240829	Los Angeles County
13555	Fee-for-Service	1144605742	1144605742	1	1	PENNER, AMY B LCSW	3/8/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
13558	Fee-for-Service	1427685395	1427685395	1	1	PHAM, GIA-CAT DPM	1/15/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2114 MCKEE RD	None	SAN JOSE	CA	95116	1427	43	06085	37.36309299	-121.8531192	Santa Clara County
13575	Fee-for-Service	1427246453	1427246453	1	1	PROFFETT, GARY J MD INC	11/1/2002	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	31780	01	General Practice	0	In state provider	None	2930 AVENIDA DE AUTLAN	None	CAMARILLO	CA	93010	7472	56	06111	34.24486617	-119.0877039	Ventura County
13591	Fee-for-Service	1780679340	1780679340	1	1	PARKIN, JAY D MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88371	20	Orthopedic Surgery	0	In state provider	None	1600 N ROSE AVE	STE 380	OXNARD	CA	93030	3790	56	06111	34.21700406	-119.1582582	Ventura County
13663	Fee-for-Service	1902844988	1902844988	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
13669	Fee-for-Service	1548343122	1548343122	1	1	PUJOL, LISA A MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85353	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
13703	Fee-for-Service	1477012730	1477012730	1	1	POURHOSSEINI, KEYSHA S DO	1/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19548	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
13705	Fee-for-Service	1770108672	1770108672	1	1	PANIRIAN, PEGAH DPM	11/6/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13624 HAWTHORNE BLVD	STE 206	HAWTHORNE	CA	90250	5818	19	06037	33.9083784	-118.3523983	Los Angeles County
13764	Fee-for-Service	1235453747	1235453747	1	1	PARK, EUNJOO J OD	10/26/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3130 W OLYMPIC BLVD	STE 105	LOS ANGELES	CA	90006	2484	19	06037	34.05258529	-118.3039795	Los Angeles County
13768	Fee-for-Service	1760672315	1760672315	1	1	PHAM, TONY D OD INC	11/16/2004	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6755 MIRA MESA BLVD	STE 141	SAN DIEGO	CA	92121	4311	37	06073	32.90722231	-117.1728229	San Diego County
13778	Fee-for-Service	1134569650	1134569650	1	1	PRIME HEALTHCARE SERVICES	9/11/2018	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	SHASTA LLC	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
13782	Fee-for-Service	1306189659	1306189659	1	1	PATEL, VISHAL Y MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135129	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
13802	Fee-for-Service	1043293194	1043293194	1	1	PLUMER, LAUREN B MD	10/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	21279	45	Nephrology (Renal-Kidney)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
13828	Fee-for-Service	1932528965	1932528965	1	1	PARUNGAO, JODI L MD	8/22/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157212	08	Family Practice	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
13839	Fee-for-Service	1326149584	1326149584	1	1	PARSOTAM, PRITI	6/13/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
13845	Fee-for-Service	1932263399	1932263399	1	1	PAUL, COLLEEN LMFT	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
13861	Fee-for-Service	1427246453	1427246453	1	1	PROFFETT, GARY J MD INC	11/1/2002	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	31780	08	Family Practice	0	In state provider	None	2930 AVENIDA DE AUTLAN	None	CAMARILLO	CA	93010	7472	56	06111	34.24486617	-119.0877039	Ventura County
13877	Fee-for-Service	1023174752	1023174752	1	1	PARK, SAMUEL MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75650	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
13891	Fee-for-Service	1336198605	1336198605	1	1	PACHECO, ARMANDO MD	8/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77249	08	Family Practice	0	In state provider	None	5823 YORK BLVD	STE 1	LOS ANGELES	CA	90042	2634	19	06037	34.11850913	-118.1915335	Los Angeles County
13914	Fee-for-Service	1417206475	1417206475	1	1	PREUSS, RUBEN A MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
13934	Fee-for-Service	1932208568	1932208568	1	1	PORT, ROBERT S MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88069	30	Radiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
13953	Fee-for-Service	1902844988	1902844988	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
13963	Fee-for-Service	1184027104	1184027104	1	6	PACIFIC SKIN INSTITUTE	1/29/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	6544 LONETREE BLVD	None	ROCKLIN	CA	95765	5874	31	06061	38.80386	-121.2972705	Placer County
14035	Fee-for-Service	1609043207	1609043207	1	1	PUGALENTHI, AMUDHAN MD	12/11/2019	208600000X	NA	General Surgery	026	PHYSICIANS	118130	02	General Surgery	0	In state provider	None	3838 SAN DIMAS ST	B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
14048	Fee-for-Service	1861468027	1861468027	1	1	PUTNAM, RICHARD L MD	6/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50068	08	Family Practice	0	In state provider	None	16870 W BERNARDO DR	None	SAN DIEGO	CA	92127	1677	37	06073	33.01956754	-117.0809122	San Diego County
14075	Fee-for-Service	1063419943	1063419943	1	1	PEDIATRIC ACADEMIC	1/1/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	ASSOCIATION INC	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
14080	Fee-for-Service	1326813627	1326813627	1	1	PHAN, KHANH PT	1/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
14108	Fee-for-Service	1053920355	1053920355	1	1	PUERTO, DENISE M PSYD	8/17/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
14117	Fee-for-Service	1740584259	1740584259	1	1	PARK, JUNTAE LAC	11/3/2016	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	11821 DEL AMO BLVD	None	CERRITOS	CA	90703	7605	19	06037	33.84610447	-118.081287	Los Angeles County
14211	Fee-for-Service	1073991741	1073991741	1	1	PEBENITO, MILANA J MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145256	01	General Practice	0	In state provider	None	2335 E KASHIAN LN	STE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
14212	Fee-for-Service	1003021791	1003021791	1	1	PATEL, ANKIT B DO	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
14215	Fee-for-Service	1194832394	1194832394	1	1	PRICE, YVETTE R MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65505	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
14251	Fee-for-Service	1750430641	1750430641	1	1	PEPIN, LAURETTE L	8/31/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6367	43	06085	37.36777579	-122.0276404	Santa Clara County
14281	Fee-for-Service	1407383862	1407383862	1	1	PAUL KWON AN OPTOMETRIC CORP	2/16/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ORATION	28505 HESPERIAN BLVD	None	HAYWARD	CA	94545	5008	01	06001	37.61653109	-122.0880046	Alameda County
14332	Fee-for-Service	1235633116	1235633116	1	1	PATE, RYAN W MD	7/24/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180265	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
14352	Fee-for-Service	1134769425	1134769425	1	1	PRYCE, YEHUDAH LCSW	3/18/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	126620	-	NOT APPLICABLE	0	In state provider	None	1750 S LA CIENEGA BLVD	STE A, B, C, D	LOS ANGELES	CA	90035	4602	19	06037	34.04559008	-118.3765503	Los Angeles County
14372	Fee-for-Service	1417024274	1417024274	1	1	PARR, PAUL P CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
14389	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	11/19/2023	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
14408	Fee-for-Service	1124571286	1124571286	1	1	POWELL, LISA M LMFT	7/21/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
14456	Fee-for-Service	1730420514	1730420514	1	1	PORTER, JESSICA A LMFT	1/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	602 COMMERCE AVE	SUITE E	PALMDALE	CA	93551	3882	19	06037	34.58955354	-118.141074	Los Angeles County
14476	Fee-for-Service	1215476478	1215476478	1	1	PANE, SAMANTHA LMFT	1/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
14528	Fee-for-Service	1326008095	1326008095	1	1	PERRY, ANTHONY R MD	8/17/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1325 N LITCHFIELD RD	110	GOODYEAR	AZ	85395	1228	00	None	33.461118	-112.355739	Maricopa County
14543	Fee-for-Service	1104921691	1104921691	1	1	PRICE-HANSON, DOUGLAS R MD	1/11/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	76984	-	NOT APPLICABLE	0	In state provider	None	230 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3706	38	06075	37.78184696	-122.4142203	San Francisco County
14576	Fee-for-Service	1881053205	1881053205	1	1	PAREKH, AARUSHI R MD	1/5/2023	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	151376	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
14584	Fee-for-Service	1295759140	1295759140	1	1	PEREZ, JOSE M MD	9/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	33122	40	Pediatrics	0	In state provider	None	2143 W ORANGEWOOD AVE	None	ORANGE	CA	92868	1941	30	06059	33.79581651	-117.875781	Orange County
14585	Fee-for-Service	1750313557	1750313557	1	1	PAK, SANG J DPM	2/28/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5475 E LA PALMA AVE	SUITE 208	ANAHEIM	CA	92807	6009	30	06059	33.85997926	-117.7958236	Orange County
14623	Fee-for-Service	1598837452	1598837452	1	1	PRUDENCIO, RICHARD A MD	6/8/2010	283X00000X	NA	Hospitals	026	PHYSICIANS	111095	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
14639	Fee-for-Service	1033340104	1033340104	1	1	PATEL, TEJAS J CCC-SLP	7/8/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18271	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
14651	Fee-for-Service	1801009477	1801009477	1	1	PATEL, MITESH B MD	12/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80844	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
14671	Fee-for-Service	1396934204	1396934204	1	1	PATEL, PARUL M PSYD	5/9/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7700 IRVINE CENTER DR	STE 800	IRVINE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange County
14672	Fee-for-Service	1184974073	1184974073	1	1	PORTO, JONATHAN LMFT	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
14677	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	7/21/2022	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
14715	Fee-for-Service	1255719266	1255719266	1	1	PANDYA, NEEL MD	1/25/2019	207L00000X	NA	Other	026	PHYSICIANS	155968	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
14718	Fee-for-Service	1457703027	1457703027	1	1	PARMAR, KALGI H DPM	4/3/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2333 MOWRY AVE	STE 300	FREMONT	CA	94538	1602	01	06001	37.55614438	-121.9822469	Alameda County
14725	Fee-for-Service	1700857968	1700857968	1	1	PRESTON, ALEX MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81836	05	Anesthesiology	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
14728	Fee-for-Service	1508919432	1508919432	1	1	PLAINSE, MICHAEL A MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
14732	Fee-for-Service	1710031588	1710031588	1	13	PROVIDENCE FACEY MEDICAL FOU	3/12/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
14748	Fee-for-Service	1710031588	1710031588	1	15	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18411 CLARK STREET	SUITE 102	TARZANA	CA	91356	3524	19	06037	34.16981538	-118.5337442	Los Angeles County
14752	Fee-for-Service	1134425200	1134425200	1	1	PRODIGY HEALTHCARE, INC	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1666 SAIPAN AVENUE	ROOMS 1-8	FIREBAUGH	CA	93622	2438	10	06019	36.85289036	-120.4458562	Fresno County
14799	Fee-for-Service	1861599854	1861599854	1	1	PIERLUISSI, EDGAR MD	4/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76264	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
14829	Fee-for-Service	1831157122	1831157122	1	1	PARAMESWARAN, ASHOK R MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83809	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
14856	Fee-for-Service	1710208483	1710208483	1	1	PATEL, PUNAM V MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115029	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
14889	Fee-for-Service	1508050931	1508050931	1	1	PRIMROSE HOME HEALTH, INC	10/26/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1612 W OLIVE AVE	STE 202	BURBANK	CA	91506	2462	19	06037	34.1676558	-118.3226651	Los Angeles County
14897	Fee-for-Service	1104884592	1104884592	1	1	PREVITE, JOSEPH P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
14913	Fee-for-Service	1336465293	1336465293	1	1	PHAN, AN T MD	1/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132573	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
14914	Fee-for-Service	1790741262	1790741262	1	1	PORTER, GREGORY J MD	2/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72310	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
14916	Fee-for-Service	1447465489	1447465489	1	1	PRINZIVALLI-ROLFE,	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89332	13	Neurology (M.D. only)	0	In state provider	BRIGITTE MD	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3358	38	06075	37.78272203	-122.4433297	San Francisco County
14947	Fee-for-Service	1356685218	1356685218	1	9	PACIFIC NEUROPSYCHIATRIC SPE	10/17/2022	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS, INC.	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
14949	Fee-for-Service	1790774560	1790774560	1	1	PETRONIJEVIC, STEVEN DO	8/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5244	None	None	0	In state provider	None	17615 MORO RD	None	SALINAS	CA	93907	8541	27	06053	36.80320219	-121.663727	Monterey County
14953	Fee-for-Service	1346312154	1346312154	1	1	POLISKIN, REBECCA MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90926	41	Internal Medicine	0	In state provider	None	976 SERENO DR	None	VALLEJO	CA	94589	2400	48	06095	38.12851393	-122.2473758	Solano County
14964	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	8/19/2019	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
14977	Fee-for-Service	1114161809	1114161809	1	1	PRAHL, MARY K MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126183	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
14983	Fee-for-Service	1750492013	1750492013	1	1	PATEL, DHARINI M MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	72427	05	Anesthesiology	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
15015	Fee-for-Service	1508919432	1508919432	1	1	PLAINSE, MICHAEL A MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69651	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
15021	Fee-for-Service	1710031588	1710031588	1	13	PROVIDENCE FACEY MEDICAL FOU	3/12/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
15026	Fee-for-Service	1548348378	1548348378	1	1	PARODI, STEPHEN M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68427	77	Infectious Disease	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
15037	Fee-for-Service	1710031588	1710031588	1	15	PROVIDENCE FACEY MEDICAL FOU	4/10/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18411 CLARK STREET	SUITE 102	TARZANA	CA	91356	3524	19	06037	34.16981538	-118.5337442	Los Angeles County
15060	Fee-for-Service	1821401605	1821401605	1	1	POLIBOY, GABRIEL M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124445	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
15073	Fee-for-Service	1851521207	1851521207	1	1	PEARL, MISH M MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116511	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
15115	Fee-for-Service	1033553466	1033553466	1	1	PARKER, TANA S MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138514	01	General Practice	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
15128	Fee-for-Service	1235175563	1235175563	1	1	PEDOWITZ, ROBERT A MD	8/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	57919	20	Orthopedic Surgery	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
15159	Fee-for-Service	1144607904	1144607904	1	1	PARK, MIHEE MD	11/16/2021	207R00000X	NA	Other	026	PHYSICIANS	144865	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
15160	Fee-for-Service	1093867756	1093867756	1	1	PONTON, LYNN E MD	2/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43096	36	Psychiatry	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
15166	Fee-for-Service	1598979072	1598979072	1	1	PETEVA, YOANA L MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
15189	Fee-for-Service	1881037562	1881037562	1	1	PRIMELIVING HOME HEALTH INC	4/15/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	48521 WARM SPRINGS BLVD	SUITE 307A	FREMONT	CA	94539	7796	01	06001	37.46822788	-121.9171509	Alameda County
15191	Fee-for-Service	1063705242	1063705242	1	1	PANIGRAHI, ANIL K MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122091	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15229	Fee-for-Service	1467546424	1467546424	1	1	POOLE, MELISSA K	5/11/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
15230	Fee-for-Service	1821020215	1821020215	1	1	PAEZ, VICENTE M	9/28/2004	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	802 MAGNOLIA AVE	STE 208	CORONA	CA	92879	3157	33	06065	33.8596449	-117.5529774	Riverside County
15233	Fee-for-Service	1003067679	1003067679	1	1	PROVIDENCE HEALTH &	1/1/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES-WASHINGTON	982 E. COLUMBIA AVE	None	COLVILLE	WA	99114	3316	00	None	48.54127066	-117.8921287	Stevens County
15252	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	1/7/2022	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
15263	Fee-for-Service	1649541301	1649541301	1	1	PEINE, KEVIN J MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
15266	Fee-for-Service	1114161809	1114161809	1	1	PRAHL, MARY K MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126183	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
15268	Fee-for-Service	1932123809	1932123809	1	1	PRAKASH, VED MD	2/11/2012	2085N0904X	NA	Other	026	PHYSICIANS	26373	30	Radiology	0	In state provider	None	225 W HOSPITALITY LN	STE 100	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
15274	Fee-for-Service	1174607675	1174607675	1	1	PARIS-TEHO, DEBORAH A CRNA	8/5/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 N ROXBURY DRIVE	SUITE 600	BEVERLY HILLS	CA	90210	4220	19	06037	34.06820793	-118.4070317	Los Angeles County
15275	Fee-for-Service	1497152078	1497152078	1	1	PHAM, NGUYEN X MD	11/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155987	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
15301	Fee-for-Service	1710031588	1710031588	1	7	PROVIDENCE FACEY MEDICAL FOU	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
15303	Fee-for-Service	1508919432	1508919432	1	1	PLAINSE, MICHAEL A MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69651	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
15309	Fee-for-Service	1710031588	1710031588	1	13	PROVIDENCE FACEY MEDICAL FOU	7/3/2017	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
15322	Fee-for-Service	1326608944	1326608944	1	1	PHAM-WIGHTMAN, CHELSEA G MD	8/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178554	None	None	0	In state provider	None	947 S ANAHEIM BLVD	STE 125	ANAHEIM	CA	92805	5584	30	06059	33.82164135	-117.909385	Orange County
15358	Fee-for-Service	1376744896	1376744896	1	1	PARK, DAI MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101619	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95655	4201	50	06099	37.653219	-120.975542	Stanislaus County
15359	Fee-for-Service	1851521207	1851521207	1	1	PEARL, MISH M MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116511	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
15369	Fee-for-Service	1760678692	1760678692	2	1	PENG, BOB MD FACOG	1/3/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108823	None	None	0	In state provider	None	950 CIRCLE DRIVE	None	SALINAS	CA	93905	2150	27	06053	36.67966512	-121.6271512	Monterey County
15373	Fee-for-Service	1588200232	1588200232	1	1	PAUL KALOOSTIAN MD INC	4/28/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	960 E GREEN ST	SUITE 320	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
15375	Fee-for-Service	1396815965	1396815965	1	1	PALCHAK, DAVID L MD	12/31/1992	207RH0003X	NA	Oncology	026	PHYSICIANS	60994	78	Neoplastic Diseases/Oncology	0	In state provider	None	921 OAK PARK BLVD	SUITE 100-A	PISMO BEACH	CA	93449	3400	40	06079	35.13600697	-120.6045995	San Luis Obispo County
15377	Fee-for-Service	1932885985	1932885985	1	2	PROSUM DME LLC	3/11/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	171 N ALTADENA DR	STE 265	PASADENA	CA	91107	7352	19	06037	34.14902931	-118.0986299	Los Angeles County
15421	Fee-for-Service	1750464426	1750464426	1	1	PULLARD, MARCY D LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
15434	Fee-for-Service	1275970964	1275970964	1	1	PATEL, SMIT A OD APOC	2/1/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1071 BROADWAY	None	EL CAJON	CA	92021	4804	37	06073	32.8076427	-116.9450865	San Diego County
15435	Fee-for-Service	1801942420	1801942420	1	1	POLITO, JAMIE M MD	4/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104642	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
15472	Fee-for-Service	1306932520	1306932520	1	1	PINEDA, RICARDO S III CRNA	10/31/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
15473	Fee-for-Service	1477789220	1477789220	1	1	PALMER, BARNARD J A MD	11/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	95449	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
15482	Fee-for-Service	1629298112	1629298112	1	1	PRYSTOWSKY, BRIAN G MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108906	40	Pediatrics	0	In state provider	None	500 DOYLE PARK DRIVE	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
15506	Fee-for-Service	1609282656	1609282656	1	1	PRICE III, RICHARD L MD	2/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
15520	Fee-for-Service	1003067679	1003067679	1	1	PROVIDENCE HEALTH &	1/1/2009	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES-WASHINGTON	982 E. COLUMBIA AVE	None	COLVILLE	WA	99114	3316	00	None	48.54127066	-117.8921287	Stevens County
15529	Fee-for-Service	1083019657	1083019657	1	1	PITTSBURG SKILLED NURSING	1/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	535 SCHOOL ST	None	PITTSBURG	CA	94565	3937	07	06013	38.01986122	-121.8794794	Contra Costa County
15538	Fee-for-Service	1952487233	1952487233	1	1	POSTIGLIONE, PAULO A MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	45986	05	Anesthesiology	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
15539	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	12/17/2020	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
15541	Fee-for-Service	1134168396	1134168396	1	1	PHAM, PAUL P MD	1/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63492	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
15563	Fee-for-Service	1316041833	1316041833	2	2	PEDIATRIX MEDICAL GROUP OF C	11/6/2019	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
15564	Fee-for-Service	1518041409	1518041409	1	1	PROMES, SUSAN B MD	1/31/1992	207P00000X	NA	Other	026	PHYSICIANS	75913	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
15584	Fee-for-Service	1669838389	1669838389	1	1	PROSSER, BETHANIE	10/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1520 BROOKHOLLOW DR.	37	SANTA ANA	CA	92705	5429	30	06059	33.7145683	-117.8475378	Orange County
15589	Fee-for-Service	1710031588	1710031588	1	7	PROVIDENCE FACEY MEDICAL FOU	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
15598	Fee-for-Service	1710031588	1710031588	1	13	PROVIDENCE FACEY MEDICAL FOU	10/31/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
15622	Fee-for-Service	1730247768	1730247768	1	1	PARSONS, STACEY M	2/27/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	615 N NASH ST	STE 306	EL SEGUNDO	CA	90245	2825	19	06037	33.92533619	-118.3874815	Los Angeles County
15626	Fee-for-Service	1558717314	1558717314	1	1	PETROSYAN, JASMINE NP	11/17/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	816 N HOLLYWOOD WAY	1	BURBANK	CA	91505	2831	19	06037	34.16503922	-118.3455811	Los Angeles County
15630	Fee-for-Service	1831759521	1831759521	1	1	PAWLIWEC, ANDREW MD	10/6/2023	390200000X	NA	Other	026	PHYSICIANS	177760	None	None	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
15645	Fee-for-Service	1376744896	1376744896	1	1	PARK, DAI MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101619	03	Allergy	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95655	4201	50	06099	37.653219	-120.975542	Stanislaus County
15654	Fee-for-Service	1992870372	1992870372	1	1	PRATHER, KERI M LMFT	12/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	305 N HARBOR BLVD	SUITE 215	FULLERTON	CA	92832	1901	30	06059	33.872697	-117.924428	Orange County
15662	Fee-for-Service	1396815965	1396815965	1	1	PALCHAK, DAVID L MD	12/31/1992	207RH0003X	NA	Oncology	026	PHYSICIANS	60994	68	Hematology	0	In state provider	None	921 OAK PARK BLVD	SUITE 100-A	PISMO BEACH	CA	93449	3400	40	06079	35.13600697	-120.6045995	San Luis Obispo County
15670	Fee-for-Service	1619932209	1619932209	1	1	PEDIATRIC SURGICAL ASSOC	11/30/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	0F THE EAST BAY	744 52ND ST	# 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
15679	Fee-for-Service	1801833561	1801833561	1	1	PATEL, MAHENDRA N MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	58841	01	General Practice	0	In state provider	None	10339 BALBOA BLVD	STE 307	GRANADA HILLS	CA	91344	7370	19	06037	34.2586457	-118.5023394	Los Angeles County
15707	Fee-for-Service	1598751638	1598751638	1	1	PINILLA, CLAUDIA S MD	3/10/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60732	18	Ophthalmology	0	In state provider	#114	909 SAN RAMON VALLEY BLV	None	DANVILLE	CA	94526	4038	07	06013	37.80810228	-121.9921839	Contra Costa County
15732	Fee-for-Service	1154583847	1154583847	1	1	PARAMVEER BHUGRA	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13677 W MCDOWELL RD	None	GOODYEAR	AZ	85395	2635	00	None	33.461982	-112.3535475	Maricopa County
15733	Fee-for-Service	1346478385	1346478385	1	1	PERIYANAYAGAM, USHA MD	8/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135431	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
15737	Fee-for-Service	1699745349	1699745349	1	1	PHAM, THIEN C OD	8/25/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	THIEN C PHAM OPTOMETRY	956 SAN BENITO ST	STE A	HOLLISTER	CA	95023	4877	35	06069	36.8454512	-121.4023089	San Benito County
15782	Fee-for-Service	1063562957	1063562957	1	1	PI, KAIDUAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 PORT WASHINGTON BLVD	None	ROSLYN	NY	11576	0000	00	None	40.804308	-73.670589	Nassau County
15805	Fee-for-Service	1386031672	1386031672	1	1	PABLA, SANDEEP S MD	12/7/2017	390200000X	NA	Other	026	PHYSICIANS	150846	08	Family Practice	0	In state provider	None	938 N CHERRY ST	None	VISALIA	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
15827	Fee-for-Service	1811455306	1811455306	1	1	PSYCH PARTNERS	1/21/2020	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
15830	Fee-for-Service	1134168396	1134168396	1	1	PHAM, PAUL P MD	1/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63492	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
15846	Fee-for-Service	1841305414	1841305414	1	1	PRATT, LISA A MD MPH	11/22/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	68980	-	NOT APPLICABLE	0	In state provider	None	1326 4TH AVE	None	SAN FRANCISCO	CA	94122	2616	38	06075	37.76379697	-122.4609136	San Francisco County
15876	Fee-for-Service	1710031588	1710031588	1	7	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
15880	Fee-for-Service	1568550523	1568550523	1	1	PEDIATRIC PARTNERS	3/2/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1107 S MISSION RD	None	FALLBROOK	CA	92028	3224	37	06073	33.37242711	-117.2534301	San Diego County
15884	Fee-for-Service	1710031588	1710031588	1	13	PROVIDENCE FACEY MEDICAL FOU	12/19/2017	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
15901	Fee-for-Service	1932613759	1932613759	1	1	PARKVIEW PODIATRY INC	1/25/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	175 PARK ST	None	LAKEPORT	CA	95453	4803	17	06033	39.04282879	-122.9140827	Lake County
15923	Fee-for-Service	1346604105	1346604105	1	1	PATTERSON, RICHARD	7/23/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
15942	Fee-for-Service	1750637021	1750637021	1	1	POSTE, ALETHEA MD	9/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186667	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
15958	Fee-for-Service	1619932209	1619932209	1	1	PEDIATRIC SURGICAL ASSOC	11/30/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	85	Surgery-Pediatric	0	In state provider	0F THE EAST BAY	744 52ND ST	# 4100	OAKLAND	CA	94609	1810	01	06001	37.83734299	-122.2677613	Alameda County
15967	Fee-for-Service	1457461725	1457461725	1	1	PANTERA, RICHARD L MD	1/12/2012	2084N0400X	NA	Neurology	026	PHYSICIANS	36466	None	None	0	In state provider	None	623 W WILLOW AVE	STE A	VISALIA	CA	93291	6101	54	06107	36.328077	-119.298519	Tulare County
15969	Fee-for-Service	1609003961	1609003961	1	1	PAN, CHUAN-JU G MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110998	78	Neoplastic Diseases/Oncology	0	In state provider	None	1010 W LA VETA AVE	SUITE 250	ORANGE	CA	92868	4303	30	06059	33.78028244	-117.8635552	Orange County
15981	Fee-for-Service	1790751956	1790751956	1	1	PRESANT, LARRY A MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	42579	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
15993	Fee-for-Service	1659503241	1659503241	1	1	PAUL, RABEE Y MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133752	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
15997	Fee-for-Service	1083894802	1083894802	1	1	PEARSON, LISA F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93483	08	Family Practice	0	In state provider	None	1301 SOUTH POINT BLVD	#A	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
16001	Fee-for-Service	1679970511	1679970511	1	1	POWELL, SIMONE MD	5/4/2020	207R00000X	NA	Other	026	PHYSICIANS	143764	41	Internal Medicine	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
16028	Fee-for-Service	1427175710	1427175710	1	1	PARRA, LAURA LCSW	4/15/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1554 S SEPULVEDA BLVD	#204	LOS ANGELES	CA	90025	3377	19	06037	34.04932139	-118.4457323	Los Angeles County
16042	Fee-for-Service	1609190578	1609190578	1	1	PUGMIRE, BRIAN S MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138998	30	Radiology	0	In state provider	None	1504 N WISHON AVENUE	None	FRESNO	CA	93728	1827	10	06019	36.763497	-119.8010405	Fresno County
16068	Fee-for-Service	1851522254	1851522254	1	1	PROVIDENCE FOOT & ANKLE	2/25/2010	261QP1100X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	CENTER INC	3130 W OLYMPIC BLVD	STE 170	LOS ANGELES	CA	90006	2648	19	06037	34.05258529	-118.3039795	Los Angeles County
16072	Fee-for-Service	1982372058	1982372058	1	1	PYNE, SAMANTHA L AU	4/18/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
16093	Fee-for-Service	1073967188	1073967188	1	1	PANG, HAOMING MD	7/1/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	150989	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
16110	Fee-for-Service	1295102457	1295102457	1	1	PATEL, HIREN A MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141743	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
16113	Fee-for-Service	1154785517	1154785517	1	4	PROVIDENT PRIMARY CARE INC	2/18/2025	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	450 E YOSEMITE AVE	A	MERCED	CA	95340	8429	24	06047	37.33211352	-120.4620165	Merced County
16114	Fee-for-Service	1023058195	1023058195	1	1	PENG, YUCHI P MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85681	78	Neoplastic Diseases/Oncology	0	In state provider	None	935 S SUNSET AVE	None	WEST COVINA	CA	91790	3408	19	06037	34.06431388	-117.9431184	Los Angeles County
16140	Fee-for-Service	1932767704	1932767704	1	1	PUMPER, MELISSA M PSYD	4/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
16148	Fee-for-Service	1316041833	1316041833	2	21	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1010 MURRAY AVENUE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
16159	Fee-for-Service	1205850567	1205850567	1	1	PETTIT, JAMES MD	1/1/1992	207L00000X	NA	Other	026	PHYSICIANS	53781	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
16161	Fee-for-Service	1578947420	1578947420	1	1	PAEZ PEREZ, YENISLEIDY DO	5/24/2021	207P00000X	NA	Other	026	PHYSICIANS	18828	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
16166	Fee-for-Service	1710031588	1710031588	1	7	PROVIDENCE FACEY MEDICAL FOU	10/25/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
16194	Fee-for-Service	1447291182	1447291182	1	1	PATEL, KEVAL D	2/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	66035	None	None	0	In state provider	None	190 LEAVESLEY RD	STE 102	GILROY	CA	95020	3635	43	06085	37.01991719	-121.5728065	Santa Clara County
16199	Fee-for-Service	1902069859	1902069859	1	1	PAREKH, CHAITALI OD	7/11/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
16242	Fee-for-Service	1679517445	1679517445	1	1	PERTILLER, SHEILA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 N HIGHLAND AVE	None	MURFREESBORO	TN	37130	3837	00	None	35.84838269	-86.38316402	Rutherford County
16258	Fee-for-Service	1609003961	1609003961	1	1	PAN, CHUAN-JU G MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110998	68	Hematology	0	In state provider	None	1010 W LA VETA AVE	SUITE 250	ORANGE	CA	92868	4303	30	06059	33.78028244	-117.8635552	Orange County
16370	Fee-for-Service	1407918832	1407918832	1	1	PONDOLFINO, PETER PHD	12/9/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
16436	Fee-for-Service	1457619165	1457619165	1	1	POTOCIN, JENNIFER M MFT	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94511	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
16443	Fee-for-Service	1972955227	1972955227	1	1	PRODIGY HEALTHCARE INC	8/29/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1900 18TH AVENUE	None	KINGSBURG	CA	93631	1629	10	06019	36.5185338	-119.5478482	Fresno County
16466	Fee-for-Service	1891108031	1891108031	1	1	PILAVIAN, CHARLES PSYD	8/28/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	138 N BRAND BLVD	SUITE 300	GLENDALE	CA	91203	4618	19	06037	34.147755	-118.2549335	Los Angeles County
16494	Fee-for-Service	1003182445	1003182445	1	1	PIROG, STEVEN C MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128295	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
16498	Fee-for-Service	1558371484	1558371484	1	2	PALM DESERT PEDIATRICS INC	7/26/2018	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	35800 BOB HOPE DR	220	RANCHO MIRAGE	CA	92270	1739	33	06065	33.790527	-116.4058645	Riverside County
16563	Fee-for-Service	1780023309	1780023309	1	1	PALANUK, KARA N MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132920	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
16583	Fee-for-Service	1457327520	1457327520	1	1	PINEDA, EDUARDO MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53030	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
16611	Fee-for-Service	1114977568	1114977568	1	1	PETERS, GEERA J MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51797	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
16614	Fee-for-Service	1275153397	1275153397	1	1	PAI, ERIC	12/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185451	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
16683	Fee-for-Service	1689759359	1689759359	1	1	PHAM, TAN TRI MD	8/31/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72983	08	Family Practice	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
16704	Fee-for-Service	1851370555	1851370555	1	1	PURVIANCE, CYNTHIA A MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61273	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
16713	Fee-for-Service	1588644025	1588644025	1	1	PETROCELLI, ALFRED R MD	6/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32082	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
16724	Fee-for-Service	1144495284	1144495284	1	1	PETREA, RODICA E MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153645	13	Neurology (M.D. only)	0	In state provider	None	6555 COYLE AVE	STE 260	SACRAMENTO	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento
16821	Fee-for-Service	1043621147	1043621147	1	1	POON, JIN K MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145662	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
16838	Fee-for-Service	1922363431	1922363431	1	1	PONCE, JOSE P DPM	1/1/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	94143	2202	19	06037	34.05112725	-118.2173921	Los Angeles County
16844	Fee-for-Service	1518259647	1518259647	1	1	PATEL, JUSMIN R MD	4/4/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	50 KIRMAN AVE	STE 201	RENO	NV	89502	1175	00	None	39.52637074	-119.7983511	Washoe County
16848	Fee-for-Service	1801260757	1801260757	1	1	PARK, DOROTHY I CRNA	4/13/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
16874	Fee-for-Service	1750435244	1750435244	1	1	PLANNED PARENTHOOD SHASTA DI	12/19/2006	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CIFIC	2 H STREET	None	SAN RAFAEL	CA	94901	1700	21	06041	37.97437033	-122.5385699	Marin County
16887	Fee-for-Service	1811368673	1811368673	1	1	PROACTIVE HOME HEALTH	4/9/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	8001 LAUREL CANYON BLVD	SUITE 202	NORTH HOLLYWOOD	CA	91605	1406	19	06037	34.216164	-118.396559	Los Angeles County
16931	Fee-for-Service	1912074832	1912074832	1	1	PARIKH, ASHA N MD	4/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	37146	40	Pediatrics	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
16939	Fee-for-Service	1679651574	1679651574	1	1	PELEGRINA, MIGUEL A MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51234	20	Orthopedic Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
16951	Fee-for-Service	1992872824	1992872824	1	1	PARKER, DAVID L MD	11/6/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52492	40	Pediatrics	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
16960	Fee-for-Service	1831204130	1831204130	1	1	PARKER, JERRY M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	8322	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 PACIFIC ST	None	MONTEREY	CA	93940	4455	27	06053	36.59073794	-121.8991783	Monterey County
16963	Fee-for-Service	1073707881	1073707881	1	1	PATEL, ANITA C MD	8/5/2008	208200000X	NA	General Surgery	026	PHYSICIANS	92098	24	Plastic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
16975	Fee-for-Service	1871781419	1871781419	1	1	PARK, HEUNG S CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GI YOUNG ACUPUNCTURE CLN	4711 OAKWOOD AVE	STE 206	LOS ANGELES	CA	90004	2476	19	06037	34.07729413	-118.3096899	Los Angeles County
17049	Fee-for-Service	1275683641	1275683641	1	1	PODACH, PATRICIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	48 LONO AVE	None	KAHULUI	HI	96732	1614	00	None	20.88897141	-156.4696669	Maui County
17051	Fee-for-Service	1295952323	1295952323	1	1	PAREEK, SMITA G MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	50459	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	0000	01	06001	37.69960369	-121.7628917	Alameda County
17059	Fee-for-Service	1518789114	1518789114	1	1	PETROVSKY, AUTUMN ROSE TOLA	2/10/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
17082	Fee-for-Service	1588442552	1588442552	1	1	PATTON, NICOLE CLD	10/28/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	23	06045	0	0	None
17089	Fee-for-Service	1295883221	1295883221	1	1	PADMANABHAN, ASWINI MD	8/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79855	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
17133	Fee-for-Service	1760413793	1760413793	1	1	PEACOCK, MARGARET R MD	6/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
17194	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	11/20/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	80695	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
17219	Fee-for-Service	1801387287	1801387287	1	1	PAIGE-IRELAND, MELINDA LMFT	8/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
17236	Fee-for-Service	1780925990	1780925990	2	2	PHI HEALTH, LLC	5/26/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5900 OLD OREGON TRL	None	REDDING	CA	96002	9330	45	06089	40.52165568	-122.2907844	Shasta County
17248	Fee-for-Service	1831204130	1831204130	1	1	PARKER, JERRY M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	8322	34	Urology and Urological Surgery	0	In state provider	None	1001 PACIFIC ST	None	MONTEREY	CA	93940	4455	27	06053	36.59073794	-121.8991783	Monterey County
17252	Fee-for-Service	1073707881	1073707881	1	1	PATEL, ANITA C MD	8/5/2008	208200000X	NA	General Surgery	026	PHYSICIANS	92098	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
17314	Fee-for-Service	1598738973	1598738973	1	1	PLANK, REBECA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MT. AUBURN PROFESSIONAL	330 MT. AUBURN ST	None	CAMBRIGDE	MA	02238	0000	00	None	42.373899	-71.1342405	Middlesex County
17385	Fee-for-Service	1255450524	1255450524	1	1	PORTILLO, RICHARD A OD	11/5/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1624 I ST	None	MODESTO	CA	95354	1122	50	06099	37.64429935	-120.9928535	Stanislaus County
17418	Fee-for-Service	1740291954	1740291954	1	1	PHILLIPS, JEFFREY J MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	49045	30	Radiology	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
17426	Fee-for-Service	1659354868	1659354868	1	1	PATEL, RAHUL L MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50086	41	Internal Medicine	0	In state provider	None	1779 W YOSEMITE AVE	STE 103	MANTECA	CA	95337	5180	39	06077	37.7973565	-121.246434	San Joaquin County
17430	Fee-for-Service	1770574097	1770574097	1	1	PEITZ, THOMAS J MD	12/31/1990	207P00000X	NA	Other	026	PHYSICIANS	72830	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 E 4TH ST	None	NATIONAL CITY	CA	91950	1350	37	06073	32.68038513	-117.1040623	San Diego County
17460	Fee-for-Service	1992883730	1992883730	1	1	PACIOTTI, HEATHER M MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84442	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
17474	Fee-for-Service	1427585280	1427585280	1	2	PINNACLE SURGERY CENTER INC.	5/3/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	100 N. WIGET LANE	140	WALNUT CREEK	CA	94598	5917	07	06013	37.92514495	-122.0237725	Contra Costa County
17482	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	9/22/2023	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
17516	Fee-for-Service	1922141431	1922141431	1	1	PATIENT CARE TRANSPORT	6/19/2003	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SYEDA HUSSAIN	227 S GARDENGLEN ST	None	WEST COVINA	CA	91790	3120	19	06037	34.06935307	-117.9194499	Los Angeles County
17529	Fee-for-Service	1962583757	1962583757	1	1	PRUITT, CHARLES W. MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	100 N MEDICAL DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
17555	Fee-for-Service	1114900610	1114900610	1	1	PANGANIBAN, VIRGILIO	3/2/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34146	None	None	0	In state provider	None	9604 ARTESIA BLVD	STE 103	BELLFLOWER	CA	90706	8042	19	06037	33.87472842	-118.1288599	Los Angeles County
17583	Fee-for-Service	1518620137	1518620137	1	1	PIROUTI, ALEXA LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
17587	Fee-for-Service	1225607013	1225607013	1	1	PEREZ, MANUEL J CSW	7/8/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
17593	Fee-for-Service	1306006192	1306006192	1	1	PARK, JEE-HYON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109437	41	Internal Medicine	0	In state provider	None	7212 ORANGETHORPE AVE	STE 8	BUENA PARK	CA	90621	4667	30	06059	33.85890953	-118.007244	Orange County
17612	Fee-for-Service	1679527824	1679527824	2	1	PLEDGER, DAVID MD	2/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
17630	Fee-for-Service	1366858656	1366858656	1	1	PATEL, SHALIN R MD	10/26/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144153	36	Psychiatry	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
17672	Fee-for-Service	1790198968	1790198968	1	1	PREMIER HEALTHCARE SERVICES	2/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	2937 VENEMAN AVE	SUITE A-100	MODESTO	CA	95356	0639	50	06099	37.68940892	-121.0483835	Stanislaus County
17684	Fee-for-Service	1386864734	1386864734	1	1	PARVIZI, JOSEF MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94400	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2299	43	06085	37.43304542	-122.1759654	Santa Clara County
17719	Fee-for-Service	1285837229	1285837229	1	1	PANARES, ROY L MD	1/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82354	78	Neoplastic Diseases/Oncology	0	In state provider	None	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	30	06059	33.89443025	-117.9288328	Orange County
17729	Fee-for-Service	1932204146	1932204146	1	1	PRICE, MICHAEL A MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70181	30	Radiology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
17746	Fee-for-Service	1679596449	1679596449	1	1	PEREZ, HUBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87279	18	Ophthalmology	0	In state provider	None	444 S SAN VICENTE BLVD	STE 1102	LOS ANGELES	CA	90048	4169	19	06037	34.06999878	-118.3755119	Los Angeles County
17749	Fee-for-Service	1629042346	1629042346	1	1	PFLEGER, MARK J MD	5/16/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51571	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
17756	Fee-for-Service	1881709814	1881709814	2	1	P R M PHARMACEUTICAL INC	6/16/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11126 PALMS BLVD	None	LOS ANGELES	CA	90034	6503	19	06037	34.01964766	-118.4213325	Los Angeles County
17762	Fee-for-Service	1386616761	1386616761	1	1	PLYUSHCHEVA, NATALIYA V	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81876	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
17771	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	2/19/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
17781	Fee-for-Service	1821018680	1821018680	1	1	PIANTINI, REBECCA E MD	5/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69929	40	Pediatrics	0	In state provider	None	7223 CHURCH ST	None	HIGHLAND	CA	92346	5869	36	06071	34.122888	-117.1737945	San Bernardino County
17799	Fee-for-Service	1073073730	1073073730	1	1	PANSE, KETAKI M MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	179534	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
17837	Fee-for-Service	1336499623	1336499623	1	1	PETER, ANNA K MD	6/21/2019	207P00000X	NA	Other	026	PHYSICIANS	154293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
17848	Fee-for-Service	1861999427	1861999427	1	1	PROCTOR, DANIEL J MD	8/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167198	20	Orthopedic Surgery	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
17857	Fee-for-Service	1134579170	1134579170	1	1	PATBERG, JONATHAN C MD	1/9/2018	390200000X	NA	Other	026	PHYSICIANS	151718	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
17879	Fee-for-Service	1073074209	1073074209	1	1	PSYCHOLOGICAL AND SUBSTANCE	11/9/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ABUSE SERVICES, INC	21250 SPRINGS RD	203	MORENO VALLEY	CA	92557	8705	33	06065	33.94660149	-117.29169	Riverside County
17891	Fee-for-Service	1689884330	1689884330	1	1	PRICE, MARTIN C MD	1/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171012	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
17893	Fee-for-Service	1740538818	1740538818	2	1	PLOOF, PAULA LCSW	9/25/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1821 4TH ST	None	SANTA ROSA	CA	95404	3202	49	06097	38.450619	-122.69781	Sonoma County
17905	Fee-for-Service	1396908059	1396908059	1	1	PUGEDA, JAMES P MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135881	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
17909	Fee-for-Service	1083994487	1083994487	1	1	PHAN, JEANINE T DO	12/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12447	01	General Practice	0	In state provider	None	275 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
17919	Fee-for-Service	1932511904	1932511904	2	1	PATEL, NIKITA M MD	10/11/2022	207RR0500X	NA	Other	026	PHYSICIANS	143360	83	Rheumatology	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
17948	Fee-for-Service	1215702956	1215702956	1	1	POLARIS SPECIALTY PHARMACY,	8/13/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 E ARROW HWY	None	COVINA	CA	91724	1020	19	06037	34.10635635	-117.8701434	Los Angeles County
17970	Fee-for-Service	1588221485	1588221485	1	1	PRUZANSKY, ALIX J MD	1/25/2023	208M00000X	NA	Other	026	PHYSICIANS	178324	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
17973	Fee-for-Service	1063170892	1063170892	1	1	PATEL, DIVYA P PT	10/12/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
17989	Fee-for-Service	1649335092	1649335092	1	1	PATIENCE C.ONUOHA DO	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11133 DUNN RD	STE 2427	SAINT LOUIS	MO	63136	6163	00	None	38.7761964	-90.23879933	St. Louis County
17997	Fee-for-Service	1912919804	1912919804	1	1	PULMONARY CONSULTANTS &	4/16/1980	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PRIMARY CARE PHYSICIANS	1010 W LA VETA AVENUE	SUITE 750	ORANGE	CA	92868	4312	30	06059	33.78028244	-117.8635552	Orange County
18014	Fee-for-Service	1083969018	1083969018	1	1	P B NIKRAVESH DPM APC	7/22/2013	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6404 WILSHIRE BLVD	SUITE 600	LOS ANGELES	CA	90048	5508	19	06037	34.06373411	-118.3685394	Los Angeles County
18015	Fee-for-Service	1932305596	1932305596	1	1	POOLE, PATRICIA S MD	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108383	30	Radiology	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
18019	Fee-for-Service	1447317128	1447317128	1	1	POLLOCK PINES ESD	5/12/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2701 AMBER TRAIL	None	POLLOCK PINES	CA	95726	9266	09	06017	38.74681776	-120.5794075	El Dorado County
18030	Fee-for-Service	1841361516	1841361516	1	1	PANCIO, SHARON K MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	65242	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
18032	Fee-for-Service	1275680654	1275680654	1	1	PANEK, KAREN M MD	1/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89261	08	Family Practice	0	In state provider	None	3200 BELL ROAD	None	AUBURN	CA	95603	9244	31	06061	38.94193574	-121.103139	Placer County
18038	Fee-for-Service	1831450519	1831450519	1	1	PRIEST, NNEAMAKA A MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151054	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
18059	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	1/20/2020	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
18085	Fee-for-Service	1194354076	1194354076	1	1	POPAT, VINITA MD	7/18/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
18192	Fee-for-Service	1548267164	1548267164	1	1	PEPKOWITZ, SAMUEL H MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	44156	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
18243	Fee-for-Service	1568467140	1568467140	1	1	PHUNG, CHI H MD INC	1/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	64118	01	General Practice	0	In state provider	None	13155 BROOKHURST ST	None	GARDEN GROVE	CA	92843	1080	30	06059	33.77167222	-117.9551894	Orange County
18244	Fee-for-Service	1902345747	1902345747	1	1	PUJA THAKKAR, D.O., MEDICAL	4/23/2024	207RS0012X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 EL CERRO BLVD	SUITE 107	DANVILLE	CA	94526	1731	07	06013	37.82888506	-122.0021827	Contra Costa County
18250	Fee-for-Service	1366908543	1366908543	1	1	PHAM, PETER NP	11/13/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
18264	Fee-for-Service	1821176991	1821176991	1	1	PHO, EDDY Q MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55915	30	Radiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
18285	Fee-for-Service	1912919804	1912919804	1	1	PULMONARY CONSULTANTS &	4/16/1980	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	PRIMARY CARE PHYSICIANS	1010 W LA VETA AVENUE	SUITE 750	ORANGE	CA	92868	4312	30	06059	33.78028244	-117.8635552	Orange County
18289	Fee-for-Service	1316041833	1316041833	2	10	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
18310	Fee-for-Service	1851336184	1851336184	1	1	PATEL, BIREN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1828 E FLORENCE BLVD	STE 100 BLDG A	CASA GRANDE	AZ	85222	4783	00	None	32.880348	-111.7089855	Pinal County
18320	Fee-for-Service	1396932968	1396932968	1	1	PASKITTI, MEGAN E MD	7/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116182	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
18325	Fee-for-Service	1447327200	1447327200	1	1	PAUL II, FINSTER L MD	12/31/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67598	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
18346	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	10/28/2021	193400000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
18353	Fee-for-Service	1356389001	1356389001	1	1	PELTZ AND ASSOCIATES PHYSICA	4/30/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	L THERAPY INC	140 WIKIUP DRIVE	None	SANTA ROSA	CA	95403	7756	49	06097	38.50801929	-122.7585236	Sonoma County
18368	Fee-for-Service	1194354076	1194354076	1	1	POPAT, VINITA MD	7/18/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
18372	Fee-for-Service	1376841700	1376841700	1	1	PEARSON, LESLIE E LCSW	8/12/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
18376	Fee-for-Service	1003041492	1003041492	1	1	PEREZ, SUSAN A MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107880	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
18386	Fee-for-Service	1679651160	1679651160	1	1	PAEK, SANDRA C MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95182	07	Dermatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
18461	Fee-for-Service	1154016558	1154016558	1	1	PALM SPRINGS REHAB LLC	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	68487 E PALM CANYON DR	STE 44	CATHEDRAL CITY	CA	92234	5434	33	06065	33.78041692	-116.4668852	Riverside County
18481	Fee-for-Service	1114121407	1114121407	1	2	PHUC DANG NGUYEN M.D INC	8/4/2021	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	7901 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75930046	-117.991053	Orange County
18483	Fee-for-Service	1689693962	1689693962	1	1	PADRON-SPENCE, CLARA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61202	08	Family Practice	0	In state provider	None	1503 N IMPERIAL AVE	STE 204	EL CENTRO	CA	92243	6302	13	06025	32.806881	-115.5697535	Imperial County
18536	Fee-for-Service	1205306271	1205306271	1	1	PACIFIC CARE NON-EMERGENCY M	1/5/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RTATION	14416 VICTORY BLVD	STE 218	VAN NUYS	CA	91401	6260	19	06037	34.1866455	-118.447209	Los Angeles County
18539	Fee-for-Service	1457671521	1457671521	1	1	PREMIER CARE AT HOME INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2000 W MAGNOLIA BLVD	SUITE 208	BURBANK	CA	91506	1744	19	06037	34.17361386	-118.3297964	Los Angeles County
18606	Fee-for-Service	1831320761	1831320761	1	1	PETERS, ROBERT R DO	4/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	MAIL CODE J 10	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
18616	Fee-for-Service	1750425278	1750425278	1	1	PLURAD, DAVID S MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	87433	01	General Practice	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
18633	Fee-for-Service	1679771703	1679771703	1	1	PELTON, KEVIN J MD INC	2/11/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
18635	Fee-for-Service	1780752352	1780752352	1	1	PREMIER SURGERY CENTER	9/5/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF SANTA MARIA	816 E ENOS DR	STE B	SANTA MARIA	CA	93454	7295	42	06083	34.93442228	-120.4224903	Santa Barbara County
18637	Fee-for-Service	1538948732	1538948732	1	1	PIERCE, JENNIFER A LMFT	2/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
18653	Fee-for-Service	1710048723	1710048723	1	1	PRISAZNIK, SHERRI A	2/8/2015	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
18675	Fee-for-Service	1679651160	1679651160	1	1	PAEK, SANDRA C MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95182	02	General Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
18731	Fee-for-Service	1982800215	1982800215	1	1	PANDIT, SANDEEP R MD	11/3/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	148512	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
18737	Fee-for-Service	1487191573	1487191573	1	1	PREMIER LAB SOLUTIONS, LLC	5/13/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3440 N 16TH ST	None	PHOENIX	AZ	85016	7125	00	None	33.488568	-112.0480335	Maricopa County
18745	Fee-for-Service	1235195181	1235195181	1	1	PRIMERO, EILEEN P MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	50284	40	Pediatrics	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
18746	Fee-for-Service	1477635589	1477635589	1	1	PACHECO, RENEE MD	5/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62441	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
18749	Fee-for-Service	1780493858	1780493858	1	1	PEREZ, ESPERANSA LCSW	2/7/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
18779	Fee-for-Service	1053739185	1053739185	1	1	POWELSON, IAN A	10/1/2022	208600000X	NA	General Surgery	026	PHYSICIANS	170626	None	None	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
18810	Fee-for-Service	1689817892	1689817892	1	1	PAIZ, AELA DO	7/29/2014	390200000X	NA	Other	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	808 W 58TH STREET	None	LOS ANGELES	CA	90037	4045	19	06037	33.98965917	-118.287673	Los Angeles County
18827	Fee-for-Service	1457671521	1457671521	1	1	PREMIER CARE AT HOME INC	7/21/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2000 W MAGNOLIA BLVD	SUITE 208	BURBANK	CA	91506	1744	19	06037	34.17361386	-118.3297964	Los Angeles County
18839	Fee-for-Service	1659812915	1659812915	1	1	PARSONS, DAVID MD	4/29/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	23 UPPER RAGSDALE DR	STE 200	MONTEREY	CA	93940	5771	27	06053	36.57529358	-121.8101334	Monterey County
18863	Fee-for-Service	1649203316	1649203316	1	1	PRUETT, WESLEY C MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85876	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
18872	Fee-for-Service	1760618391	1760618391	1	1	PAUL, JOAN A MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144383	07	Dermatology	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
18913	Fee-for-Service	1972911097	1972911097	1	1	PRENDIVILLE PROPERTIES INC	1/15/2016	207W00000X	NA	Ophthalmology	026	PHYSICIANS	45074	18	Ophthalmology	0	In state provider	None	2600 S MAIN ST	None	CORONA	CA	92882	5941	33	06065	33.84962792	-117.5703874	Riverside County
18917	Fee-for-Service	1811185051	1811185051	1	1	PEREA, SAMANTHA E MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102259	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
18930	Fee-for-Service	1164435681	1164435681	1	1	POAST, JENNIFER L DO	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8245	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
18943	Fee-for-Service	1912661174	1912661174	1	1	PRIMECARE GLOBAL SERVICES CO	8/23/2023	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RP	5493 STONEVIEW RD	None	RANCHO CUCAMONGA	CA	91739	8933	36	06071	34.15424712	-117.5318491	San Bernardino County
18984	Fee-for-Service	1528167087	1528167087	1	1	PAIK, JULIANA S MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73976	40	Pediatrics	0	In state provider	None	950 N STATE ST	BLDG B STE D	HEMET	CA	92543	1485	33	06065	33.763266	-116.9717935	Riverside County
18993	Fee-for-Service	1508483587	1508483587	1	1	PARADISE RAYS HOSPICE INC	2/24/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	217 E ALAMEDA AVE	UNIT 201	LOS ANGELES	CA	91502	1500	19	06037	34.17516147	-118.2991383	Los Angeles
18997	Fee-for-Service	1043630932	1043630932	1	1	PONTO, GARY C MD INC	6/3/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
19035	Fee-for-Service	1477635589	1477635589	1	1	PACHECO, RENEE MD	5/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62441	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
19041	Fee-for-Service	1659663045	1659663045	1	1	PAGUNTALAN, HELEN G MD	8/8/2018	390200000X	NA	Other	026	PHYSICIANS	125285	40	Pediatrics	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
19052	Fee-for-Service	1538190871	1538190871	1	1	POLK, DONNA M MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86316	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
19059	Fee-for-Service	1356514673	1356514673	1	1	PLA, CECILIA A LMFT	9/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
19077	Fee-for-Service	1114549144	1114549144	1	1	PROVIDENCE RECOVERY CENTERS,	10/29/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC.	11165 BONNIE VIEW AVE	None	MORENO VALLEY	CA	92555	5254	33	06065	33.95860735	-117.1714883	Riverside County
19078	Fee-for-Service	1841679255	1841679255	1	1	PEREZ, ALEJANDRO MD	5/17/2022	207ZP0102X	NA	Other	026	PHYSICIANS	175025	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
19083	Fee-for-Service	1184290801	1184290801	1	1	PIERANGELO, TIFFANY CCC-SLP	6/29/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
19089	Fee-for-Service	1528049335	1528049335	1	1	PAUL RUSSELL JENSEN M.D.	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 MEDICAL DR	None	BOUNTIFUL	UT	84010	4908	00	None	40.88671331	-111.8683023	Davis County
19110	Fee-for-Service	1023793023	1023793023	1	1	PHUNG, WILLIAM PT	9/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
19147	Fee-for-Service	1164426961	1164426961	1	1	PUA, SHIRLEY MD	2/21/2018	207R00000X	NA	Other	026	PHYSICIANS	151394	10	Gastroenterology (M.D. only)	0	In state provider	None	938 N CHERRY ST	None	VISALIA	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
19149	Fee-for-Service	1124039524	1124039524	1	1	PHOON, ANDREW K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76330	41	Internal Medicine	0	In state provider	None	9619 CHESAPEAKE DR	STE 102	SAN DIEGO	CA	92123	1373	37	06073	32.83359409	-117.1237093	San Diego County
19156	Fee-for-Service	1700197217	1700197217	2	1	PATEL, RAJAN MD	12/23/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	133181	13	Neurology (M.D. only)	0	In state provider	None	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
19174	Fee-for-Service	1306330451	1306330451	1	1	POA-LI, CHRISTINA Y MD	8/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	164528	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
19180	Fee-for-Service	1669089066	1669089066	1	1	PHAM, TRINIQUE T PT	7/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
19242	Fee-for-Service	1629275235	1629275235	1	1	PROTELL, TRACY R MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122555	36	Psychiatry	0	In state provider	None	1090 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
19264	Fee-for-Service	1770958621	1770958621	1	1	PERAKIS, JACLYN M PT	12/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	426 N. IMPERIAL AVE.	None	EL CENTRO	CA	92243	2329	13	06025	32.79599732	-115.5700423	Imperial County
19265	Fee-for-Service	1821386244	1821386244	1	1	PAO, HOLLY J OD	9/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2171 JUNIPERO SERRA BLVD	SUITE 100	DALY CITY	CA	94014	1987	41	06081	37.69836798	-122.4706688	San Mateo County
19272	Fee-for-Service	1649216235	1649216235	1	1	PETERSON, GARRICK K OD	2/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	141 S MIRAGE AVE	None	LINDSAY	CA	93247	2541	54	06107	36.20245187	-119.0885408	Tulare County
19281	Fee-for-Service	1508483587	1508483587	1	1	PARADISE RAYS HOSPICE INC	2/24/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	217 E ALAMEDA AVE	UNIT 201	LOS ANGELES	CA	91502	1500	19	06037	34.17516147	-118.2991383	Los Angeles
19294	Fee-for-Service	1356454458	1356454458	1	1	PIRNAZAR, CYRUS MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	22671	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
19308	Fee-for-Service	1992800353	1992800353	1	1	PARK, JIN D.O	8/7/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6738	08	Family Practice	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
19316	Fee-for-Service	1104991561	1104991561	1	1	PEREZ, JOSE A MD	7/31/1978	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20957	None	None	0	In state provider	None	8301 S VERMONT AVE	STE A	LOS ANGELES	CA	90044	3470	19	06037	33.96332763	-118.2918812	Los Angeles County
19323	Fee-for-Service	1386099570	1386099570	1	1	PANNU, ANVINDERJEET S MD	1/18/2019	390200000X	NA	Other	026	PHYSICIANS	157316	08	Family Practice	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
19334	Fee-for-Service	1295296515	1295296515	1	1	PALUSHAJ, BIANCA MD	5/14/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	182208	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19347	Fee-for-Service	1679644181	1679644181	1	1	PANG, JASON J MD	5/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69884	41	Internal Medicine	0	In state provider	None	23401 EL TORO RD	STE 100	LAKE FOREST	CA	92630	6923	30	06059	33.62343549	-117.6971029	Orange County
19371	Fee-for-Service	1144372079	1144372079	1	1	PERONETTO, FRANK A PT	2/12/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
19464	Fee-for-Service	1649347485	1649347485	1	1	PEDERSEN, KRESTEN B OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11911 CENTRAL AVENUE	None	CHINO	CA	91710	1906	36	06071	34.03704117	-117.6893971	San Bernardino County
19532	Fee-for-Service	1629275235	1629275235	1	1	PROTELL, TRACY R MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122555	26	Psychiatry (child)	0	In state provider	None	1090 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
19543	Fee-for-Service	1770850737	1770850737	1	1	PRICER, MELISSA K LCSW	4/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
19560	Fee-for-Service	1053675504	1053675504	1	1	PASCUAL, NADINE E	12/24/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	16519 VICTOR ST	STE 201	VICTORVILLE	CA	92395	3966	36	06071	34.5212432	-117.3044617	San Bernardino County
19584	Fee-for-Service	1598028482	1598028482	1	1	PICKLE, LARA N DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13019	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
19585	Fee-for-Service	1679749071	1679749071	1	1	PATHAK, RICHA MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116183	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
19613	Fee-for-Service	1730856378	1730856378	1	1	PHAM, MINDY N PT	10/8/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
19623	Fee-for-Service	1326512542	1326512542	1	1	PARAMOUNT HOPE DIALYSIS	12/23/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER PC	8319 ALONDRA BLVD	None	PARAMOUNT	CA	90723	4403	19	06037	33.88929852	-118.153908	Los Angeles County
19662	Fee-for-Service	1578557765	1578557765	1	1	PROTO SCRIPT PHARMACEUTICALS	11/14/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CORP	337 N VINEYARD AVE.	STE. 400	ONTARIO	CA	91764	4436	36	06071	34.066728	-117.611622	San Bernardino County
19685	Fee-for-Service	1093736001	1093736001	1	1	PALISADES GENERAL HOSP	1/1/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7600 RIVER RD	None	NORTH BERGEN	NJ	07047	6299	00	None	40.79415047	-73.99721903	Hudson County
19696	Fee-for-Service	1871656892	1871656892	1	1	PETERS, ROBIN PSYD	2/11/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
19708	Fee-for-Service	1023411964	1023411964	1	1	PARADIGM SURGICAL SPECIALIST	11/21/2016	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	PC	2043 19TH AVE	None	SAN FRANCISCO	CA	94116	1253	38	06075	37.74965673	-122.4761431	San Francisco County
19750	Fee-for-Service	1730100256	1730100256	1	1	PECK, ROBERT S MD	8/21/1996	207L00000X	NA	Other	026	PHYSICIANS	62779	05	Anesthesiology	0	In state provider	None	1310 W STEWART DR	STE 310	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
19761	Fee-for-Service	1811997901	1811997901	1	1	PROCTOR, LAUREN MD	9/11/2023	207R00000X	NA	Other	026	PHYSICIANS	187560	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
19769	Fee-for-Service	1073832903	1073832903	1	1	PLAUCHE, JESSICA MD	12/30/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	118030	36	Psychiatry	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
19803	Fee-for-Service	1952304479	1952304479	1	1	PERCER THOMAS LM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24304	36	Psychiatry	0	In state provider	None	6226 E SPRING ST	STE 230	LONG BEACH	CA	90815	1457	19	06037	33.81040053	-118.1102715	Los Angeles County
19820	Fee-for-Service	1629275235	1629275235	1	1	PROTELL, TRACY R MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122555	40	Pediatrics	0	In state provider	None	1090 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
19845	Fee-for-Service	1740450378	1740450378	1	2	PEDIATRIC SLEEP, ADOPTION AN	4/15/2022	173F00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D DEVELOPMENT CLINIC, IN	4902 IRVINE CENTER DR	STE 104	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
19870	Fee-for-Service	1396200739	1396200739	1	1	PIO, RUZZIEL	11/16/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	25931 GLEN SUMMER DRIVE	None	LOMA LINDA	CA	92354	6529	36	06071	34.05338129	-117.2386142	San Bernardino County
19896	Fee-for-Service	1124490792	1124490792	1	1	PREMIERCARE 2 CONGREGATE	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING INC	9349 ROSE ST	None	BELLFLOWER	CA	90706	6423	19	06037	33.86962352	-118.1343195	Los Angeles County
19941	Fee-for-Service	1346618386	1346618386	1	1	PINEDO, LISETTE	8/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
19964	Fee-for-Service	1588639710	1588639710	1	1	PODOLSKY, WILLIAM J MD	1/24/1995	2085R0001X	NA	Other	026	PHYSICIANS	34710	30	Radiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93715	0000	10	06019	36.741663	-119.7841005	Fresno County
19974	Fee-for-Service	1093736001	1093736001	1	1	PALISADES GENERAL HOSP	8/11/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7600 RIVER RD	None	NORTH BERGEN	NJ	07047	6299	00	None	40.79415047	-73.99721903	Hudson County
19990	Fee-for-Service	1619908134	1619908134	1	1	PATEL, HARISHCHANDRA	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41341	41	Internal Medicine	0	In state provider	None	3400 W BALL RD	STE 203	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
19991	Fee-for-Service	1366197311	1366197311	1	1	PRECISE MED	8/5/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1198 MELODY LN	STE 110	ROSEVILLE	CA	95678	5100	31	06061	38.72406677	-121.2920171	Placer County
19995	Fee-for-Service	1023411964	1023411964	1	1	PARADIGM SURGICAL SPECIALIST	11/21/2016	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	PC	2043 19TH AVE	None	SAN FRANCISCO	CA	94116	1253	38	06075	37.74965673	-122.4761431	San Francisco County
20016	Fee-for-Service	1871856898	1871856898	1	1	PATNAIK, SUVAG K MD	12/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143961	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
20021	Fee-for-Service	1730346024	1730346024	1	1	PARK, MICHELLE J MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106354	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20035	Fee-for-Service	1649405895	1649405895	1	1	PARK, CLAIRE MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107414	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20045	Fee-for-Service	1265518054	1265518054	1	1	POPEL, OLGA MD	4/6/2020	207RR0500X	NA	Other	026	PHYSICIANS	42577	83	Rheumatology	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
20072	Fee-for-Service	1548596513	1548596513	1	1	PHILLIPSEN, REBECCA K LCSW	10/12/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
20086	Fee-for-Service	1952304479	1952304479	1	1	PERCER THOMAS LM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24304	40	Pediatrics	0	In state provider	None	6226 E SPRING ST	STE 230	LONG BEACH	CA	90815	1457	19	06037	33.81040053	-118.1102715	Los Angeles County
20106	Fee-for-Service	1861622052	1861622052	1	1	PARASHAR, ANUSHREE MD	3/25/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	129750	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
20114	Fee-for-Service	1760723910	1760723910	1	1	PACIFIC CENTRAL COAST HEALTH	11/15/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1400 E CHURCH STREET	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
20115	Fee-for-Service	1861554552	1861554552	1	1	PENA, KRISTIN S MD	7/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75967	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
20129	Fee-for-Service	1760456156	1760456156	1	1	PFANNENSTIEL, MICHAEL T MD	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
20133	Fee-for-Service	1740450378	1740450378	1	2	PEDIATRIC SLEEP, ADOPTION AN	4/15/2022	173F00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	D DEVELOPMENT CLINIC, IN	4902 IRVINE CENTER DR	STE 104	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
20156	Fee-for-Service	1124438080	1124438080	1	1	PARK, CHRISTINE J LMFT	6/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5199 E PACIFIC COAST HWY	STE 312N	LONG BEACH	CA	90804	3344	19	06037	33.78293818	-118.1329326	Los Angeles County
20157	Fee-for-Service	1396200739	1396200739	1	1	PIO, RUZZIEL	11/16/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	25931 GLEN SUMMER DRIVE	None	LOMA LINDA	CA	92354	6529	36	06071	34.05338129	-117.2386142	San Bernardino County
20248	Fee-for-Service	1437520558	1437520558	1	1	P & T VENTURE INC	11/5/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16055-D BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	1566	30	06059	33.72960657	-117.9548029	Orange County
20262	Fee-for-Service	1699735860	1699735860	1	1	PAIGE, TODD E MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
20263	Fee-for-Service	1255453171	1255453171	1	1	PILLUTLA, PRIYA MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94291	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
20280	Fee-for-Service	1619908134	1619908134	1	1	PATEL, HARISHCHANDRA	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41341	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3400 W BALL RD	STE 203	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
20306	Fee-for-Service	1730346024	1730346024	1	1	PARK, MICHELLE J MD	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106354	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20336	Fee-for-Service	1265518054	1265518054	1	1	POPEL, OLGA MD	4/6/2020	207RR0500X	NA	Other	026	PHYSICIANS	42577	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
20345	Fee-for-Service	1548331234	1548331234	1	1	PRIYADARSHI, ANAMIKA MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88454	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20401	Fee-for-Service	1124040621	1124040621	1	1	PAYLESS DRUG STORE 5927	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1165 ARNOLD DR	None	MARTINEZ	CA	94553	4104	07	06013	37.99388182	-122.1013551	Contra Costa County
20412	Fee-for-Service	1154363448	1154363448	1	1	PHELPS-SANDALL, BARBARA A MD	7/5/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71692	None	None	0	In state provider	None	815 POLLARD ROAD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
20422	Fee-for-Service	1134488026	1134488026	1	1	PAI, SHEKHAR S MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131332	41	Internal Medicine	0	In state provider	None	2710 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
20446	Fee-for-Service	1174120166	1174120166	1	1	PALLEY, LISA LMFT	10/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
20466	Fee-for-Service	1154081867	1154081867	1	1	PHOENIX HOUSE ORANGE COUNTY,	12/23/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	NIC	1901 E. 4TH ST	UNIT 350	SANTA ANA	CA	92705	3908	30	06059	33.74826845	-117.8397675	Orange County
20473	Fee-for-Service	1164881314	1164881314	1	1	PINNACLE WOMEN'S HEALTH GROU	3/6/2018	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	P INC.	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
20477	Fee-for-Service	1285711564	1285711564	1	1	PHELPS, REGINA I LMFT	1/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51988	-	NOT APPLICABLE	0	In state provider	None	303 SOUTH C ST	None	LOMPOC	CA	93436	7305	42	06083	34.63525845	-120.451628	Santa Barbara County
20481	Fee-for-Service	1245327071	1245327071	1	1	PHAN, KIM N PHD	8/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
20522	Fee-for-Service	1184756082	1184756082	1	1	PARK, JUNG W MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56214	40	Pediatrics	0	In state provider	None	7215 55TH STREET	None	SACRAMENTO	CA	95823	2601	34	06067	38.495196	-121.440681	Sacramento County
20553	Fee-for-Service	1255453171	1255453171	1	1	PILLUTLA, PRIYA MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94291	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
20573	Fee-for-Service	1639349749	1639349749	1	1	PACIFIC RIM REHABILITATION	8/22/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DAVID PATTERSON GEN PTR	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
20618	Fee-for-Service	1548817836	1548817836	1	3	PREMIER NEPHROLOGY OF ORANGE	12/2/2019	246ZN0300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COUNTY INC	11100 WARNER AVE	STE 158	FOUNTAIN VALLEY	CA	92708	7510	30	06059	33.716291	-117.9355051	Orange County
20628	Fee-for-Service	1669548244	1669548244	1	1	PECK, MARTHA M CRNA	9/22/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
20632	Fee-for-Service	1447730874	1447730874	1	1	PAK, HANA NP	3/26/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
20634	Fee-for-Service	1366516833	1366516833	1	1	PULAGAM, SRINIVAS R MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129613	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.74248474	-121.8493369	Butte County
20637	Fee-for-Service	1144233487	1144233487	1	1	PERINATAL ASSOCIATES OF	4/4/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTRAL CALIFORNIA MED	2210 E ILLINOIS AVE	STE 308	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
20651	Fee-for-Service	1033497334	1033497334	1	1	PEREZ, CRISTINA M LMFT	8/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	252 WEST FAIRVIEW AVENUE	None	SAN GABRIEL	CA	91776	2943	19	06037	34.08974094	-118.1032228	Los Angeles County
20745	Fee-for-Service	1174718134	1174718134	1	2	PARK, RICHARD MD	12/23/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	111560	-	NOT APPLICABLE	0	In state provider	None	955 E THOMPSON BLVD	None	VENTURA	CA	93001	3008	56	06111	34.27831162	-119.286174	Ventura County
20767	Fee-for-Service	1538625975	1538625975	1	1	PURPOSEFUL RESIDENTIAL CARE	9/19/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1308 ERIE ST	None	BAKERSFIELD	CA	93307	3974	15	06029	35.34285419	-118.9829541	Kern County
20777	Fee-for-Service	1902985575	1902985575	1	1	PUGELY, JAMES M MD	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	31785	03	Allergy	0	In state provider	None	2504 HARRISON AVE	STE B&C	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
20807	Fee-for-Service	1578104964	1578104964	1	1	PARAS, KIMBERLY D NP	10/24/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
20840	Fee-for-Service	1346773660	1346773660	1	1	PENNEWELL, AMELIA LMFT	12/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
20875	Fee-for-Service	1023125804	1023125804	1	1	PAWLOWSKA, ANNA B MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70334	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
20892	Fee-for-Service	1740318153	1740318153	1	1	PLAZA SURGERY CENTER LP	9/26/2003	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	525 E PLAZA DR	STE 100	SANTA MARIA	CA	93454	6966	42	06083	34.9373822	-120.4296004	Santa Barbara County
20899	Fee-for-Service	1235738782	1235738782	1	1	PENINSULA HEALTHCARE CENTER	6/16/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	22330 HAWTHORNE BLVD	STE J	TORRANCE	CA	90505	2551	19	06037	33.824763	-118.350914	Los Angeles County
20901	Fee-for-Service	1730362344	1730362344	1	1	POPMA, BRITA B CNM	2/8/2015	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	617 SAXONY PLACE	SUITE 103	ENCINITAS	CA	92024	2797	37	06073	33.05482353	-117.285912	San Diego County
20906	Fee-for-Service	1003085192	1003085192	1	1	PRICE, ROBERT H MD	12/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43730	13	Neurology (M.D. only)	0	In state provider	None	77 CASA STREET	SUITE 108	SAN LUIS OBISPO	CA	93405	5804	40	06079	35.29306786	-120.6650709	San Luis Obispo County
20907	Fee-for-Service	1508102856	1508102856	1	1	PAUL, JACQUELINE K LCSW	3/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
20911	Fee-for-Service	1407034234	1407034234	1	1	PATEL, MILAN D MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91157	30	Radiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
20927	Fee-for-Service	1144233487	1144233487	1	1	PERINATAL ASSOCIATES OF	10/13/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CENTRAL CALIFORNIA MED	2210 E ILLINOIS AVE	STE 308	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
20970	Fee-for-Service	1326516840	1326516840	1	1	PEREZ, RYAN PT	9/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
21010	Fee-for-Service	1265164784	1265164784	1	1	PANNU, JAFFARDEEP CNP	12/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3035 EL CAMINO AVE	None	SACRAMENTO	CA	95821	6014	34	06067	38.610828	-121.3926255	Sacramento County
21030	Fee-for-Service	1043242696	1043242696	1	1	PAYNE, DENNIS MD	11/1/2019	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	45903	-	NOT APPLICABLE	0	In state provider	None	50100 GOLSH RD	None	VALLEY CENTER	CA	92082	5338	37	06073	33.27715948	-116.9618201	San Diego County
21056	Fee-for-Service	1093969115	1093969115	1	2	PLANNED PARENTHOOD OF LA	8/12/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1500 W WASHINGTON BLVD	None	LOS ANGELES	CA	90007	1257	19	06037	34.03998053	-118.289682	Los Angeles County
21075	Fee-for-Service	1477003101	1477003101	1	1	POLIFRONE, STACY L LCSW	6/30/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
21083	Fee-for-Service	1932548179	1932548179	1	1	PULLI, BENJAMIN MD	6/17/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159390	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21086	Fee-for-Service	1396772034	1396772034	2	1	PATEL, GIRISH K MD	7/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	30152	None	None	0	In state provider	None	460 GREENFIELD AVE	STE 12	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
21087	Fee-for-Service	1063500106	1063500106	1	1	PEDIATRIC PARTNERS	11/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MED PROFESSIONAL GROUP	26900 NEWPORT RD	STE 111	MENIFEE	CA	92584	9224	33	06065	33.68505762	-117.1904714	Riverside County
21137	Fee-for-Service	1710331962	1710331962	1	1	PHAM, TRINH T MD	11/15/2022	207L00000X	NA	Other	026	PHYSICIANS	178991	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
21142	Fee-for-Service	1730139825	1730139825	1	1	PHILLIPS, ALISTAIR B M MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55907	33	Thoracic Surgery	0	In state provider	None	127 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07470367	-118.3786107	Los Angeles County
21164	Fee-for-Service	1023125804	1023125804	1	1	PAWLOWSKA, ANNA B MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70334	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
21196	Fee-for-Service	1790915502	1790915502	1	1	PATEL, RINA P MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130941	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
21199	Fee-for-Service	1407034234	1407034234	1	1	PATEL, MILAN D MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91157	78	Neoplastic Diseases/Oncology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
21204	Fee-for-Service	1831438209	1831438209	1	1	PULIS, GEORGE J LMFT	3/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
21210	Fee-for-Service	1790738698	1790738698	1	1	PARK,SARA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
21211	Fee-for-Service	1154998318	1154998318	1	1	POOLE, DAISHEA LMFT	12/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
21253	Fee-for-Service	1043388150	1043388150	1	1	PARK, TRINA E	2/14/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
21316	Fee-for-Service	1093969115	1093969115	1	27	PLANNED PARENTHOOD OF LA	4/17/2025	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	10625 PLAINVIEW AVE	None	TUJUNGA	CA	90142	1723	19	06037	34.259922	-118.300491	Los Angeles County
21319	Fee-for-Service	1558307173	1558307173	1	1	PACKARD, DAVID M MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73876	45	Nephrology (Renal-Kidney)	0	In state provider	None	3351 M ST	STE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
21362	Fee-for-Service	1508920760	1508920760	1	1	PAWSON, LESLIE-LYNN MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36539	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
21364	Fee-for-Service	1538256193	1538256193	1	1	PRIME HEALTH MEDICAL	6/2/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3228 SANTA ANITA AVE	None	EL MONTE	CA	91733	1360	19	06037	34.06689273	-118.0423912	Los Angeles County
21367	Fee-for-Service	1295066884	1295066884	1	1	PATARIA, BRIJPAL S PT	4/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4339 E MORADA LN STE 150	150	STOCKTON	CA	95212	1634	39	06077	38.039067	-121.259493	San Joaquin County
21376	Fee-for-Service	1497968523	1497968523	1	1	PARMAR, JAYWANT P MD	7/28/2008	2085R0204X	NA	Other	026	PHYSICIANS	80323	30	Radiology	0	In state provider	None	522 EAST PLAZA DRIVE	None	SANTA MARIA	CA	93454	6908	42	06083	34.93727355	-120.4288678	Santa Barbara County
21380	Fee-for-Service	1730107012	1730107012	1	1	PORTER, VERNA R MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55356	13	Neurology (M.D. only)	0	In state provider	None	1245 16TH ST	None	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
21392	Fee-for-Service	1467031971	1467031971	1	1	PHUNG, ANDREW DO	8/15/2024	390200000X	NA	Other	026	PHYSICIANS	22573	08	Family Practice	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
21408	Fee-for-Service	1366558827	1366558827	1	1	P&M HEALTHCARE HOLDINGS	8/1/2000	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	RANCHO MESA CARE CENTER	9333 LA MESA DR	None	ALTA LOMA	CA	91701	5805	36	06071	34.12342353	-117.601605	San Bernardino County
21411	Fee-for-Service	1467538140	1467538140	1	1	PARIS,CAROLYN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
21421	Fee-for-Service	1487968749	1487968749	1	1	PEACE HOME HEALTH	4/1/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2420 W CARSON ST	SUITE 200	TORRANCE	CA	90501	3166	19	06037	33.83131647	-118.3262625	Los Angeles County
21425	Fee-for-Service	1134713704	1134713704	1	1	PRESTIGE ORTHOPAEDICS AND SP	5/28/2021	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	ORTS MEDICINE, INC.	11939 RANCHO BERNARDO RD	STE 115	SAN DIEGO	CA	92128	2073	37	06073	33.02279756	-117.0732316	San Diego County
21446	Fee-for-Service	1922113711	1922113711	1	1	PATRICIA S DWYER, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 PARK AVE	None	DERRY	NH	03038	2113	00	None	42.8829221	-71.3222689	Rockingham County
21453	Fee-for-Service	1023125804	1023125804	1	1	PAWLOWSKA, ANNA B MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70334	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
21466	Fee-for-Service	1467727081	1467727081	1	1	PORTER, JACOB S DO	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15727	40	Pediatrics	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
21474	Fee-for-Service	1366542995	1366542995	1	1	PRAKASAM, ESWARI MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68597	40	Pediatrics	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
21515	Fee-for-Service	1659396356	1659396356	1	1	PARANAY, GREGORY MD	5/31/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40604	None	None	0	In state provider	None	22777 LYONS AVE	STE 106	NEWHALL	CA	91321	2800	19	06037	34.38063512	-118.5316765	Los Angeles County
21549	Fee-for-Service	1316575467	1316575467	1	1	PHARMEDQUEST PHARMACY SERVIC	6/8/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2740 S ELM AVE	ROOM 2	FRESNO	CA	93706	5435	10	06019	36.70101129	-119.7908643	Fresno County
21561	Fee-for-Service	1831544352	1831544352	1	1	PATTON, JOHN W MD	1/8/2021	207L00000X	NA	Other	026	PHYSICIANS	150671	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
21596	Fee-for-Service	1922328269	1922328269	1	1	PALAVI, CYNTHIA J LCSW	12/1/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
21607	Fee-for-Service	1558307173	1558307173	1	1	PACKARD, DAVID M MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73876	41	Internal Medicine	0	In state provider	None	3351 M ST	STE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
21644	Fee-for-Service	1376624981	1376624981	1	1	PROVIDENCE HEALTH &	10/29/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES WASHINGTON	914 S SCHEUBER RD	None	CENTRALIA	WA	98531	9027	00	None	46.71220956	-122.9870103	Lewis County
21650	Fee-for-Service	1629138474	1629138474	1	1	PINKEL, SARA SUZANNE MD	8/31/1993	207R00000X	NA	Other	026	PHYSICIANS	72663	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
21651	Fee-for-Service	1659562791	1659562791	1	1	PORTEOUS, REBECCA S LCSW	5/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3135 BOEING AVE	STE A1	MCKINLEYVILLE	CA	95519	9373	12	06023	40.96714219	-124.1136378	Humboldt County
21696	Fee-for-Service	1215348677	1215348677	1	1	PACIFICA NORTH COUNTY SL LP	7/10/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1351 E WASHINGTON AVE	None	ESCONDIDO	CA	92027	1934	37	06073	33.13481146	-117.065009	San Diego County
21701	Fee-for-Service	1750090296	1750090296	1	1	PALACE OF JOY INC	12/15/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6701 KURL WAY	None	RESEDA	CA	91335	5211	19	06037	34.19202674	-118.5427971	Los Angeles County
21706	Fee-for-Service	1891918694	1891918694	1	1	POLISHUK,PAUL V MD INC	3/1/1998	208800000X	NA	Other	026	PHYSICIANS	84309	34	Urology and Urological Surgery	0	In state provider	None	215 S HICKORY ST	STE 114	ESCONDIDO	CA	92925	4360	37	06073	33.12335985	-117.0753842	San Diego County
21754	Fee-for-Service	1851690622	1851690622	1	1	PARVINCHIHA, PAYAM MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122389	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
21769	Fee-for-Service	1033770094	1033770094	1	1	PATEL, NEHAL MD	12/18/2023	207R00000X	NA	Other	026	PHYSICIANS	189043	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
21773	Fee-for-Service	1417998774	1417998774	1	1	PRITCHARD, RONALD MD	2/22/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156393	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
21782	Fee-for-Service	1497746473	1497746473	1	1	PISMO FAMILY PRACTICE	1/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	A MEDICAL CORPORATION	575 PRICE ST	STE 101	PISMO BEACH	CA	93449	2553	40	06079	35.14080956	-120.6390342	San Luis Obispo County
21817	Fee-for-Service	1952609760	1952609760	1	2	PHYSICIANS HOSPITAL OF	5/5/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MURIETTA, LLC	28078 BAXTER ROAD	SUITE 326	MURRIETA	CA	92563	1404	33	06065	33.615	-117.1670265	Riverside County
21832	Fee-for-Service	1053350975	1053350975	1	1	PACIFICA EMERGENCY MED	11/1/1998	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
21882	Fee-for-Service	1316041833	1316041833	2	23	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
21886	Fee-for-Service	1972633006	1972633006	1	1	PANDIT, SRILAXMI R MD	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120790	08	Family Practice	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
21888	Fee-for-Service	1679978274	1679978274	1	1	PACIFIC CENTRAL COAST HEALTH	6/10/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	715 TANK FARM ROAD	SUITE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
21896	Fee-for-Service	1255982492	1255982492	1	1	PETRICK, TRAVIS M NP	1/7/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
21916	Fee-for-Service	1811427503	1811427503	1	1	PARKER, AMANDA P S NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
21934	Fee-for-Service	1376624981	1376624981	1	1	PROVIDENCE HEALTH &	10/29/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES WASHINGTON	914 S SCHEUBER RD	None	CENTRALIA	WA	98531	9027	00	None	46.71220956	-122.9870103	Lewis County
21939	Fee-for-Service	1710031588	1710031588	1	21	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
21977	Fee-for-Service	1851558035	1851558035	1	1	PUA, TRICIA L MD	8/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117609	22	Pathology (M.D. only)	0	In state provider	None	305 PARK CREEK DRIVE	None	CLOVIS	CA	93611	4426	10	06019	36.84077548	-119.7076545	Fresno County
22019	Fee-for-Service	1609985704	1609985704	1	1	PRESS, LEAH MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42580	07	Dermatology	0	In state provider	None	3758 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
22039	Fee-for-Service	1275564296	1275564296	1	7	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	392 SIERRA ST	None	KINGSBURG	CA	93631	1706	10	06019	36.5178297	-119.5717648	Fresno County
22065	Fee-for-Service	1023783073	1023783073	1	1	PAI, ANUSHKA CCC-SLP	8/22/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
22067	Fee-for-Service	1003565912	1003565912	1	1	PATEL, BANSARI A MD	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	21613	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
22098	Fee-for-Service	1285088013	1285088013	1	1	PALACIOS, YELENNIA MD	1/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	152662	01	General Practice	0	In state provider	None	678 3RD AVD	None	CHULA VISTA	CA	91911	5736	37	06073	32.62870793	-117.0750108	San Diego County
22117	Fee-for-Service	1770103178	1770103178	1	1	PRASAD, VARSHA DO	4/12/2023	208M00000X	NA	Other	026	PHYSICIANS	20833	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
22126	Fee-for-Service	1356753602	1356753602	1	1	PILOSSYAN, LILIT MD	1/27/2020	207RR0500X	NA	Other	026	PHYSICIANS	145861	83	Rheumatology	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
22158	Fee-for-Service	1699728188	1699728188	1	3	PHYS MED A PHYSICAL THERAPY	3/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	201 S. MADERA AVE	#100	KERMAN	CA	93630	1129	10	06019	36.73266806	-120.0602444	Fresno County
22159	Fee-for-Service	1720513716	1720513716	1	1	PAYNE, ROBERT T MD	6/29/2022	207L00000X	NA	Other	026	PHYSICIANS	162886	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
22171	Fee-for-Service	1740282672	1740282672	1	1	PRINCE, RICHARD F MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	20729	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
22180	Fee-for-Service	1649203803	1649203803	2	1	PAUL, SHASHI D MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	25631	40	Pediatrics	0	In state provider	None	5726 LA JOLLA BLVD	STE 107	LA JOLLA	CA	92037	7342	37	06073	32.81639594	-117.2711804	San Diego County
22214	Fee-for-Service	1427476795	1427476795	1	1	PENICHE, ALEC MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	140270	05	Anesthesiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
22226	Fee-for-Service	1710031588	1710031588	1	21	PROVIDENCE FACEY MEDICAL FOU	8/3/2018	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
22262	Fee-for-Service	1003956350	1003956350	1	1	PHILLIPS, DENNIS S MD	3/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32083	40	Pediatrics	0	In state provider	None	24953 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	4342	30	06059	33.60028568	-117.7010887	Orange County
22265	Fee-for-Service	1841752854	1841752854	1	1	PHAM LE, UYEN T DO	1/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20400	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
22293	Fee-for-Service	1932553963	1932553963	1	1	PEREYRA, CHARLES MD	7/6/2022	207P00000X	NA	Other	026	PHYSICIANS	176229	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
22313	Fee-for-Service	1720585656	1720585656	1	1	PANCHAL, MANSI R DO	10/28/2021	208M00000X	NA	Other	026	PHYSICIANS	19062	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
22316	Fee-for-Service	1649541350	1649541350	1	1	PATEL, JAYMICA P MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122274	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
22325	Fee-for-Service	1790851236	1790851236	1	1	PARK, HYUN K DO	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9242	05	Anesthesiology	0	In state provider	None	2131 W. 3RD STREET	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
22329	Fee-for-Service	1184027104	1184027104	1	1	PACIFIC SKIN INSTITUTE	3/22/2019	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1010 NUT TREE RD	170	VACAVILLE	CA	95687	4172	48	06095	38.35458369	-121.9530637	Solano County
22348	Fee-for-Service	1316041833	1316041833	2	14	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
22355	Fee-for-Service	1720046287	1720046287	1	1	PARISE, SHAWNDRA C MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	87276	01	General Practice	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
22379	Fee-for-Service	1215279930	1215279930	1	1	PERKINS, VICTOR A DO	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16387	05	Anesthesiology	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
22441	Fee-for-Service	1891805362	1891805362	1	1	PATCHETT, H TIMOTHY	8/31/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	50465	18	Ophthalmology	0	In state provider	None	3237 PROFESSIONAL DR	STE A	AUBURN	CA	95602	2414	31	06061	38.94288181	-121.100867	Placer County
22462	Fee-for-Service	1548713050	1548713050	1	1	PROFUSION LLC	9/20/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7250 ENGINEER RD	STE D	SAN DIEGO	CA	92111	1420	37	06073	32.82719145	-117.1609245	San Diego County
22469	Fee-for-Service	1821241498	1821241498	1	1	PERSAUD, SHARLENE N MD	11/1/2010	207R00000X	NA	Other	026	PHYSICIANS	11043	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
22479	Fee-for-Service	1093969115	1093969115	1	17	PLANNED PARENTHOOD OF LA	10/12/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2955 S ROBERTSON BLVD	None	LOS ANGELES	CA	90034	3116	19	06037	34.034139	-118.391625	Los Angeles County
22482	Fee-for-Service	1316041833	1316041833	2	24	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	24451 HEALTH CENTER DRIV	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
22495	Fee-for-Service	1497072896	1497072896	1	1	PATEL, TANVI N MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133929	30	Radiology	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22514	Fee-for-Service	1710031588	1710031588	1	21	PROVIDENCE FACEY MEDICAL FOU	8/3/2018	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
22530	Fee-for-Service	1457785917	1457785917	1	1	PETERS, JESSICA L LMFT	11/12/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
22531	Fee-for-Service	1326675281	1326675281	1	1	POLES, ANTHONY A MD	8/13/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188844	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
22566	Fee-for-Service	1356410351	1356410351	1	1	PRIME HLTHCARE PARADISE VLY	3/1/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2098	37	06073	32.68637926	-117.0828839	San Diego County
22577	Fee-for-Service	1962498584	1962498584	1	1	PAUL, MYRENE PHD	5/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
22638	Fee-for-Service	1316041833	1316041833	2	1	PEDIATRIX MEDICAL GROUP OF C	11/6/2019	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	300 HILLMONT AVENUE	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
22669	Fee-for-Service	1952315319	1952315319	1	2	PHUNG, THANH G MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	42348	30	Radiology	0	In state provider	None	8338 VALLEY BLVD	None	ROSEMEAD	CA	91770	1636	19	06037	34.08030961	-118.0867777	Los Angeles County
22689	Fee-for-Service	1386106425	1386106425	1	1	PENG, GRETA MD	9/20/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	178777	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
22700	Fee-for-Service	1467985242	1467985242	1	1	PEREZ, ADAM MD	7/16/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	173819	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
22709	Fee-for-Service	1730716598	1730716598	1	1	PARK, HAN MYOUNG DO	5/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22361	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22741	Fee-for-Service	1871728741	1871728741	1	1	PAN, SAMUEL C MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120617	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22744	Fee-for-Service	1457332025	1457332025	1	1	PAPPAS, JAMES N MD	4/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4723	00	None	39.53124039	-119.8188498	Washoe County
22745	Fee-for-Service	1790812162	1790812162	1	1	PETROSSIAN, MELITA T MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120954	13	Neurology (M.D. only)	0	In state provider	None	1328 16TH STREET	2ND FLOOR	SANTA MONICA	CA	90404	1804	19	06037	34.02632404	-118.4846904	Los Angeles County
22768	Fee-for-Service	1316041833	1316041833	2	28	PEDIATRIX MEDICAL GROUP OF C	10/6/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2105 FOREST AVENUE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
22773	Fee-for-Service	1487972592	1487972592	1	1	PHANGUREH, VARINDER S MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134831	01	General Practice	0	In state provider	None	13851 E 14TH STREET	SUITE 202	SAN LEANDRO	CA	94578	2627	01	06001	37.71458918	-122.1418781	Alameda County
22803	Fee-for-Service	1710031588	1710031588	1	21	PROVIDENCE FACEY MEDICAL FOU	8/3/2018	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
22833	Fee-for-Service	1164438081	1164438081	1	1	PHILLIPS, PAUL S MD	2/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45869	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4060 4TH AVE	SUITE 206	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
22838	Fee-for-Service	1700184157	1700184157	1	1	PATEL, SHYAM DO	8/22/2024	208M00000X	NA	Other	026	PHYSICIANS	22798	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
22846	Fee-for-Service	1407301468	1407301468	1	2	PRIMECARE PHARMACY LLC	3/31/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	32144 AGOURA	STE 101	WESTLAKE VILLAGE	CA	91361	4037	19	06037	34.14848408	-118.8208595	Los Angeles County
22857	Fee-for-Service	1356410351	1356410351	1	1	PRIME HLTHCARE PARADISE VLY	3/1/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2098	37	06073	32.68637926	-117.0828839	San Diego County
22861	Fee-for-Service	1255313458	1255313458	1	1	PANAGIOTIS, NICHOLAS	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	23551	None	None	0	In state provider	None	18370 BURBANK BLVD	STE 507	TARZANA	CA	91356	2840	19	06037	34.17173059	-118.5331881	Los Angeles County
22908	Fee-for-Service	1992022271	1992022271	1	1	PATEL, LEENA N MD	1/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110501	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
22923	Fee-for-Service	1316041833	1316041833	2	6	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
22939	Fee-for-Service	1326577701	1326577701	1	1	PELESKY, GYNA CASSIA D LCSW	7/6/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
22940	Fee-for-Service	1184832800	1184832800	1	1	PERUGU, SIRSHA MD	2/7/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	100662	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
22945	Fee-for-Service	1881742815	1881742815	1	1	PADILLA, DIANA CRNA	4/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
22967	Fee-for-Service	1225736424	1225736424	1	1	PALOMARES, LESLEY ANN GUZMAN	3/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1925 240TH ST	None	LOMITA	CA	90717	1215	19	06037	33.80695147	-118.3127707	Los Angeles County
22976	Fee-for-Service	1316041833	1316041833	2	15	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	815 POLLARD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
22977	Fee-for-Service	1205996477	1205996477	1	1	POON, DAVID MD	5/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65292	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
22994	Fee-for-Service	1609226877	1609226877	1	1	PROHEALTH PARTNERS, A MEDICA	4/7/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC.	21840 S NORMANDIE AVE	STE 100A	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
23021	Fee-for-Service	1699710913	1699710913	1	1	PATEL, ANANDRAY B DO	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8911	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
23029	Fee-for-Service	1871728741	1871728741	1	1	PAN, SAMUEL C MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120617	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23031	Fee-for-Service	1245599836	1245599836	1	1	PANOYAN, LUCY MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128603	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
23036	Fee-for-Service	1275564296	1275564296	1	14	PRECISION REHABILITATION & O	10/31/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6770 N WEST AVE	101A	FRESNO	CA	93711	1399	10	06019	36.83680641	-119.8262494	Fresno County
23060	Fee-for-Service	1306025648	1306025648	1	1	PRIETTO, MARIO M LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24161	-	NOT APPLICABLE	0	In state provider	None	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	19	06037	33.98965917	-118.287673	Los Angeles County
23090	Fee-for-Service	1710031588	1710031588	1	21	PROVIDENCE FACEY MEDICAL FOU	8/3/2018	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	120,150,205,220,300,310,	SANTA CLARITA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
23103	Fee-for-Service	1548254543	1548254543	1	1	PINSON, STEPHEN J MD	8/1/1993	207L00000X	NA	Other	026	PHYSICIANS	50348	05	Anesthesiology	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
23108	Fee-for-Service	1033542741	1033542741	1	1	PESHCHEROVA, DARIA F	10/14/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
23117	Fee-for-Service	1750360350	1750360350	1	1	PONTIUS, STEVEN C MD	12/30/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23388	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	77 CASA ST	STE 104	SAN LUIS OBISPO	CA	93405	5804	40	06079	35.29306786	-120.6650709	San Luis Obispo County
23130	Fee-for-Service	1417342924	1417342924	1	1	PATEL, DARSHAN P MD	9/16/2021	208800000X	NA	Other	026	PHYSICIANS	171285	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23143	Fee-for-Service	1356410351	1356410351	1	1	PRIME HLTHCARE PARADISE VLY	3/1/2007	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2098	37	06073	32.68637926	-117.0828839	San Diego County
23182	Fee-for-Service	1366988560	1366988560	1	1	PHAM, MICHELLE A MD	7/13/2020	207R00000X	NA	Other	026	PHYSICIANS	145646	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
23191	Fee-for-Service	1952453177	1952453177	1	1	PLECQUE, DAVID C MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74540	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
23242	Fee-for-Service	1043216682	1043216682	1	1	PRIMEX CLINICAL LAB INC	7/12/2004	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	16742 STAGG ST	STE 120	VAN NUYS	CA	91406	1641	19	06037	34.21314276	-118.4983312	Los Angeles County
23252	Fee-for-Service	1225736424	1225736424	1	1	PALOMARES, LESLEY ANN GUZMAN	3/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1925 240TH ST	None	LOMITA	CA	90717	1215	19	06037	33.80695147	-118.3127707	Los Angeles County
23288	Fee-for-Service	1407840697	1407840697	1	1	PATEL, DEVESH N MD	10/20/2005	193400000X	NA	Other	026	PHYSICIANS	89330	77	Infectious Disease	0	In state provider	None	130 W ROUTE 66	STE 302	GLENDORA	CA	91740	6252	19	06037	34.12865951	-117.8651745	Los Angeles County
23309	Fee-for-Service	1164957486	1164957486	1	2	PROGRESSIVE URGENT CARE INC	12/18/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	801 17TH ST	None	MODESTO	CA	95354	1243	50	06099	37.64374164	-120.9915923	Stanislaus County
23310	Fee-for-Service	1699710913	1699710913	1	1	PATEL, ANANDRAY B DO	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8911	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
23320	Fee-for-Service	1508417817	1508417817	1	1	PRECIOUS HOSPICE CARE	4/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	126 S JACKSON ST	STE 307	GLENDALE	CA	91205	4920	19	06037	34.14533965	-118.2500741	Los Angeles County
23382	Fee-for-Service	1720158512	1720158512	1	1	PILLING, BRIDGETTE J	2/24/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	SUITE 103	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
23399	Fee-for-Service	1063504967	1063504967	1	1	PULERA, MARK R MD	12/13/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	81695	13	Neurology (M.D. only)	0	In state provider	None	7007 WASHINGTON AVE	SUITE 221	WHITTIER	CA	90602	3617	19	06037	33.9788072	-118.0350497	Los Angeles County
23416	Fee-for-Service	1750890083	1750890083	1	1	PARIA, SIONEH NP	3/20/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
23427	Fee-for-Service	1952489759	1952489759	1	1	PAZIRANDEH, SASSAN MD	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91070	10	Gastroenterology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
23433	Fee-for-Service	1932150315	1932150315	1	1	PULSIPHER, MICHAEL A MD	6/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136372	68	Hematology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
23492	Fee-for-Service	1679852313	1679852313	1	1	PRESTON, KAREN S	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
23497	Fee-for-Service	1427602341	1427602341	1	1	PAGE, JARAE Q LPCC	7/5/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
23513	Fee-for-Service	1831439553	1831439553	1	1	PERAZA, ERNESTO LMFT	9/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	504	ENCINO	CA	91436	2914	19	06037	34.15524484	-118.4756687	Los Angeles County
23530	Fee-for-Service	1669524831	1669524831	1	2	PINNACLE HEALTH CORP	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	APEX HOME HEALTH CARE SV	520 N MAIN STREET	SUITE 200	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
23551	Fee-for-Service	1548817836	1548817836	1	2	PREMIER NEPHROLOGY OF ORANGE	12/9/2019	246ZN0300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COUNTY INC	15825 LAGUNA CANYON RD	SUITE 202	IRVINE	CA	92618	2125	30	06059	33.66406324	-117.7638431	Orange County
23563	Fee-for-Service	1922367572	1922367572	1	1	PATEL, PALAK J MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142046	None	None	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
23571	Fee-for-Service	1407840697	1407840697	1	1	PATEL, DEVESH N MD	10/20/2005	193400000X	NA	Other	026	PHYSICIANS	89330	41	Internal Medicine	0	In state provider	None	130 W ROUTE 66	STE 302	GLENDORA	CA	91740	6252	19	06037	34.12865951	-117.8651745	Los Angeles County
23576	Fee-for-Service	1679583231	1679583231	1	1	PIERCE, LASHA K MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75116	None	None	0	In state provider	None	6301 3RD ST	None	SAN FRANCISCO	CA	94124	3501	38	06075	37.72070671	-122.3963144	San Francisco County
23604	Fee-for-Service	1508417817	1508417817	1	1	PRECIOUS HOSPICE CARE	4/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	126 S JACKSON ST	STE 307	GLENDALE	CA	91205	4920	19	06037	34.14533965	-118.2500741	Los Angeles County
23607	Fee-for-Service	1861544850	1861544850	1	1	PITT, WILLIAM A MD	7/31/1983	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23081	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
23618	Fee-for-Service	1164476602	1164476602	1	1	PEAN, JULES MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51988	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
23627	Fee-for-Service	1366853640	1366853640	1	1	PACHECO, LATIFA A DO	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15467	01	General Practice	0	In state provider	None	9201 BIG HORN BOULEVARD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
23646	Fee-for-Service	1821059890	1821059890	1	1	PEREIRA, SHARLENE C MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80062	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
23658	Fee-for-Service	1184083644	1184083644	1	1	PORTERVILLE PHARMACY INC	7/27/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	406 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3321	54	06107	36.06957953	-119.0261683	Tulare County
23673	Fee-for-Service	1578528485	1578528485	1	1	POSTEL, JOACHIM M MD	10/1/1999	2086S0129X	NA	General Surgery	026	PHYSICIANS	42262	05	Anesthesiology	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
23686	Fee-for-Service	1831132711	1831132711	1	1	PALACIOS, GUILLERMO A MD	2/29/2024	2085R0205X	NA	Other	026	PHYSICIANS	105760	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
23699	Fee-for-Service	1033246822	1033246822	1	1	PETERS, WILLIAM R LMFT	5/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
23723	Fee-for-Service	1083684872	1083684872	1	1	POSNER, STEVEN R	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82743	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 505	ANAHEIM	CA	92801	2812	30	06059	33.84718298	-117.933758	Orange County
23728	Fee-for-Service	1942369012	1942369012	1	1	PLANNED PARENTHOOD:	5/17/1984	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHASTA-DIABLO, INC	303 SACRAMENTO STREET	None	VALLEJO	CA	94590	5901	48	06095	38.09964602	-122.2583497	Solano County
23752	Fee-for-Service	1427355874	1427355874	1	1	PARTNERS URGENT CARE-UTC	4/3/2012	261QE0002X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4085 GOVERNOR DR	None	SAN DIEGO	CA	92122	2522	37	06073	32.8545512	-117.2023034	San Diego County
23756	Fee-for-Service	1033422951	1033422951	1	1	PAULSON, ERIK E DO	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13403	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
23769	Fee-for-Service	1245915131	1245915131	1	1	PATTON, VICTORIA J PT	9/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
23792	Fee-for-Service	1033346812	1033346812	1	1	POWERS, MATTHEW E MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108384	33	Thoracic Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
23803	Fee-for-Service	1932413713	1932413713	1	1	PIRNIA, NICHOLAS H MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103859	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
23849	Fee-for-Service	1861768152	1861768152	1	1	PATEL, TEJAS K MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142113	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
23866	Fee-for-Service	1679596191	1679596191	1	1	POTTS, LARRY MD	5/31/1983	207P00000X	NA	Other	026	PHYSICIANS	27602	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
23871	Fee-for-Service	1356363360	1356363360	1	1	PERRY, MATTHEW R	10/1/1998	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	644 E REGENT ST	STE 101	INGLEWOOD	CA	90301	1439	19	06037	33.96448447	-118.345059	Los Angeles County
23882	Fee-for-Service	1083343180	1083343180	1	1	PLANET RX, INC.	6/24/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16229 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	6910	19	06037	34.25744546	-118.485693	Los Angeles County
23895	Fee-for-Service	1003147257	1003147257	1	1	PEOPLES, BLAIR P MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125196	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
23909	Fee-for-Service	1265426274	1265426274	1	1	PHANTHOLT, STEPHEN J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 S. CATON AVENUE	None	BALTIMORE	MD	21229	5207	00	None	39.27291925	-76.67100365	Baltimore city
23920	Fee-for-Service	1669551255	1669551255	1	1	PSYCHIATRIC MEDICAL GROUP OF	11/25/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	MODESTO, INC	3425 COFFEE ROAD	SUITE 2A	MODESTO	CA	95355	1582	50	06099	37.687914	-120.9761055	Stanislaus County
23929	Fee-for-Service	1609471481	1609471481	1	1	PALISPIS, YLEMRAM D CRNA	1/6/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
23961	Fee-for-Service	1578528485	1578528485	1	1	POSTEL, JOACHIM M MD	10/1/1999	2086S0129X	NA	General Surgery	026	PHYSICIANS	42262	33	Thoracic Surgery	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
23994	Fee-for-Service	1538840244	1538840244	1	1	PARTNERS IN CARE OF ADDISON	1/16/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	WAY INC	4659 STRATFORD PLACE	None	PERRIS	CA	92571	5155	33	06065	33.854139	-117.209106	Riverside County
23997	Fee-for-Service	1831270362	1831270362	1	1	PENUNURI, RAFAEL A MD	10/13/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	50737	-	NOT APPLICABLE	0	In state provider	None	2900 BRISTOL STREET	SUITE E103	COSTA MESA	CA	92626	7906	30	06059	33.67689875	-117.8872016	Orange County
24011	Fee-for-Service	1811428220	1811428220	1	1	PATEL, HARSHIL	8/23/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171074	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
24013	Fee-for-Service	1154358075	1154358075	1	1	PERLMAN, BARRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
24040	Fee-for-Service	1548281496	1548281496	1	1	POTENZA, BRUCE M MD MPH	8/9/1993	2086S0102X	NA	General Surgery	026	PHYSICIANS	77333	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
24042	Fee-for-Service	1700457504	1700457504	1	1	PROHEALTH PARTNERS A MEDICAL	3/14/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3224 SANTA ANA ST	None	SOUTH GATE	CA	90280	2306	19	06037	33.9635023	-118.2111523	Los Angeles County
24046	Fee-for-Service	1801944855	1801944855	1	1	PATEL, JAYANA MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66876	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
24052	Fee-for-Service	1851685432	1851685432	1	1	PIOTROWSKI, ANNA A MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134907	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
24077	Fee-for-Service	1013408434	1013408434	1	1	PRORESULTS PHYSICAL THERAPY	8/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC.	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
24100	Fee-for-Service	1144566050	1144566050	2	1	PHARMEDQUEST PHARMACY SERVIC	10/22/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	451 W. LAMBERT RD	SUITE 209	BREA	CA	92821	3920	30	06059	33.92478245	-117.9016438	Orange County
24123	Fee-for-Service	1891046744	1891046744	1	1	PENA, ANITA	7/6/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
24140	Fee-for-Service	1285263046	1285263046	1	1	PATEL, SHASHVAT MD	2/20/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	191096	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
24171	Fee-for-Service	1356337331	1356337331	2	1	PHAN T. NGUYEN	2/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3301 MATLOCK RD	None	ARLINGTON	TX	76015	2908	00	None	32.692662	-97.1125785	Tarrant County
24227	Fee-for-Service	1174695902	1174695902	1	1	PONT, JOAN M MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46223	41	Internal Medicine	0	In state provider	None	1350 S ELISEO DR	None	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
24250	Fee-for-Service	1578528485	1578528485	1	1	POSTEL, JOACHIM M MD	10/1/1999	2086S0129X	NA	General Surgery	026	PHYSICIANS	42262	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
24271	Fee-for-Service	1598874992	1598874992	1	1	PAYLESS DRUG STORE 6058	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	31 FAIR LN	None	PLACERVILLE	CA	95667	3922	09	06017	38.72207966	-120.8333548	El Dorado County
24283	Fee-for-Service	1144380726	1144380726	1	1	PHILLIPS, REBECCA	10/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 220	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
24286	Fee-for-Service	1831200195	1831200195	1	1	PRIORITY CARE MEDICAL GROUP	2/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61014	08	Family Practice	0	In state provider	INC	18663 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6709	30	06059	33.69170358	-117.9543032	Orange County
24307	Fee-for-Service	1184645020	1184645020	1	1	PHUNG, MAI T DO	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12194	01	General Practice	0	In state provider	None	7551 MADISON AVENUE	None	CARMICHAEL	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
24317	Fee-for-Service	1184730780	1184730780	1	1	PINTO, MONEESHA M MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60932	41	Internal Medicine	0	In state provider	None	2115 S CENTERPOINTE PKWY	None	SANTA MARIA	CA	93455	1334	42	06083	34.92292048	-120.428709	Santa Barbara County
24323	Fee-for-Service	1780808550	1780808550	1	1	PHYSICAL THERAPY & SPORTS	6/30/1993	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INJURY REHABILITATION	16311 VENTURA BLVD	SUITE 955	ENCINO	CA	91436	4339	19	06037	34.15706864	-118.4885978	Los Angeles County
24333	Fee-for-Service	1356531321	1356531321	1	1	PEDIATRIC SUBSPLTY FACUL	4/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	PEDIATRIC PULMONOLOGY	1201 W LA VETA AVE	STE 201	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
24344	Fee-for-Service	1093062796	1093062796	1	1	PERITONEAL DIALYSIS CENTER	7/23/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA-SAN GABRIEL	809 S ATLANTIC BLVD	STE 103	MONTEREY PARK	CA	91754	4756	19	06037	34.05248855	-118.1371554	Los Angeles County
24378	Fee-for-Service	1417023409	1417023409	1	1	PATHOLOGY & LABORATORY	11/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
24390	Fee-for-Service	1114239571	1114239571	1	1	PIKUL B PATEL M.D	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1215 E COURT ST	None	SEGUIN	TX	78155	5129	00	None	29.569055	-97.94688981	Guadalupe County
24412	Fee-for-Service	1760550420	1760550420	1	1	PAN, JENNY S MD	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43079	40	Pediatrics	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
24421	Fee-for-Service	1881764298	1881764298	1	1	PEDIATRIC MEDICAL CENTER	8/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2921 REDONDO AVE	None	LONG BEACH	CA	90806	2415	19	06037	33.808185	-118.1513675	Los Angeles County
24438	Fee-for-Service	1760587950	1760587950	1	1	PINEDA, ROSIE	10/1/2006	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	171 E ROWLAND ST	None	COVINA	CA	91723	3049	19	06037	34.0790973	-117.8882424	Los Angeles County
24447	Fee-for-Service	1326672940	1326672940	1	1	PEDLAR, ANNIE NP	11/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
24473	Fee-for-Service	1205032950	1205032950	1	1	PARHAM, CHRISTOPHER A MD	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108378	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24483	Fee-for-Service	1952185050	1952185050	1	1	PINCKNEY, KEITHA NP	7/16/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95030270	-	NOT APPLICABLE	0	In state provider	None	320 E PALMDALE BLVD	None	PALMDALE	CA	93550	4598	19	06037	34.57983613	-118.1240079	Los Angeles County
24531	Fee-for-Service	1093814113	1093814113	2	1	PC MEDICAL CLINIC INC	10/7/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	27141 HIDAWAY AVE	204	SANTA CLARITA	CA	91351	4147	19	06037	34.41483	-118.469039	Los Angeles County
24535	Fee-for-Service	1578838520	1578838520	1	7	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED, APC	2547 W SHAW AVE	SUITE 114	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
24552	Fee-for-Service	1043567399	1043567399	1	1	PERKINS, COLETTE A LMFT	2/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	193 BLUE RAVINE RD	SUITE #220	FOLSOM	CA	95630	4756	34	06067	38.653461	-121.17996	Sacramento County
24563	Fee-for-Service	1336210269	1336210269	1	1	PAREKH, ASHISH R MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78830	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
24618	Fee-for-Service	1962595769	1962595769	1	1	PELTZ, GARY A MD	11/30/1988	207R00000X	NA	Other	026	PHYSICIANS	54530	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24620	Fee-for-Service	1356531321	1356531321	1	1	PEDIATRIC SUBSPLTY FACUL	4/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC PULMONOLOGY	1201 W LA VETA AVE	STE 201	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
24625	Fee-for-Service	1386095925	1386095925	1	1	PARKER EMERGENCY SERVICES	8/10/2016	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	LLC	1200 W MOHAVE ROAD	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
24655	Fee-for-Service	1962488304	1962488304	1	1	PRESBYTERIAN HEALTHCARE	10/13/2011	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	301 E MIEL DR LUNA	None	TUCUMCARI	NM	88401	3810	00	None	35.15633071	-103.7235819	Quay County
24669	Fee-for-Service	1376991380	1376991380	1	1	PUNJABI, SHAMITA MD	6/18/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	153562	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
24683	Fee-for-Service	1720279599	1720279599	1	1	PANCHAL, VISHAL J MD	7/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107478	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
24703	Fee-for-Service	1508051939	1508051939	1	1	PATEL, MINESH N MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125286	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
24760	Fee-for-Service	1790909968	1790909968	1	1	PAZ, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69435	05	Anesthesiology	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
24785	Fee-for-Service	1992142384	1992142384	1	1	PENDHARKAR, ARJUN V MD	5/26/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	137709	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
24791	Fee-for-Service	1649904806	1649904806	1	1	PHAM, PETER M	8/17/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
24796	Fee-for-Service	1306224985	1306224985	1	1	PATEL, SANDEEP P DPM	12/12/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24819	Fee-for-Service	1093814113	1093814113	2	1	PC MEDICAL CLINIC INC	6/10/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	27141 HIDAWAY AVE	204	SANTA CLARITA	CA	91351	4147	19	06037	34.41483	-118.469039	Los Angeles County
24823	Fee-for-Service	1578838520	1578838520	1	7	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INCORPORATED, APC	2547 W SHAW AVE	SUITE 114	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
24831	Fee-for-Service	1245359892	1245359892	2	1	PUNATI, JAYA B MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117571	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
24836	Fee-for-Service	1063590677	1063590677	1	1	PATTERSON, MARK A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35400	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
24873	Fee-for-Service	1033260377	1033260377	1	1	PALO VERDE UNIFIED SCHOOL	6/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	825 NORTH LOVEKIN STREET	None	BLYTHE	CA	92225	1703	33	06065	33.62349303	-114.6058323	Riverside County
24884	Fee-for-Service	1750352167	1750352167	1	1	PAGE, WILLIAM R MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	38630	34	Urology and Urological Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
24906	Fee-for-Service	1285053330	1285053330	1	1	PINA, GABRIELLE A DO	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14299	None	None	0	In state provider	None	25845 BARTON ROAD	SUITE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
24909	Fee-for-Service	1962595769	1962595769	1	1	PELTZ, GARY A MD	11/30/1988	207R00000X	NA	Other	026	PHYSICIANS	54530	83	Rheumatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24935	Fee-for-Service	1821040866	1821040866	1	1	PHAM,JUSTIN H MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71126	30	Radiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
24947	Fee-for-Service	1962488304	1962488304	1	1	PRESBYTERIAN HEALTHCARE	10/13/2011	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	301 E MIEL DR LUNA	None	TUCUMCARI	NM	88401	3810	00	None	35.15633071	-103.7235819	Quay County
24955	Fee-for-Service	1134488034	1134488034	2	1	PHARMACY4HUMANITY	5/31/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5356 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4032	19	06037	34.01989465	-118.1549717	Los Angeles County
24995	Fee-for-Service	1700889607	1700889607	1	1	PENNOCK, GREGORY D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6206 E PIMA ST	STE 4	TUCSON	AZ	85712	7001	00	None	32.242626	-110.85993	Pima County
25008	Fee-for-Service	1316041833	1316041833	2	30	PEDIATRIX MEDICAL GROUP OF C	10/6/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
25037	Fee-for-Service	1467693408	1467693408	1	1	PAREDES, MARIGOLD NP	7/13/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8001 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
25087	Fee-for-Service	1003996216	1003996216	1	1	PRESIDIO MEDICAL GROUP	12/1/1997	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	4440 LAMONT ST	None	SAN DIEGO	CA	92109	4560	37	06073	32.79985626	-117.2350361	San Diego County
25098	Fee-for-Service	1275752362	1275752362	1	1	PATEL, ARTY C PT	9/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
25155	Fee-for-Service	1326032830	1326032830	1	1	PENINSULA ENT MED GRP IN	7/25/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	1828 EL CAMINO REAL	STE 704	BURLINGAME	CA	94010	3122	41	06081	37.59552262	-122.3838771	San Mateo County
25159	Fee-for-Service	1336433408	1336433408	1	1	PHYSICAL THERAPY OF TEMECULA	8/2/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29826 HAUN ROAD	SUITE 106	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
25215	Fee-for-Service	1558624874	1558624874	1	1	PATEL, AMY D MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130694	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
25234	Fee-for-Service	1467664185	1467664185	1	2	PEARSON-PLUMMER, ELIZABETH	10/27/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	19690	-	NOT APPLICABLE	0	In state provider	PHD	2055 SAVIERS ROAD	SUITE A	OXNARD	CA	93033	3608	56	06111	34.179219	-119.1776065	Ventura County
25266	Fee-for-Service	1497819361	1497819361	2	1	PURDOM II, KENNETH R II MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	21180	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12311 NORWALK BLVD	None	NORWALK	CA	90650	2039	19	06037	33.91930525	-118.0727385	Los Angeles County
25267	Fee-for-Service	1487682613	1487682613	1	1	PAUL E WILLIAMS	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
25277	Fee-for-Service	1699004564	1699004564	1	1	POTTER, HEATHER M PT	7/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25251 PASEO DE ALICIA	SUITE 201	LAGUNA HILLS	CA	92653	4616	30	06059	33.60148289	-117.6894952	Orange County
25291	Fee-for-Service	1790780070	1790780070	2	1	PEARSONS MEDICAL GROUP	7/26/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
25296	Fee-for-Service	1023373040	1023373040	1	1	PHREANER, NICHOLAS J MD	6/17/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	126789	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25301	Fee-for-Service	1467668772	1467668772	1	1	PARK, SUSAN Y MD	12/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94505	None	None	0	In state provider	None	8750 WILSHIRE BLVD	SUITE 100	BEVERLY HILLS	CA	90211	2713	19	06037	34.06685846	-118.3829408	Los Angeles County
25347	Fee-for-Service	1437688462	1437688462	1	1	PORDAL, ANGAD MD	2/14/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
25367	Fee-for-Service	1982015210	1982015210	1	1	PHAN, JENNY Q DO	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13101	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
25377	Fee-for-Service	1316373681	1316373681	1	1	PANEK, KRISTI AU	1/8/2024	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	26726 CROWN VALLEY PKWY	STE 210	MISSION VIEJO	CA	92691	8006	30	06059	33.56385623	-117.6639538	Orange County
25413	Fee-for-Service	1710031588	1710031588	1	20	PROVIDENCE FACEY MEDICAL FOU	7/6/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9111 CORBIN AVE	None	NORTHRIDGE	CA	91324	2402	19	06037	34.235784	-118.5623255	Los Angeles County
25417	Fee-for-Service	1750046785	1750046785	1	1	PASA ALTA HOLDINGS INC	12/9/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1790 N FAIR OAKS AVE	None	PASADENA	CA	91103	1617	19	06037	34.17638445	-118.1507161	Los Angeles County
25445	Fee-for-Service	1225800667	1225800667	1	1	PACIFIC GOLDEN GATE LLC	11/13/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5421 SHADOW STONE ST	None	BAKERSFIELD	CA	93313	4321	15	06029	35.30566071	-119.0883401	Kern County
25462	Fee-for-Service	1619462314	1619462314	1	1	PARK, KEVIN MD	10/18/2023	207L00000X	NA	Other	026	PHYSICIANS	164626	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
25472	Fee-for-Service	1306904305	1306904305	1	1	PARRY, SIOBHAN M CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
25479	Fee-for-Service	1528030665	1528030665	1	1	PAUL H LIN MD	12/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
25482	Fee-for-Service	1235587007	1235587007	1	1	PATEL, APEKSHA U MD	11/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168869	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
25484	Fee-for-Service	1134207863	1134207863	1	1	PHAM, TAN H MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91398	34	Urology and Urological Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
25489	Fee-for-Service	1730757071	1730757071	1	1	PARK, ELLENNE J PT	4/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
25509	Fee-for-Service	1609806900	1609806900	1	1	PARKER, JONI R MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81690	01	General Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
25527	Fee-for-Service	1982255055	1982255055	1	1	PEREIRA-WEISS, JENIFER LMFT	4/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
25547	Fee-for-Service	1538431432	1538431432	1	2	PREVENTIVE CARE PATHWAYS	7/14/2023	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5709 MARKET ST STE A	None	OAKLAND	CA	94608	2811	01	06001	37.84173278	-122.2745576	Alameda County
25564	Fee-for-Service	1346360930	1346360930	1	1	PDAP OF VENTURA COUNTY, INC	4/14/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	450 ROSEWOOD AVENUE	SUITE 215	CAMARILLO	CA	93010	5914	56	06111	34.22053776	-119.0615694	Ventura County
25565	Fee-for-Service	1629033782	1629033782	1	1	PFAHLER, JOLIE H MD	5/31/1995	193400000X	NA	Other	026	PHYSICIANS	80734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
25567	Fee-for-Service	1568400208	1568400208	1	1	POPULAR MED CLINIC INC	4/29/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	420 S BRISTOL ST	None	SANTA ANA	CA	92703	4527	30	06059	33.74216489	-117.8852849	Orange County
25578	Fee-for-Service	1316041833	1316041833	2	34	PEDIATRIX MEDICAL GROUP OF C	1/8/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	30 MARK WEST SPRINGS	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
25672	Fee-for-Service	1760063390	1760063390	1	1	PELLEGRINI, ERIC MD	1/8/2025	390200000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
25700	Fee-for-Service	1710031588	1710031588	1	20	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9111 CORBIN AVE	None	NORTHRIDGE	CA	91324	2402	19	06037	34.235784	-118.5623255	Los Angeles County
25702	Fee-for-Service	1366468746	1366468746	1	1	PERSON, CHERYL MD	2/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	156677	None	None	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
25704	Fee-for-Service	1801141692	1801141692	1	1	PAPAZIAN, JASON H MD	2/25/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
25726	Fee-for-Service	1740478395	1740478395	1	1	POULLOS, PETER D MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73516	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
25754	Fee-for-Service	1245401033	1245401033	1	1	PAN, YANN Y MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105981	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
25764	Fee-for-Service	1396759817	1396759817	1	1	PATEL, NITA H MD	2/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52978	40	Pediatrics	0	In state provider	None	2400 BALFOUR RD	STE 229	BRENTWOOD	CA	94513	4945	07	06013	37.92519383	-121.734461	Contra Costa County
25807	Fee-for-Service	1184704504	1184704504	1	1	PATEL, BINITA MD	5/26/2023	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
25808	Fee-for-Service	1962519868	1962519868	1	1	PROFESSIONAL MED CLINIC	9/1/1981	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOR WOMEN SACRAMENTO INC	7237 E SOUTHGATE DR	STE C	SACRAMENTO	CA	95823	2637	34	06067	38.494629	-121.435686	Sacramento County
25825	Fee-for-Service	1952366676	1952366676	1	1	PAUL JEFFREY SULLIVAN,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
25878	Fee-for-Service	1932701562	1932701562	1	1	PIAZZA, ANDREA LPCC	3/10/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
25893	Fee-for-Service	1780746297	1780746297	1	1	POWELL, DEBORAH R	5/20/2016	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	UNIV AUDIOLOGIC ASSOCS	1325 HOWE AVE	STE 101	SACRAMENTO	CA	95825	3364	34	06067	38.590191	-121.416624	Sacramento County
25950	Fee-for-Service	1710483607	1710483607	1	1	POKHAREL, ANU MD	9/22/2021	207R00000X	NA	Other	026	PHYSICIANS	166161	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
25988	Fee-for-Service	1710031588	1710031588	1	20	PROVIDENCE FACEY MEDICAL FOU	7/6/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9111 CORBIN AVE	None	NORTHRIDGE	CA	91324	2402	19	06037	34.235784	-118.5623255	Los Angeles County
26002	Fee-for-Service	1639227556	1639227556	1	1	PHILLIPSON, JULIA MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62074	22	Pathology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26004	Fee-for-Service	1346516143	1346516143	1	2	PHANG, SAMUEL K MD	11/1/2018	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 VIA MARINA AVE	None	OXNARD	CA	93035	0000	56	06111	34.18842594	-119.2120922	Ventura County
26009	Fee-for-Service	1528448958	1528448958	1	1	PUCCINELLI, CASSANDRA L MD	7/6/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	168750	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
26029	Fee-for-Service	1740644111	1740644111	1	1	PATEL, KARISHMA M MD	12/19/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	161454	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
26033	Fee-for-Service	1174652267	1174652267	1	1	PETERS, LIZETH	9/17/2022	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1274 CENTER COURT DR	#112	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
26044	Fee-for-Service	1245401033	1245401033	1	1	PAN, YANN Y MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105981	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
26082	Fee-for-Service	1942210943	1942210943	1	1	PATEL, MIHIR B MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71546	41	Internal Medicine	0	In state provider	None	1654 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1603813	Los Angeles County
26087	Fee-for-Service	1255416939	1255416939	1	1	PATEL, SNEHA P MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88705	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
26092	Fee-for-Service	1639791353	1639791353	1	1	PAM CARE HOSPICE	9/9/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5300 SANTA MONICA BLVD	SUITE 307	LOS ANGELES	CA	90029	1259	19	06037	34.09075271	-118.305509	Los Angeles County
26120	Fee-for-Service	1598341000	1598341000	1	1	POGOSYAN, YANA NP	7/27/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
26137	Fee-for-Service	1700231370	1700231370	1	1	PHAM, KATIE NP	5/26/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
26156	Fee-for-Service	1275580250	1275580250	1	1	PASCUZZI, THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7920 CARMEL AVE NE	STE 1	ALBUQUERQUE	NM	87122	3056	00	None	35.17714152	-106.5574845	Bernalillo County
26160	Fee-for-Service	1356685218	1356685218	1	7	PACIFIC NEUROPSYCHIATRIC SPE	3/29/2021	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	26024 ACERO	None	MISSION VIEJO	CA	92691	2768	30	06059	33.61784172	-117.6769661	Orange County
26178	Fee-for-Service	1407983026	1407983026	1	1	PUTINI, MICHELE A LMFT	5/23/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2335 W FOOTHILL BLVD	SUITE 11	UPLAND	CA	91786	3577	36	06071	34.1069073	-117.6972257	San Bernardino County
26183	Fee-for-Service	1992839310	1992839310	1	1	POYNTER, GAYLE M LCSW	11/7/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
26192	Fee-for-Service	1770925810	1770925810	1	1	PALLAN, MONICA L LMFT	6/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
26202	Fee-for-Service	1215961701	1215961701	1	1	POTTS, ROBERT C JR MD	3/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51763	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
26228	Fee-for-Service	1942648449	1942648449	1	1	PEREZ, ALYSSA A MD	8/17/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	147944	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26234	Fee-for-Service	1104884931	1104884931	1	1	PAZ, CELESTE A OD	12/31/1984	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 MOWRY AVE	STE 106	FREMONT	CA	94538	1509	01	06001	37.55425535	-121.9836939	Alameda County
26276	Fee-for-Service	1710031588	1710031588	1	20	PROVIDENCE FACEY MEDICAL FOU	7/6/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	9111 CORBIN AVE	None	NORTHRIDGE	CA	91324	2402	19	06037	34.235784	-118.5623255	Los Angeles County
26303	Fee-for-Service	1720826787	1720826787	1	1	PUTA, ERINDA MD	1/23/2025	207U00000X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
26307	Fee-for-Service	1760584049	1760584049	2	1	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	88 MESA RD	None	BOLINAS	CA	94924	9713	21	06041	37.91055483	-122.6971512	Marin County
26324	Fee-for-Service	1700873023	1700873023	1	1	PICHAKRON, KULLADA O MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92499	02	General Surgery	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
26365	Fee-for-Service	1962471961	1962471961	1	1	PRAVIN, PARESH H MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76056	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
26379	Fee-for-Service	1639791353	1639791353	1	1	PAM CARE HOSPICE	9/9/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5300 SANTA MONICA BLVD	SUITE 307	LOS ANGELES	CA	90029	1259	19	06037	34.09075271	-118.305509	Los Angeles County
26451	Fee-for-Service	1669624532	1669624532	1	1	PASILLAS, CHARLOTTE A LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
26458	Fee-for-Service	1245684554	1245684554	1	1	PARIKH, AMIT A MD	11/30/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171972	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
26461	Fee-for-Service	1881872489	1881872489	1	1	PROCHAZKA, ERNEST J MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51296	01	General Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	None	SAN DIEGO	CA	91942	3014	37	06073	32.781195	-117.0070695	San Diego
26473	Fee-for-Service	1336776301	1336776301	1	1	PARK, JOHN F MD	4/4/2024	207L00000X	NA	Other	026	PHYSICIANS	189126	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
26477	Fee-for-Service	1639275993	1639275993	1	1	PARTAMIAN, LEON N.	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48491	08	Family Practice	0	In state provider	None	1808 VERTIGO BLVD.	None	GLENDALE	CA	91208	0000	19	06037	0	0	None
26484	Fee-for-Service	1982752903	1982752903	1	1	PROTACIO, SUSAN A MD	4/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93832	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
26550	Fee-for-Service	1346399433	1346399433	1	1	PACIFIC VISION MEDICAL	1/1/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CENTER	515 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8342	08	06015	41.77269652	-124.199019	Del Norte County
26589	Fee-for-Service	1811920937	1811920937	1	1	PAPANICKOLAS, WILLIAM L	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77663	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
26594	Fee-for-Service	1760584049	1760584049	2	1	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	88 MESA RD	None	BOLINAS	CA	94924	9713	21	06041	37.91055483	-122.6971512	Marin County
26603	Fee-for-Service	1659802742	1659802742	1	1	PHANGUREH, INDERPARTAP S MD	12/10/2021	207R00000X	NA	Other	026	PHYSICIANS	171873	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
26635	Fee-for-Service	1710031588	1710031588	1	16	PROVIDENCE FACEY MEDICAL FOU	4/10/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
26638	Fee-for-Service	1386748614	1386748614	1	1	PID ASSOCIATES MED GROUP	8/16/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
26663	Fee-for-Service	1174624654	1174624654	1	1	PITUKCHEEWANONT, P MD	3/1/1998	2080P0205X	NA	Endocrinology	026	PHYSICIANS	64844	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
26667	Fee-for-Service	1598143133	1598143133	2	1	PHARMACY4HUMANITY	5/30/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1988 HACIENDA DR	None	VISTA	CA	92081	6026	37	06073	33.18501367	-117.2846232	San Diego County
26669	Fee-for-Service	1538138631	1538138631	1	1	POLANCO, TRACY L MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80610	08	Family Practice	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
26670	Fee-for-Service	1568570372	1568570372	1	1	PALMER, DENNIS L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S CLARK ST	None	BUTTLE	MT	59701	0000	00	None	46.00840837	-112.5461616	Silver Bow County
26672	Fee-for-Service	1184027104	1184027104	1	4	PACIFIC SKIN INSTITUTE	8/19/2022	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	9291 LAGUNA SPRINGS DR	120	ELK GROVE	CA	95758	7843	34	06067	38.420397	-121.396392	Sacramento County
26706	Fee-for-Service	1225260268	1225260268	1	1	PAO, CHRISTINE H LCSW	4/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
26710	Fee-for-Service	1366016578	1366016578	1	1	PERRY, MEGAN	10/18/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	556 N 1ST ST	SUITE 201	SAN JOSE	CA	95112	5300	43	06085	37.34591974	-121.8977166	Santa Clara County
26722	Fee-for-Service	1942239751	1942239751	1	1	POSADA AMBULATORY SURGERY	6/4/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LP	322 POSADA LANE	STE B	TEMPLETON	CA	93465	4003	40	06079	35.55263004	-120.7215336	San Luis Obispo County
26726	Fee-for-Service	1558348094	1558348094	1	1	POPA, BOGDAN R MD	7/1/2001	207L00000X	NA	Other	026	PHYSICIANS	60994	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
26737	Fee-for-Service	1841225869	1841225869	1	1	PAGE, JON P MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96171	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
26746	Fee-for-Service	1104215151	1104215151	1	1	PROHEALTH PARTNERS AMC INC	3/30/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
26763	Fee-for-Service	1316041833	1316041833	2	3	PEDIATRIX MEDICAL GROUP OF C	11/6/2019	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
26803	Fee-for-Service	1154344604	1154344604	1	1	PARKER, NEIL H MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	24845	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	# 32220	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
26832	Fee-for-Service	1801986617	1801986617	1	1	PACIFIC AUDIOLOGICAL	1/1/1979	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	9033 BASE LINE ROAD	SUITE F	RANCHO CUCAMONGA	CA	91730	1214	36	06071	34.12151248	-117.6080805	San Bernardino County
26833	Fee-for-Service	1891321899	1891321899	1	1	PETTWAY, BRIA L MD	11/15/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187154	15	Obstetrics (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
26883	Fee-for-Service	1023640950	1023640950	1	1	PALMAS, KASSANDRA LMFT	3/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
26924	Fee-for-Service	1710031588	1710031588	1	16	PROVIDENCE FACEY MEDICAL FOU	4/10/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
26935	Fee-for-Service	1205106754	1205106754	1	1	PRIETO, ANN LMFT	8/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
26947	Fee-for-Service	1699877654	1699877654	1	1	PEARSDICKSON, ROCHELLE M LCS	12/12/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5150 SUNRISE BLVD	NO. G-5	FAIR OAKS	CA	95628	4939	34	06067	38.659716	-121.2717105	Sacramento County
26952	Fee-for-Service	1174624654	1174624654	1	1	PITUKCHEEWANONT, P MD	3/1/1998	2080P0205X	NA	Endocrinology	026	PHYSICIANS	64844	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
26957	Fee-for-Service	1003456112	1003456112	1	1	PIROOZ, NEGAR D OD	9/11/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
26978	Fee-for-Service	1548224421	1548224421	1	1	PIGEON, GAIL NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	570 W BROWN RD	None	MESA	AZ	85201	3227	00	None	33.434577	-111.8444355	Maricopa County
26982	Fee-for-Service	1093969115	1093969115	1	19	PLANNED PARENTHOOD OF LA	10/12/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	825 W 60TH ST	None	LOS ANGELES	CA	90044	5512	19	06037	33.98552745	-118.2880643	Los Angeles County
27006	Fee-for-Service	1194987263	1194987263	1	1	PROMOD KUMAR, RAMACHANDRAN P	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137836	14	Neurological Surgery	0	In state provider	MD	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
27023	Fee-for-Service	1881012235	1881012235	1	1	PREST, LAUREN C DO	9/22/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21376	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
27049	Fee-for-Service	1477101897	1477101897	1	1	PRESPECTIVE HOSPICE INC	9/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	STE 201	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
27051	Fee-for-Service	1114053360	1114053360	1	1	PARNES, JANE MD	6/30/1985	207K00000X	NA	Other	026	PHYSICIANS	47153	01	General Practice	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
27052	Fee-for-Service	1316041833	1316041833	2	13	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	309 BEVERLY	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
27121	Fee-for-Service	1891321899	1891321899	1	1	PETTWAY, BRIA L MD	11/15/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187154	09	Gynecology (D.O. only)	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
27123	Fee-for-Service	1336224377	1336224377	2	2	PYRAMIDS PHARMACY CORP	6/20/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1121 SOUTH STATE STREET	None	HEMET	CA	92543	7635	33	06065	33.7292124	-116.9716135	Riverside County
27134	Fee-for-Service	1114339207	1114339207	1	1	PARKVIEW MEDICAL GROUP INC	6/15/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9041 MAGNOLIA AVE	SUITE 107	RIVERSIDE	CA	92503	3900	33	06065	33.92541585	-117.4378266	Riverside County
27151	Fee-for-Service	1538507587	1538507587	1	2	PROHEALTH HOME CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1776 WEST MARCH LANE	SUITE 400B	STOCKTON	CA	95207	6450	39	06077	37.98763864	-121.3270969	San Joaquin County
27189	Fee-for-Service	1962567321	1962567321	1	1	PAK, JAEWOO	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77617	None	None	0	In state provider	None	11841 SOUTH ST	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
27207	Fee-for-Service	1306299524	1306299524	1	1	PEARCE, TARA R	5/26/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
27213	Fee-for-Service	1710031588	1710031588	1	16	PROVIDENCE FACEY MEDICAL FOU	4/10/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
27237	Fee-for-Service	1497381909	1497381909	1	1	PERILLO, CRISTINA PT	4/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
27248	Fee-for-Service	1942620976	1942620976	1	1	PANTHER DIALYSIS LLC	9/2/2015	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	29878 HAUN RD	SUITE 100	MENIFEE	CA	92586	6531	33	06065	33.68616926	-117.1753127	Riverside County
27252	Fee-for-Service	1376932905	1376932905	1	1	PHI, KATHY THAO	7/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
27275	Fee-for-Service	1396332813	1396332813	1	1	PACIFIC CENTRAL COAST HEALTH	4/30/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	901 OAK PARK BLVD	SUITE 202	PISMO BEACH	CA	93449	3410	40	06079	35.13460775	-120.6050814	San Luis Obispo County
27278	Fee-for-Service	1245624170	1245624170	1	1	PATZELT, MICHELLE T MD	7/31/2019	207L00000X	NA	Other	026	PHYSICIANS	146467	05	Anesthesiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
27285	Fee-for-Service	1831714013	1831714013	1	1	PASSIONATE HOSPICE AND	5/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6025 N FIGUEROA ST	STE D	LOS ANGELES	CA	90042	1367	19	06037	34.11145162	-118.1890445	Los Angeles County
27328	Fee-for-Service	1851849244	1851849244	1	1	PAZMINO, ISABELLA LMFT	7/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	595 E COLORADO BLVD STE	None	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
27334	Fee-for-Service	1073532065	1073532065	1	1	PAUER, DEBORAH L MD	11/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73272	01	General Practice	0	In state provider	None	3460 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
27336	Fee-for-Service	1477101897	1477101897	1	1	PRESPECTIVE HOSPICE INC	9/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	STE 201	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
27338	Fee-for-Service	1699728188	1699728188	1	5	PHYS MED A PHYSICAL THERAPY	3/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	1209 WHITLEY AVE	None	CORCORAN	CA	93212	2327	16	06031	36.09801547	-119.5628355	Kings County
27356	Fee-for-Service	1588863047	1588863047	1	1	PENSE, BART LMFT	5/16/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
27408	Fee-for-Service	1487737136	1487737136	1	1	PINKERTON,BRUCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
27427	Fee-for-Service	1073142949	1073142949	1	1	PARIKH, ALOMI O MD	8/6/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	188684	18	Ophthalmology	0	In state provider	None	1513 S GRAND AVE	STE 200	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
27429	Fee-for-Service	1447308358	1447308358	1	1	PARME, SUSAN W NP	10/10/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
27438	Fee-for-Service	1538507587	1538507587	1	2	PROHEALTH HOME CARE INC	9/4/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1776 WEST MARCH LANE	SUITE 400B	STOCKTON	CA	95207	6450	39	06077	37.98763864	-121.3270969	San Joaquin County
27455	Fee-for-Service	1467557504	1467557504	1	1	PHREANER, DAVID L MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	80179	08	Family Practice	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
27457	Fee-for-Service	1326068743	1326068743	1	1	PAWLOWSKI, TOMASZ J MD	2/8/2015	207ZP0102X	NA	Other	026	PHYSICIANS	69183	22	Pathology (M.D. only)	0	In state provider	None	15248 11TH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
27461	Fee-for-Service	1285776005	1285776005	1	1	PEARSON, CLIFFORD F	4/1/1983	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2400 LAS GALLINAS AVE	STE 150	SAN RAFAEL	CA	94903	1449	21	06041	38.03313103	-122.5443973	Marin County
27483	Fee-for-Service	1184845398	1184845398	1	1	PLUMAS UNIFIED SD	10/3/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	50 CHURCH STREET	None	QUINCY	CA	95971	9451	32	06063	39.936186	-120.9441425	Plumas County
27503	Fee-for-Service	1710031588	1710031588	1	16	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
27528	Fee-for-Service	1558434589	1558434589	1	1	PENINSULA GASTRO MED GRP	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2900 WHIPPLE AVE	STE 245	REDWOOD CITY	CA	94062	2851	41	06081	37.4783072	-122.2551089	San Mateo County
27530	Fee-for-Service	1477907970	1477907970	1	1	PATEL, RONICA DO	2/17/2022	390200000X	NA	Other	026	PHYSICIANS	16010	None	None	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
27538	Fee-for-Service	1003980566	1003980566	1	1	PAPPAS, PETER B.A. MD	12/1/1999	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	74506	20	Orthopedic Surgery	0	In state provider	None	76 BROOKWOOD AVE	None	SANTA ROSA	CA	95404	4312	49	06097	38.443041	-122.706486	Sonoma County
27539	Fee-for-Service	1710174172	1710174172	1	1	PRAKASH SURYANARAYANA MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
27557	Fee-for-Service	1649655937	1649655937	1	1	PEREA, NATALIE LCSW	8/22/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23945 SUNNYMEAD BLVD.	3	MORENO VALLEY	CA	92553	3025	33	06065	33.93897472	-117.2450469	Riverside County
27568	Fee-for-Service	1831714013	1831714013	1	1	PASSIONATE HOSPICE AND	5/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6025 N FIGUEROA ST	STE D	LOS ANGELES	CA	90042	1367	19	06037	34.11145162	-118.1890445	Los Angeles County
27585	Fee-for-Service	1043263189	1043263189	1	2	PLANNED PARENTHOOD MAR MONTE	1/30/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1694 TULLY ROAD	STE 40	SAN JOSE	CA	95122	2538	43	06085	37.32177408	-121.826526	Santa Clara County
27602	Fee-for-Service	1972053007	1972053007	1	1	PATTERSON, AMBER D	3/20/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
27640	Fee-for-Service	1013049725	1013049725	1	1	PATEL, ANISHA LCSW	8/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1920 OLIVE DR	None	SANTA MARIA	CA	93454	7852	42	06083	34.925922	-120.4309835	Santa Barbara County
27675	Fee-for-Service	1952531030	1952531030	1	1	PARIKH, NEIL G MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115437	41	Internal Medicine	0	In state provider	None	1451 SECRET RAVINE PKWY	SUITE 150	ROSEVILLE	CA	95661	6052	31	06061	38.7647101	-121.2431538	Placer County
27686	Fee-for-Service	1639798044	1639798044	1	1	PERRY, KELSEY A MD	2/25/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
27742	Fee-for-Service	1962576660	1962576660	2	1	PROGRESSIVE AMBULANCE, INC.	7/23/2019	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	350 E RIDGECREST BLVD	SUITE 107	RIDGECREST	CA	93555	3928	15	06029	35.62252049	-117.6644025	Kern County
27790	Fee-for-Service	1770223869	1770223869	1	1	PARK, ELIZABETH LMFT	2/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
27808	Fee-for-Service	1376708479	1376708479	1	1	PUNJABI, KUSUM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 ROBERT WOOD JOHNSON PL	None	NEW BRUNSWICK	NJ	08901	1928	00	None	40.49580805	-74.45050729	Middlesex County
27872	Fee-for-Service	1669452850	1669452850	1	1	PROMES, JOHN T MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133938	02	General Surgery	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
27887	Fee-for-Service	1942501317	1942501317	1	1	PATEL, KANU K MD INC	1/1/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	32124	20	Orthopedic Surgery	0	In state provider	None	7851 WALKER ST	103	LA PALMA	CA	90623	1734	30	06059	33.848253	-118.037309	Orange County
27896	Fee-for-Service	1366447534	1366447534	1	1	PEGASUS HOME HEALTH CARE INC	12/27/1994	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	505 N BRAND BLVD	SUITE 1000	GLENDALE	CA	91203	3945	19	06037	34.153506	-118.255137	Los Angeles County
27905	Fee-for-Service	1871793380	1871793380	1	1	PILLSBURY, EDMUND P MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2874 N CARSON ST	STE 300	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
27922	Fee-for-Service	1316041833	1316041833	2	41	PEDIATRIX MEDICAL GROUP OF C	3/8/2024	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	438 LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
27936	Fee-for-Service	1154046548	1154046548	1	1	PEET, MELISSA NP	11/23/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
27944	Fee-for-Service	1336113489	1336113489	1	1	PACIFIC CANCER MEDICAL	12/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	1801 W ROMNEYA DR	STE 203	ANAHEIM	CA	92801	1830	30	06059	33.8506615	-117.946413	Orange County
27961	Fee-for-Service	1952531030	1952531030	1	1	PARIKH, NEIL G MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115437	03	Allergy	0	In state provider	None	1451 SECRET RAVINE PKWY	SUITE 150	ROSEVILLE	CA	95661	6052	31	06061	38.7647101	-121.2431538	Placer County
27989	Fee-for-Service	1225228703	1225228703	1	1	PROLIFIC HEALTH CARE INC	12/17/2009	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12631 IMPERIAL HWY	SUITE F-228	SANTA FE SPRINGS	CA	90670	4710	19	06037	33.91718487	-118.0627524	Los Angeles County
27994	Fee-for-Service	1366670671	1366670671	1	1	PEARLMAN, BORIS A MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113879	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
28046	Fee-for-Service	1205034873	1205034873	1	1	PRATT, ANN E MD	2/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6554 S MCCARRAN BLVD	STE B	RENO	NV	89509	6149	00	None	39.47663442	-119.7992969	Washoe County
28084	Fee-for-Service	1316916836	1316916836	1	1	PLANNED PARENTHOOD/	6/15/1981	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	14372 BEACH BLVD	None	WESTMINSTER	CA	92683	4578	30	06059	33.75341465	-117.989413	Orange County
28096	Fee-for-Service	1215295662	1215295662	1	1	POURSHALIMI, DANIEL M MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128413	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
28142	Fee-for-Service	1437610490	1437610490	1	1	PEREZ, ADELA C MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	181935	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
28146	Fee-for-Service	1639503386	1639503386	1	1	PERRY, ANDREW MD	5/10/2019	208600000X	NA	General Surgery	026	PHYSICIANS	133182	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
28182	Fee-for-Service	1316041833	1316041833	2	4	PEDIATRIX MEDICAL GROUP OF C	6/1/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
28196	Fee-for-Service	1801161302	1801161302	1	1	PEACE, RUTH A DPM	9/11/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
28203	Fee-for-Service	1205254703	1205254703	1	1	PHAM, HUNG VIET N MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141127	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
28207	Fee-for-Service	1750545141	1750545141	1	1	PADMANABHAN, SRIRANJANI P MD	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138616	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
28229	Fee-for-Service	1225127566	1225127566	1	1	PACIFIC OAKS MED GRP INC	8/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	150 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
28245	Fee-for-Service	1528787157	1528787157	1	1	PERSONAL TOUCH ELDER CARE	1/12/2023	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27926 ROCKWOOD AVENUE	None	MORENO VALLEY	CA	92555	5729	33	06065	33.90846848	-117.1756126	Riverside County
28253	Fee-for-Service	1316021942	1316021942	1	10	PILAR M DE CASTRO & CO	3/25/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10031 ANTIGUA ST	None	ANAHEIM	CA	92804	5371	30	06059	33.81717818	-117.9618647	Orange County
28332	Fee-for-Service	1912007543	1912007543	1	1	PLANTA, MARY M MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64045	08	Family Practice	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
28364	Fee-for-Service	1962026898	1962026898	1	1	PATTERSON-KERR, JENNY D LMFT	8/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2 PADRE PKWY	302A	ROHNERT PARK	CA	94928	2124	49	06097	38.34982429	-122.7083127	Sonoma County
28399	Fee-for-Service	1275627655	1275627655	1	1	PENT, MICHELLE P MD	7/28/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	55145	-	NOT APPLICABLE	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B6	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
28404	Fee-for-Service	1356688394	1356688394	1	1	PULIDO, PATRICIA PHD	3/10/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 N BRAND BLVD	SUITE 603	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
28437	Fee-for-Service	1518995497	1518995497	1	1	PIDOUX, MARCEL R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81222	05	Anesthesiology	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
28449	Fee-for-Service	1205362852	1205362852	1	1	PEAIRS, NICHOLAS R MD	7/7/2021	207P00000X	NA	Other	026	PHYSICIANS	165507	None	None	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
28461	Fee-for-Service	1508123902	1508123902	1	1	PHILLIPS, MONICA R MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110753	22	Pathology (M.D. only)	0	In state provider	None	400 PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
28462	Fee-for-Service	1154785517	1154785517	1	2	PROVIDENT PRIMARY CARE INC	9/18/2024	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3349 G ST.	STE C	MERCED	CA	95340	0978	24	06047	37.32432497	-120.4693064	Merced County
28472	Fee-for-Service	1760462204	1760462204	1	1	PATZ, MARY K MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83228	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
28519	Fee-for-Service	1225127566	1225127566	1	1	PACIFIC OAKS MED GRP INC	8/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	150 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
28536	Fee-for-Service	1316529167	1316529167	1	1	PRESTIGE LIFE HOME HEALTH	3/16/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	5311 TOPANGA CANYON BLVD	STE 208	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
28603	Fee-for-Service	1225059926	1225059926	1	1	PALAPATI, KAVITA MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76381	38	Geriatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
28651	Fee-for-Service	1114952496	1114952496	1	1	PERLMUTTER, AARON M MD	4/9/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	70055	77	Infectious Disease	0	In state provider	None	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	19	06037	34.21957849	-118.6082685	Los Angeles County
28685	Fee-for-Service	1992010193	1992010193	1	1	POLESKY, TREY J LCSW	9/27/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2910 HARRIS ST	None	EUREKA	CA	95503	4811	12	06023	40.78047548	-124.1348625	Humboldt County
28690	Fee-for-Service	1386480200	1386480200	1	1	PEACEFULNESS MENTAL HEALTH I	11/20/2024	261QM0801X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	NC	1906 COMMERCENTER E	210	SAN BERNARDINO	CA	92408	3422	36	06071	34.066692	-117.282329	San Bernardino County
28708	Fee-for-Service	1548279821	1548279821	1	1	PERRY, CAROLINE A MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111038	13	Neurology (M.D. only)	0	In state provider	None	400 TAYLOR BOULEVARD	SUITE 301	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
28721	Fee-for-Service	1346258506	1346258506	1	1	PHYSICAL THERAPY &	12/9/2000	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	WELLNESS CENTER, INC	2490 S MAIN ST	None	RED BLUFF	CA	96080	4337	52	06103	40.15020135	-122.2183126	Tehama County
28729	Fee-for-Service	1265953293	1265953293	1	1	PIDDINGTON, CHRISTINE M LCSW	7/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
28733	Fee-for-Service	1699846519	1699846519	1	1	PAK, SUNG-HI MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73546	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
28743	Fee-for-Service	1982872552	1982872552	1	1	PRABHU, SUJATA P MD	7/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115965	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
28750	Fee-for-Service	1508123902	1508123902	1	1	PHILLIPS, MONICA R MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110753	90	Pathology-Forensic	0	In state provider	None	400 PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
28773	Fee-for-Service	1760989768	1760989768	1	1	PETERSON, JULIA E DO	4/4/2022	208M00000X	NA	Other	026	PHYSICIANS	17829	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
28806	Fee-for-Service	1093969115	1093969115	1	8	PLANNED PARENTHOOD OF LA	2/2/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12431 ROSCOE BLVD	None	SUN VALLEY	CA	91352	3723	19	06037	34.22168751	-118.4040855	Los Angeles County
28876	Fee-for-Service	1508903683	1508903683	1	1	PINE RIDGE TREATMENT CENTER	4/12/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	2727 HIGHLAND DR	None	RUNNING SPRINGS	CA	92382	2303	36	06071	34.20458302	-117.1036536	San Bernardino County
28882	Fee-for-Service	1942371851	1942371851	1	1	PARK, ROBERT J MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60528	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
28890	Fee-for-Service	1225059926	1225059926	1	1	PALAPATI, KAVITA MD	8/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76381	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
28913	Fee-for-Service	1316556608	1316556608	1	1	PERMANENT HOME HEALTH INC	1/5/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1100 E BROADWAY	SUITE 204	GLENDALE	CA	91205	2490	19	06037	34.14622171	-118.2415193	Los Angeles County
28918	Fee-for-Service	1851999767	1851999767	1	1	PHILLEO, ERIN L PT	4/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
28921	Fee-for-Service	1134680010	1134680010	1	1	PRICE, COLLIN M MD	2/16/2023	174400000X	NA	Other	026	PHYSICIANS	178778	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
28940	Fee-for-Service	1740435510	1740435510	1	1	PANSARASA, CORI L PHD	11/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
28962	Fee-for-Service	1659964195	1659964195	1	1	PAYANG ENTERPRISE LLC	7/27/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	294 LAGUNA DR	None	TRACY	CA	95376	1930	39	06077	37.76007248	-121.421439	San Joaquin County
28972	Fee-for-Service	1346536349	1346536349	1	1	PARK, KELLY	1/25/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	20007	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
28977	Fee-for-Service	1386480200	1386480200	1	1	PEACEFULNESS MENTAL HEALTH I	11/20/2024	261QM0801X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	NC	1906 COMMERCENTER E	210	SAN BERNARDINO	CA	92408	3422	36	06071	34.066692	-117.282329	San Bernardino County
28986	Fee-for-Service	1487164877	1487164877	1	1	PRODIGY HEALTHCARE, INC	11/9/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3125 WRIGHT ST	None	FRESNO	CA	93662	2429	10	06019	36.58060376	-119.6151959	Fresno
28988	Fee-for-Service	1689816621	1689816621	1	1	PARK, CONNIE J MD	10/18/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	157152	77	Infectious Disease	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
28997	Fee-for-Service	1942575303	1942575303	1	1	PRAKASH, NEHA MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126791	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
29019	Fee-for-Service	1306917331	1306917331	1	1	POON, MICHAEL W MD	4/1/1995	208800000X	NA	Other	026	PHYSICIANS	81542	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
29026	Fee-for-Service	1326004078	1326004078	1	1	PAKOUR, MEADA MD	2/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76745	40	Pediatrics	0	In state provider	LA PEDIATRA	1075 N WESTERN AVE	# 110	LOS ANGELES	CA	90029	2307	19	06037	34.090398	-118.309198	Los Angeles County
29029	Fee-for-Service	1306305792	1306305792	1	1	PACIFIC CARE GROUP LLC	12/10/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15300 VENTURA BLVD	STE 305	SHERMAN OAKS	CA	91403	3153	56	06111	34.15387425	-118.4666626	Los Angeles County
29056	Fee-for-Service	1952578817	1952578817	1	1	PIETRAS, CHRISTOPHER J	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107254	None	None	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
29063	Fee-for-Service	1568561645	1568561645	1	1	PACIFIC ANESTHESIA	10/1/2000	207L00000X	NA	Other	026	PHYSICIANS	53997	05	Anesthesiology	0	In state provider	CONSULTANTS AMC	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
29072	Fee-for-Service	1316041833	1316041833	2	32	PEDIATRIX MEDICAL GROUP OF C	11/12/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6919	38	06075	37.78610439	-122.421569	San Francisco County
29073	Fee-for-Service	1063571164	1063571164	1	1	PENFIL, RICHARD L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27481	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
29109	Fee-for-Service	1932634896	1932634896	1	1	PELAYO, ELIZABETH MD	5/30/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	160258	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
29152	Fee-for-Service	1336978170	1336978170	1	1	PARK, JUDY J NP	10/10/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
29218	Fee-for-Service	1124678719	1124678719	1	2	PACIFIC BLUE PSYCHOLOGICAL S	10/24/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERVICES	27611 LA PAZ RD	STE A4	LAGUNA NIGUEL	CA	92677	3999	30	06059	33.56292857	-117.7081472	Orange County
29226	Fee-for-Service	1346449113	1346449113	1	1	PRYOR, DAVID W LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
29231	Fee-for-Service	1437517299	1437517299	1	1	PALM DESERT PHARMACY INC	9/19/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	73261 HIGHWAY 111	STE 101	PALM DESERT	CA	92660	3928	33	06065	33.72114702	-116.386473	Riverside County
29234	Fee-for-Service	1457105587	1457105587	1	1	POMONA DEL SOL ADHC LLC	1/7/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	3240 N GAREY AVE	None	POMONA	CA	91767	1308	19	06037	34.106535	-117.746811	Los Angeles County
29264	Fee-for-Service	1902873425	1902873425	1	1	PAUL R. REAY DO	4/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	450 WILLIAMS WAY	None	MOAB	UT	84532	2185	00	None	38.57434043	-109.5593762	Grand County
29270	Fee-for-Service	1467499228	1467499228	1	1	PARK, JENNIFER Y MD	8/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91570	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
29285	Fee-for-Service	1275894479	1275894479	1	1	PHAM, KEVIN C MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128919	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
29323	Fee-for-Service	1215295563	1215295563	1	1	PARK, SEA MI MD	8/10/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	150800	None	None	0	In state provider	None	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
29328	Fee-for-Service	1801245527	1801245527	1	1	PLOTTIER-RAMIREZ, LAURA LMF	1/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
29353	Fee-for-Service	1811310162	1811310162	1	1	PABILONA, CHRISTINE MD	12/16/2019	207R00000X	NA	Other	026	PHYSICIANS	135634	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
29370	Fee-for-Service	1104929140	1104929140	1	1	PHAM, JOHN H DPM	12/27/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
29388	Fee-for-Service	1902317472	1902317472	1	1	PACIFIC PSYCHIATRY INC., A P	6/27/2022	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ROFESSIONAL MEDICAL CORP	1551 BISHOP ST	A 150	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
29419	Fee-for-Service	1902108541	1902108541	1	1	PLANNED PARENTHOOD SHASTA	4/20/2011	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIABLO INC	2 H STREET	None	SAN RAFAEL	CA	94901	1700	21	06041	37.97437033	-122.5385699	Marin County
29437	Fee-for-Service	1962720128	1962720128	1	1	PAIK, STEVEN Z MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109382	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
29466	Fee-for-Service	1417980244	1417980244	1	1	PRICE, JAMES B MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74482	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
29472	Fee-for-Service	1568766830	1568766830	1	1	PURYEAR, SARAH B MD	8/30/2019	207R00000X	NA	Other	026	PHYSICIANS	148094	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
29489	Fee-for-Service	1457705360	1457705360	1	1	PROGRESS HOME HEALTH CARE	2/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	126 S JACKSON ST	STE 306	GLENDALE	CA	91205	4921	19	06037	34.14533965	-118.2500741	Los Angeles County
29505	Fee-for-Service	1922290840	1922290840	1	1	PADILLA, PAULINA A LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
29536	Fee-for-Service	1366608127	1366608127	1	1	PANDYA, SANGITA MD	12/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	107710	08	Family Practice	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
29546	Fee-for-Service	1457643215	1457643215	1	2	PARK, KENNETH J DO	9/13/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14077	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
29563	Fee-for-Service	1447740675	1447740675	1	1	PUZZO, JULIE MD DO	7/28/2022	207P00000X	NA	Other	026	PHYSICIANS	19312	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
29572	Fee-for-Service	1871027540	1871027540	1	1	PETROSIAN, RAFFI MD	1/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165604	None	None	0	In state provider	None	23861 MCBEAN	E24	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
29611	Fee-for-Service	1992867964	1992867964	1	1	PANG, KIN M MD	5/19/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	65767	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
29612	Fee-for-Service	1114025251	1114025251	1	1	PENASKOVIC, STEPHEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
29653	Fee-for-Service	1306299581	1306299581	1	1	PANOLLI, JULIAN CRNA	10/17/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 GREENFIELD AVENUE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
29668	Fee-for-Service	1023351962	1023351962	1	1	PATEL, NARMISHA V MD	6/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140908	41	Internal Medicine	0	In state provider	None	2 WEST FERN	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
29725	Fee-for-Service	1780607838	1780607838	1	1	PATIL, SHALINI MD	3/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93518	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
29748	Fee-for-Service	1225358682	1225358682	1	1	PAKDAMAN, REZA MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139305	30	Radiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
29790	Fee-for-Service	1407015159	1407015159	1	1	PAIKA, MOHAMMED K MD	1/9/2018	207R00000X	NA	Other	026	PHYSICIANS	152240	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
29798	Fee-for-Service	1144389776	1144389776	1	1	PARKER, CINDY DO	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
29805	Fee-for-Service	1508857079	1508857079	1	1	PINSKY, IRINA DPM	10/17/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
29808	Fee-for-Service	1700921863	1700921863	1	1	PISANO, SANDRA PHD	12/2/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HEALTH PSYCHOLOGY MED	1040 ELM AVE	STE 203	LONG BEACH	CA	90813	3266	19	06037	33.779799	-118.1879535	Los Angeles County
29816	Fee-for-Service	1609420926	1609420926	1	1	POWERS, KELLY NP	1/7/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
29824	Fee-for-Service	1083827109	1083827109	1	1	PEPPERMINT RIDGE	12/10/1982	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	825 MAGNOLIA AVE	None	CORONA	CA	92879	3129	33	06065	33.86004536	-117.5526662	Riverside County
29832	Fee-for-Service	1205087160	1205087160	1	1	PATHARE, SANDHYA S MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103247	08	Family Practice	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
29844	Fee-for-Service	1548279755	1548279755	1	1	PRESSER, ERIC R MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55135	33	Thoracic Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	STE E421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
29847	Fee-for-Service	1225000532	1225000532	1	1	PATEL, JIGAR D DO	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7495	None	None	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
29849	Fee-for-Service	1093218869	1093218869	1	1	PHILLIPS, ASHAKIE I NP	7/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2433 MARCONI AVENUE	None	SACRAMENTO	CA	95821	4807	34	06067	38.619405	-121.4045595	Sacramento County
29855	Fee-for-Service	1912788597	1912788597	1	1	PARADISE INDEPENDENT CARE	12/30/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7639 ALCOVE AVE	None	NORTH HOLLYWOOD	CA	91605	2015	19	06037	34.20942162	-118.4133755	Los Angeles County
29868	Fee-for-Service	1407845381	1407845381	1	1	POHL, ANDREW M. MD	10/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
29874	Fee-for-Service	1568411833	1568411833	1	1	PAPPAS, ANASTASIA MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	72537	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
29907	Fee-for-Service	1841677317	1841677317	1	1	PATEL, HEETABH	9/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147827	None	None	0	In state provider	None	2202 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5706	19	06037	34.03277088	-118.4813792	Los Angeles County
30003	Fee-for-Service	1922684091	1922684091	1	1	PANIAGUA, LUIS A MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	180439	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
30019	Fee-for-Service	1336574508	1336574508	1	1	PICCINATI, DAVID J MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127284	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
30112	Fee-for-Service	1083826135	1083826135	2	1	PAI AND CHAN PHARMACY	8/19/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	501 E. HARDY STREET	SUITE 130	INGLEWOOD	CA	90301	4095	19	06037	33.9491005	-118.348857	Los Angeles County
30141	Fee-for-Service	1922454545	1922454545	1	1	PHAM, NAM DO	6/1/2020	207P00000X	NA	Other	026	PHYSICIANS	16688	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
30151	Fee-for-Service	1518251636	1518251636	1	1	PIESTER, TRAVIS L	7/19/2017	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	124852	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
30155	Fee-for-Service	1568480838	1568480838	1	1	PRAKASH, NEAL MD	6/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83199	79	Neurology-Child	0	In state provider	None	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
30160	Fee-for-Service	1548370596	1548370596	1	1	PIKUS, MARY M MD	9/30/1986	207R00000X	NA	Other	026	PHYSICIANS	42264	01	General Practice	0	In state provider	None	3939 IOWA ST	None	SAN DIEGO	CA	92104	3008	37	06073	32.749398	-117.1264015	San Diego County
30210	Fee-for-Service	1720297906	1720297906	1	1	PEREZ- EGANA MONGE, RAMON	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	99906	41	Internal Medicine	0	In state provider	A MD	240 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
30214	Fee-for-Service	1538114913	1538114913	1	2	PHYSICIANS CHOICE HOME	6/2/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	3220 SEPULVEDA BLVD	STE 100	TORRANCE	CA	90505	8160	19	06037	33.82490043	-118.3436029	Los Angeles County
30226	Fee-for-Service	1073516860	1073516860	1	1	PATEL, SHEELA T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89777	02	General Surgery	0	In state provider	None	1 SHRADER ST	STE 600	SAN FRANCISCO	CA	94117	1018	38	06075	37.77467326	-122.4529451	San Francisco County
30251	Fee-for-Service	1821351198	1821351198	1	1	PARK, SOO MD	3/12/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	135455	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
30258	Fee-for-Service	1578838520	1578838520	1	5	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	704 I STREET	SUITE A	MODESTO	CA	95354	2224	50	06099	37.63754428	-121.001759	Stanislaus County
30283	Fee-for-Service	1134461411	1134461411	1	1	PARK, JANE MD	5/3/2022	208M00000X	NA	Other	026	PHYSICIANS	134557	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
30302	Fee-for-Service	1518370816	1518370816	1	1	PINOT, GIAN MD	1/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147722	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
30303	Fee-for-Service	1275602625	1275602625	1	1	PUOPOLO, ANTHONY D II MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104552	08	Family Practice	0	In state provider	None	8901 ACTIVITY ROAD	None	SAN DIEGO	CA	92126	4427	37	06073	32.8960193	-117.1345934	San Diego County
30330	Fee-for-Service	1013322304	1013322304	1	1	POSTONE, ARIEL MD	8/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171876	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
30339	Fee-for-Service	1447448873	1447448873	1	1	PEDARSANI, MARJAN A DO	11/20/2007	207R00000X	NA	Other	026	PHYSICIANS	9507	08	Family Practice	0	In state provider	None	23512 MADERA RD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
30366	Fee-for-Service	1417145079	1417145079	1	1	PETERSON, JEANNE M PHD	10/20/2014	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3633 CAMINO DEL RIO S	STE 102	SAN DIEGO	CA	92108	4012	37	06073	32.77798059	-117.1163142	San Diego County
30403	Fee-for-Service	1215624416	1215624416	1	1	PITTS, ASHLEY LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
30450	Fee-for-Service	1598810079	1598810079	1	1	PRATT, MARCELLE E PSYD	3/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5588 N PALM AVE	SUITE I-1	FRESNO	CA	93704	1913	10	06019	36.818874	-119.8082415	Fresno County
30468	Fee-for-Service	1205000239	1205000239	1	1	PORTER, DOUGLAS R MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120368	13	Neurology (M.D. only)	0	In state provider	None	300 PLAZA MEDICAL PLAZA	B200	LOS ANGELES	CA	90045	5655	19	06037	34.06473399	-118.445865	Los Angeles County
30476	Fee-for-Service	1629306881	1629306881	1	1	PATEL, SHAMIN J MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102429	40	Pediatrics	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
30481	Fee-for-Service	1629108139	1629108139	1	1	PINEDA, DIANA E LCSW	3/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
30513	Fee-for-Service	1073516860	1073516860	1	1	PATEL, SHEELA T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89777	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1 SHRADER ST	STE 600	SAN FRANCISCO	CA	94117	1018	38	06075	37.77467326	-122.4529451	San Francisco County
30515	Fee-for-Service	1891183935	1891183935	1	1	PAIK, WENDY E PHD	3/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
30523	Fee-for-Service	1770930075	1770930075	1	1	PALMER, ROSS MD	9/9/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154113	36	Psychiatry	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
30533	Fee-for-Service	1861506743	1861506743	1	1	PASILIAO, RONNIE V MD	6/2/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87832	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
30547	Fee-for-Service	1578838520	1578838520	1	5	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	704 I STREET	SUITE A	MODESTO	CA	95354	2224	50	06099	37.63754428	-121.001759	Stanislaus County
30555	Fee-for-Service	1427357029	1427357029	1	1	PIPER ELIZABETH RICHEY M.D.	2/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
30557	Fee-for-Service	1881691269	1881691269	1	1	PATEL, NISHITA S MD	11/23/2010	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	113143	77	Infectious Disease	0	In state provider	None	795 E SECOND ST	STE 5	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
30568	Fee-for-Service	1518320456	1518320456	1	1	POOLE, EMMILY J MD	3/31/2020	207R00000X	NA	Other	026	PHYSICIANS	159552	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
30608	Fee-for-Service	1720469828	1720469828	1	1	PATEL, PRITIBEN MD	8/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153457	08	Family Practice	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
30640	Fee-for-Service	1205532793	1205532793	1	1	PIKE, STACY L PSYD	4/11/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
30667	Fee-for-Service	1306067640	1306067640	1	1	PRODANOVIC, EDWARD M MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55130	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	SUITE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
30691	Fee-for-Service	1609952860	1609952860	1	1	PARSONS, MARGARET E MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55877	07	Dermatology	0	In state provider	None	1605 ALHAMBRA BLVD	STE 2300	SACRAMENTO	CA	95816	7051	34	06067	38.56562254	-121.4682653	Sacramento County
30692	Fee-for-Service	1972644763	1972644763	1	1	PATEL, ANUPAMA MD	8/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97588	None	None	0	In state provider	None	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
30701	Fee-for-Service	1104943356	1104943356	2	1	PHAN, TREVOR T MD	9/2/2014	207R00000X	NA	Other	026	PHYSICIANS	111505	41	Internal Medicine	0	In state provider	None	1375 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3382	49	06097	38.627145	-122.863779	Sonoma County
30724	Fee-for-Service	1093969115	1093969115	1	9	PLANNED PARENTHOOD OF LA	2/2/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	10027 LURLINE AVE	None	CHATSWORTH	CA	91311	3153	19	06037	34.2535807	-118.5842077	Los Angeles County
30726	Fee-for-Service	1730119074	1730119074	1	1	PETRIE, RUSSELL MD	12/9/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	85402	20	Orthopedic Surgery	0	In state provider	None	22 CORPORATE PLAZA DR	None	NEWPORT BEACH	CA	92660	7985	30	06059	33.607602	-117.876852	Orange County
30763	Fee-for-Service	1386702496	1386702496	1	1	PACHECO, DINA Y	2/27/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8283 GROVE AVE	STE 104	RANCHO CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
30773	Fee-for-Service	1275974461	1275974461	1	1	PACIFIC CENTRAL COAST HEALTH	4/4/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	210 SOUTH PALISADE DRIVE	SUITE 101	SANTA MARIA	CA	93454	8901	42	06083	34.95169604	-120.4120907	Santa Barbara County
30792	Fee-for-Service	1851708853	1851708853	1	1	PARENTIS HOSPICE AND HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	24012 CALLE DE LA PLATA	SUITE 400	LAGUNA HILLS	CA	92653	3621	30	06059	33.61012113	-117.7115908	Orange County
30822	Fee-for-Service	1306153572	1306153572	1	1	POURTAHERI, SINA MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136713	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
30869	Fee-for-Service	1316021942	1316021942	1	5	PILAR M DE CASTRO & CO	9/1/1999	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	6282 LOS ROBLES AVE	None	BUENA PARK	CA	90621	3002	30	06059	33.86916	-117.991651	Orange County
30871	Fee-for-Service	1578527339	1578527339	1	1	PROHEALTH ADV IMAGING	12/1/2002	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INSTITUTE LLC	7345 MEDICAL CENTER DR	STE 130	WEST HILLS	CA	91307	1932	19	06037	34.20369349	-118.629837	Los Angeles County
30924	Fee-for-Service	1780645432	1780645432	1	1	POPE, STEPHEN E MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	28637	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	157 2ND AVE	None	SAN MATEO	CA	94401	3801	41	06081	37.56545786	-122.3244504	San Mateo County
30927	Fee-for-Service	1184324220	1184324220	1	1	PHILLIP, DESTINY DENAE	12/8/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11692 AUTUMN SAGE AVE	None	JURUPA VALLEY	CA	91752	5016	33	06065	34.00263673	-117.5388692	Riverside County
30932	Fee-for-Service	1285667659	1285667659	1	2	PEDIATRIC RENAL MEDICAL CORP	11/3/2021	2080P0210X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORATION	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
30954	Fee-for-Service	1053730952	1053730952	1	1	PINNELAS, REBECCA MD	10/1/2021	207R00000X	NA	Other	026	PHYSICIANS	170360	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
30957	Fee-for-Service	1306067640	1306067640	1	1	PRODANOVIC, EDWARD M MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55130	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	SUITE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
30975	Fee-for-Service	1134168651	1134168651	1	1	PATTON, WENDY L MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78460	30	Radiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
30977	Fee-for-Service	1225497563	1225497563	1	1	PAPP, ALEXANDRA MD	6/21/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
30999	Fee-for-Service	1841375532	1841375532	1	1	PEARSON, JONATHAN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC EMERGENCY MED	100 N MEDICAL DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77069459	-111.8370155	Salt Lake County
31004	Fee-for-Service	1386892529	1386892529	1	1	PACIFIC MEDICAL INC	9/5/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 E ORANGEBURG	#102	MODESTO	CA	95355	5512	50	06099	37.66364947	-120.9857985	Stanislaus County
31007	Fee-for-Service	1265449979	1265449979	1	1	PARIVASH KASHANI	12/1/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 GAYLEY AVE	SUITE 201	LOS ANGELES	CA	90024	3426	19	06037	34.06135763	-118.447479	Los Angeles County
31081	Fee-for-Service	1851708853	1851708853	1	1	PARENTIS HOSPICE AND HEALTH	1/3/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	24012 CALLE DE LA PLATA	SUITE 400	LAGUNA HILLS	CA	92653	3621	30	06059	33.61012113	-117.7115908	Orange County
31083	Fee-for-Service	1861548976	1861548976	1	1	PHARMACY 801, INC	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MACY	801 N TUSTIN AVE	SUITE 100	SANTA ANA	CA	92705	3612	30	06059	33.752286	-117.8341735	Orange County
31093	Fee-for-Service	1265044168	1265044168	1	1	PENINSULA COUNSELING AND CON	6/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SULTING, INC.	3099 TELEGRAPH AVE	SUITE 202	BERKELEY	CA	94705	2035	01	06001	37.85389859	-122.2599904	Alameda County
31119	Fee-for-Service	1194203398	1194203398	2	1	PENN TRAN OD, INC	7/13/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1299 UNIVERSITY AVE	SUITE 103	RIVERSIDE	CA	92507	7236	33	06065	33.97576948	-117.339417	Riverside County
31127	Fee-for-Service	1396031639	1396031639	1	1	PRIME HEALTHCARE SERVICES	5/28/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SHERMAN OAKS LLC	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
31130	Fee-for-Service	1821086778	1821086778	1	1	POPESCU, IOANA MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54523	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
31162	Fee-for-Service	1124678719	1124678719	1	1	PACIFIC BLUE PSYCHOLOGICAL S	4/5/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERVICES INC	15235 BURBANK BLVD	STE A2	SHERMAN OAKS	CA	91411	3555	19	06037	34.17211848	-118.465128	Los Angeles County
31210	Fee-for-Service	1689748287	1689748287	1	1	PAUL, BENJAMIN Z MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84521	05	Anesthesiology	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
31218	Fee-for-Service	1184324220	1184324220	1	1	PHILLIP, DESTINY DENAE	12/8/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11692 AUTUMN SAGE AVE	None	JURUPA VALLEY	CA	91752	5016	33	06065	34.00263673	-117.5388692	Riverside County
31221	Fee-for-Service	1699129122	1699129122	1	1	PATANE, JONATHAN J MD	12/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146794	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
31237	Fee-for-Service	1427303122	1427303122	1	1	PAREKH, KARISHMA MD	11/10/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	None	None	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
31241	Fee-for-Service	1306067640	1306067640	1	1	PRODANOVIC, EDWARD M MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55130	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	SUITE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
31285	Fee-for-Service	1124207006	1124207006	1	1	PHAN, ANTHONY MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83470	41	Internal Medicine	0	In state provider	None	2925 SYCAMORE DR	STE 304	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
31304	Fee-for-Service	1669689451	1669689451	1	1	PARIDARI, MAHDI MD	12/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98666	08	Family Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4100	19	06037	34.2206967	-118.5342638	Los Angeles County
31305	Fee-for-Service	1114250925	1114250925	1	1	PAN, YANN P MD	3/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105286	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
31371	Fee-for-Service	1295204121	1295204121	1	1	PEDRAZA GUTIERREZ, ROSARIO	3/14/2025	103TC1900X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LPCC	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
31377	Fee-for-Service	1205194008	1205194008	1	1	PATIL, KAVITA OT	6/28/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
31423	Fee-for-Service	1821086778	1821086778	1	1	POPESCU, IOANA MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54523	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
31444	Fee-for-Service	1437861432	1437861432	1	3	PURE HEALTHCARE PROFESSIONAL	6/20/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	MEDICAL GROUP	2321 WEST MARCH LN	100	STOCKTON	CA	95207	5261	39	06077	37.98565925	-121.3356299	San Joaquin County
31491	Fee-for-Service	1356685218	1356685218	1	11	PACIFIC NEUROPSYCHIATRIC SPE	2/10/2025	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	302 LA VETA AVE	SUITE 202	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
31509	Fee-for-Service	1235103813	1235103813	1	1	PADULA, ANTHONY S MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83508	83	Rheumatology	0	In state provider	None	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
31511	Fee-for-Service	1346328168	1346328168	1	1	PARMAR, APURVA M MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82227	01	General Practice	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
31550	Fee-for-Service	1801954466	1801954466	1	1	PROVIDENT HOME HEALTH INC	10/10/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5015 EAGLE ROCK BLVD	SUITE 207	LOS ANGELES	CA	90041	2085	19	06037	34.1375206	-118.2146494	Los Angeles County
31555	Fee-for-Service	1952744070	1952744070	1	1	PREMIUM URGENT CARE, INC	4/10/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2021 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	6101	10	06019	36.83757551	-119.6792955	Fresno County
31585	Fee-for-Service	1528478435	1528478435	1	1	PHAM, ERIC Q DO	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14575	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
31601	Fee-for-Service	1023062593	1023062593	1	1	PLANNED PARENTHOOD MAR	7/1/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MONTE INC	6095 N FIRST ST	None	FRESNO	CA	93710	5444	10	06019	36.82524765	-119.7723922	Fresno County
31603	Fee-for-Service	1407897481	1407897481	1	1	PATEL, JAGDISH A MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	31816	-	NOT APPLICABLE	0	In state provider	None	72 W 11TH ST	None	TRACY	CA	95376	3437	39	06077	37.7396427	-121.427681	San Joaquin County
31614	Fee-for-Service	1972881159	1972881159	1	1	PENN, ALEX C H MD	4/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122596	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
31620	Fee-for-Service	1316041833	1316041833	2	17	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
31624	Fee-for-Service	1770607947	1770607947	1	1	PERCIVAL, PAUL J MD	11/1/1995	193400000X	NA	Other	026	PHYSICIANS	83115	01	General Practice	0	In state provider	MEDICAL CORPORATION	591 MCCRAY STREET	STE 221	HOLLISTER	CA	95023	2224	35	06069	36.85020209	-121.397521	San Benito County
31632	Fee-for-Service	1316041833	1316041833	2	20	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
31676	Fee-for-Service	1548269533	1548269533	2	1	PHARMACY4HUMANITY	5/28/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3007	37	06073	32.74828048	-117.1634535	San Diego County
31697	Fee-for-Service	1831613975	1831613975	1	3	PAULA VANG, O.D., INC.	4/2/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	811 GRAND AVE	STE B	SACRAMENTO	CA	95838	3466	34	06067	38.637621	-121.4470125	Sacramento County
31712	Fee-for-Service	1144475898	1144475898	1	1	PANGANIBAN, VIRGILIO C	2/28/1981	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34146	08	Family Practice	0	In state provider	MD INC	16704 CLARK AVE	None	BELLFLOWER	CA	90706	5204	19	06037	33.882777	-118.133931	Los Angeles County
31720	Fee-for-Service	1265658892	1265658892	1	1	PRESIDENT JOHN ADAMS	1/30/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MANOR III-FALCONER	5701 FALCONER WAY	None	SACRAMENTO	CA	95824	1517	34	06067	38.523177	-121.447971	Sacramento County
31723	Fee-for-Service	1700178993	1700178993	1	1	PALERMO, ANGELO D MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127894	40	Pediatrics	0	In state provider	None	2652 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3041	43	06085	37.35228637	-121.9754073	Santa Clara County
31738	Fee-for-Service	1427325802	1427325802	1	2	PRO HOSPICE AGENCY	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	494 W TWAIN AVE	None	FRESNO	CA	93704	2513	10	06019	36.80941898	-119.8014623	Fresno County
31745	Fee-for-Service	1306881487	1306881487	1	1	PANITCH, NORMAN M MD	10/7/1976	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17117	10	Gastroenterology (M.D. only)	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
31786	Fee-for-Service	1437335361	1437335361	1	1	PARK, KITAE K MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
31796	Fee-for-Service	1700288057	1700288057	1	1	PEDNEKAR, NORRIE J MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145308	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
31864	Fee-for-Service	1528230588	1528230588	1	1	PARADISE UNIFIED SCHOOL	8/1/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	6696 CLARK RD	None	PARADISE	CA	95969	2861	04	06007	39.778813	-121.5898956	Butte County
31870	Fee-for-Service	1780897769	1780897769	1	1	PATEL, PRITI H MD	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95407	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31902	Fee-for-Service	1902006695	1902006695	1	1	PETERS, MARK JASON MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104059	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31987	Fee-for-Service	1730208877	1730208877	1	1	PETIT, NATASHA I LCSW	12/20/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
32026	Fee-for-Service	1427325802	1427325802	1	2	PRO HOSPICE AGENCY	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	494 W TWAIN AVE	None	FRESNO	CA	93704	2513	10	06019	36.80941898	-119.8014623	Fresno County
32030	Fee-for-Service	1912338450	1912338450	1	1	PICCOLO, LIESL NP	11/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
32032	Fee-for-Service	1306881487	1306881487	1	1	PANITCH, NORMAN M MD	10/7/1976	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17117	41	Internal Medicine	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
32042	Fee-for-Service	1164817334	1164817334	1	1	PANDYA, SHACHI MD	7/12/2023	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	174732	None	None	0	In state provider	None	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
32059	Fee-for-Service	1548218613	1548218613	1	1	PROGRESSIVE MEDICAL ASSOCIAT	12/10/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	ES PLLC	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
32077	Fee-for-Service	1437335361	1437335361	1	1	PARK, KITAE K MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56093	41	Internal Medicine	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
32088	Fee-for-Service	1487659769	1487659769	1	1	PATHWAYS HOME HEALTH &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	585 N MARY AVE	None	SUNNYVALE	CA	94085	2905	43	06085	37.39246753	-122.0374438	Santa Clara County
32091	Fee-for-Service	1316955768	1316955768	1	1	PARSA, KATHRYN D OD	2/23/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
32109	Fee-for-Service	1497334916	1497334916	1	1	POLIAKOFF, JACOB MD	10/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
32114	Fee-for-Service	1700925328	1700925328	1	1	PITRE, TANISHA PSYD	4/26/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
32119	Fee-for-Service	1235265851	1235265851	1	1	PVCH CLINICAL LABORATORY	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
32154	Fee-for-Service	1275055329	1275055329	1	1	PEKARCIK, HAYLEY S CNP	8/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
32160	Fee-for-Service	1770344053	1770344053	1	1	PEACE-REDD, JILLIAN A LMFT	3/1/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
32206	Fee-for-Service	1912134982	1912134982	1	1	PATEL, SANKETKUMAR MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119164	41	Internal Medicine	0	In state provider	None	655 EUCLID AVE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
32223	Fee-for-Service	1487071825	1487071825	1	1	PATEL, HARSH S DO	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15289	08	Family Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
32226	Fee-for-Service	1700280252	1700280252	1	1	PRINTZIAN, IRENE PAULA D CRN	8/15/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
32241	Fee-for-Service	1043263189	1043263189	1	1	PLANNED PARENTHOOD MAR MONTE	5/1/1974	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN JOSE HEALTH CENTER	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	43	06085	37.3373761	-121.9192532	Santa Clara County
32267	Fee-for-Service	1982776795	1982776795	1	1	PAYNE, AUDREY M MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87036	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
32268	Fee-for-Service	1386089878	1386089878	1	1	PACIFIC MD HOUSECALLS PC	2/19/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62689	08	Family Practice	0	In state provider	None	2804 GATEWAY OAKS DR	SUITE 200	SACRAMENTO	CA	95833	4345	34	06067	38.619342	-121.5175005	Sacramento County
32278	Fee-for-Service	1063584894	1063584894	1	1	PADILLA, PATRICIA G MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61445	01	General Practice	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
32288	Fee-for-Service	1275678393	1275678393	1	1	PETERSON, ALISSA M MD	9/9/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	88758	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
32295	Fee-for-Service	1780938944	1780938944	1	1	PERRY, JENNIFER R	8/25/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	116 S PALISADE DRIVE	STE 206	SANTA MARIA	CA	93454	8906	42	06083	34.9523869	-120.4120717	Santa Barbara County
32320	Fee-for-Service	1306881487	1306881487	1	1	PANITCH, NORMAN M MD	10/7/1976	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17117	40	Pediatrics	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
32335	Fee-for-Service	1033117692	1033117692	1	1	PECHA, BRIAN S MD	8/1/1993	207R00000X	NA	Other	026	PHYSICIANS	69573	41	Internal Medicine	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
32347	Fee-for-Service	1851486310	1851486310	1	1	PANG, GARY K MD	5/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78054	05	Anesthesiology	0	In state provider	None	6900 BROCKTON AVE	STE 100	RIVERSIDE	CA	92506	3817	33	06065	33.94872	-117.3967215	Riverside County
32349	Fee-for-Service	1780925990	1780925990	2	4	PHI HEALTH, LLC	6/22/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10713 AIRPORT	None	COLUMBIA	CA	95310	9727	55	06109	38.03139	-120.413511	Tuolumne County
32350	Fee-for-Service	1053314724	1053314724	1	1	PORCH-CURREN, CRISTINA N	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74064	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
32372	Fee-for-Service	1902433568	1902433568	1	1	PARMER-CHOW, CAITLIN M MD	8/9/2023	207R00000X	NA	Other	026	PHYSICIANS	186380	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32375	Fee-for-Service	1487659769	1487659769	1	1	PATHWAYS HOME HEALTH &	6/24/1991	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	585 N MARY AVE	None	SUNNYVALE	CA	94085	2905	43	06085	37.39246753	-122.0374438	Santa Clara County
32380	Fee-for-Service	1053364109	1053364109	1	1	PLANNED PARENTHOOD	11/24/1982	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MAR MONTE INC	760 RENZ LANE	None	GILROY	CA	95020	9584	43	06085	37.00466254	-121.5555242	Santa Clara County
32447	Fee-for-Service	1538625975	1538625975	1	3	PURPOSEFUL RESIDENTIAL CARE	1/20/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	WELLMAN PLACE	503 HASWELL STREET	None	BAKERSFIELD	CA	93312	5763	15	06029	35.36250276	-119.1306576	Kern County
32448	Fee-for-Service	1093969115	1093969115	1	21	PLANNED PARENTHOOD OF LA	4/6/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	322 LUCAS AVE	None	LOS ANGELES	CA	90017	1406	19	06037	34.05764954	-118.2619807	Los Angeles County
32491	Fee-for-Service	1316041833	1316041833	2	5	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
32503	Fee-for-Service	1518003607	1518003607	1	1	PATTANACHINDA, ANUCHIT	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32822	08	Family Practice	0	In state provider	DIANNE WABER	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
32518	Fee-for-Service	1376556357	1376556357	1	1	PELAYO, JOSE A MD	1/31/1994	207R00000X	NA	Other	026	PHYSICIANS	53898	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
32525	Fee-for-Service	1922141175	1922141175	1	1	PETERSON, KIMBERLY M	7/1/1998	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 N RIVERSIDE AVE	STE 100	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
32564	Fee-for-Service	1063584894	1063584894	1	1	PADILLA, PATRICIA G MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61445	08	Family Practice	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
32571	Fee-for-Service	1003421090	1003421090	1	1	PERENNIAL HOSPICE INC	8/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14664 VICTORY BLVD	STE 202	VAN NUYS	CA	91411	1621	19	06037	34.18663547	-118.4529105	Los Angeles County
32603	Fee-for-Service	1538993969	1538993969	1	1	POWELL, ANDREA NP	11/20/2024	2080N0001X	NA	Pediatric Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
32605	Fee-for-Service	1023734688	1023734688	1	1	PEACE, GRACIELA PT	10/22/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	790 S GRADE RD	None	ALPINE	CA	91901	2912	37	06073	32.83328047	-116.798687	San Diego County
32606	Fee-for-Service	1437236155	1437236155	1	1	PAVLOVICH, SASHA MD	2/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113212	22	Pathology (M.D. only)	0	In state provider	None	81-715 DOCTOR CARREON BL	SUITE A-2	INDIO	CA	92201	5564	33	06065	33.70743317	-116.2302643	Riverside County
32696	Fee-for-Service	1275927691	1275927691	1	1	PATEL, RUBY V MD	11/1/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146426	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
32757	Fee-for-Service	1508050790	1508050790	1	1	PALNITKAR, RACHANA M MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111367	77	Infectious Disease	0	In state provider	None	340 DARDANELLI LN	SUITE 26	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
32765	Fee-for-Service	1316041833	1316041833	2	12	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
32810	Fee-for-Service	1598872830	1598872830	1	1	PAK, SOPHIA Y MD	1/1/1982	207ZP0101X	NA	Other	026	PHYSICIANS	29601	22	Pathology (M.D. only)	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
32813	Fee-for-Service	1184641664	1184641664	1	2	PLANNED PARENTHOOD	5/1/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2651 SOUTH C ST	SUITE 100	OXNARD	CA	93033	3560	56	06111	34.17497898	-119.1811966	Ventura County
32847	Fee-for-Service	1295013951	1295013951	1	1	PETER, NEIVEEN M MD	6/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129836	None	None	0	In state provider	None	1818 N ORANGE GROVE AVE	# 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
32854	Fee-for-Service	1740416544	1740416544	1	1	PEDDI, HIMAJA MD	1/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119124	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
32857	Fee-for-Service	1003421090	1003421090	1	1	PERENNIAL HOSPICE INC	8/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14664 VICTORY BLVD	STE 202	VAN NUYS	CA	91411	1621	19	06037	34.18663547	-118.4529105	Los Angeles County
32932	Fee-for-Service	1154980829	1154980829	1	1	PHAM, RYAN M MD	5/16/2022	207R00000X	NA	Other	026	PHYSICIANS	178169	None	None	0	In state provider	None	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
32952	Fee-for-Service	1689837171	1689837171	1	1	PATEL, NILEM MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103483	67	Endocrinology	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
32958	Fee-for-Service	1255539102	1255539102	1	1	POTTS, CAMERON J	4/4/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9834 GENESEE AVE	SUITE 105	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
32964	Fee-for-Service	1376513754	1376513754	1	1	PALOMAR HEALTH	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
33060	Fee-for-Service	1790016772	1790016772	1	1	PATEL, NEHA S MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124494	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
33078	Fee-for-Service	1740211812	1740211812	1	1	PAMELA J. DEKEYSER ARNP	2/14/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
33082	Fee-for-Service	1356400097	1356400097	1	1	PATEL, MANISH J MD	3/20/2008	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	80516	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
33090	Fee-for-Service	1568705721	1568705721	1	1	PLESHAKOV, TAMARA S V DO	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13973	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
33100	Fee-for-Service	1528098019	1528098019	1	1	PEARCE, DAVID MD	2/28/1988	207RN0300X	NA	Nephrology	026	PHYSICIANS	52963	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	STE M997	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
33119	Fee-for-Service	1851619480	1851619480	1	1	PEARLSTEIN, MAURA H DO MD	1/9/2018	208600000X	NA	General Surgery	026	PHYSICIANS	14971	02	General Surgery	0	In state provider	None	2800 L STREET	SUITE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
33171	Fee-for-Service	1467495986	1467495986	1	1	PETERSEN, GLEN W MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	26004	41	Internal Medicine	0	In state provider	None	635 ANDERSON RD	STE 4	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
33189	Fee-for-Service	1467800276	1467800276	1	1	PETERSON, JOSEPH D MD	9/1/2022	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	180264	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
33202	Fee-for-Service	1821442609	1821442609	1	1	PENA, JONATHAN DELL P MD	5/20/2019	207P00000X	NA	Other	026	PHYSICIANS	146279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
33204	Fee-for-Service	1922345362	1922345362	1	1	PAWAR, LEENA K MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136010	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
33240	Fee-for-Service	1689837171	1689837171	1	1	PATEL, NILEM MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103483	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
33255	Fee-for-Service	1376513754	1376513754	1	1	PALOMAR HEALTH	9/21/2022	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
33267	Fee-for-Service	1366700171	1366700171	1	1	PEREZ, ROSEMARY LMFT	2/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97744	-	NOT APPLICABLE	0	In state provider	None	930 F ST	None	WASCO	CA	93280	2040	15	06029	35.590986	-119.3337445	Kern County
33274	Fee-for-Service	1275627655	1275627655	1	2	PENT, MICHELLE P MD MPH	7/18/2019	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	55145	-	NOT APPLICABLE	0	In state provider	None	3575 PERSHING AVE	None	SAN DIEGO	CA	92104	3413	37	06073	32.74353067	-117.1346152	San Diego County
33301	Fee-for-Service	1801056205	1801056205	1	1	PARKES, NESHE S PHD	11/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
33316	Fee-for-Service	1720147325	1720147325	1	1	PRAKASH, SUSHMA MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44978	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
33317	Fee-for-Service	1154360998	1154360998	1	1	PATEL, AVANI M MD	12/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74919	41	Internal Medicine	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
33380	Fee-for-Service	1952728081	1952728081	1	1	PAI, ANGELINE F MD	8/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148225	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
33394	Fee-for-Service	1245388412	1245388412	1	1	POONIA, MOHINDER S	1/29/2008	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36683	None	None	0	In state provider	None	5359 N FRESNO ST	STE 101F	FRESNO	CA	93710	6831	10	06019	36.815031	-119.7813855	Fresno County
33421	Fee-for-Service	1710934088	1710934088	1	1	PHAN, ANDY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	75547	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
33465	Fee-for-Service	1407147846	1407147846	1	1	PHATAK, ANITA V MD	10/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122435	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
33489	Fee-for-Service	1770892952	1770892952	1	1	PLUMB, N LUCAS PHD	8/2/2012	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1008 5TH ST	None	SANTA ROSA	CA	95404	4307	49	06097	38.443941	-122.708187	Sonoma County
33493	Fee-for-Service	1922345362	1922345362	1	1	PAWAR, LEENA K MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136010	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
33499	Fee-for-Service	1568839066	1568839066	1	1	PRISM ENTERPRISES, INC.	2/4/2021	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21600 OXNARD ST.	SUITE 1030	WOODLAND HILLS	CA	91367	4976	19	06037	34.17915728	-118.5992441	Los Angeles County
33508	Fee-for-Service	1841256948	1841256948	1	1	PATEL, NIRALI A MD	12/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80548	67	Endocrinology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
33521	Fee-for-Service	1710983671	1710983671	2	1	PATH LABS LLC	3/10/2010	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	950 RIVERSIDE PARKWAY	SUITE 90	WEST SACRAMENTO	CA	95605	1501	57	06113	38.58746816	-121.5668948	Yolo County
33527	Fee-for-Service	1962623348	1962623348	1	1	PANG, LILY N MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94399	22	Pathology (M.D. only)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95201	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
33541	Fee-for-Service	1376513754	1376513754	1	1	PALOMAR HEALTH	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
33543	Fee-for-Service	1992387088	1992387088	1	1	PETERSON, PORSHA NP	10/3/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
33554	Fee-for-Service	1760464960	1760464960	1	1	PLANTE, CHARLES F	5/23/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
33586	Fee-for-Service	1881772671	1881772671	1	1	PAHTA, JON K MD	7/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80944	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
33593	Fee-for-Service	1750309811	1750309811	1	1	PARKER, STEVEN W MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	75 PRINGLE WAY	STE 705	RENO	NV	89502	1472	00	None	39.52621891	-119.7944075	Washoe County
33627	Fee-for-Service	1275564296	1275564296	1	1	PRECISION REHABILITATION & O	2/16/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 MORTON	B	PORTERVILLE	CA	93257	1940	54	06107	36.07332205	-119.0428201	Tulare County
33643	Fee-for-Service	1275564296	1275564296	1	11	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1132 ACADEMY AVE	101	SANGER	CA	93657	3195	10	06019	36.69982659	-119.5544778	Fresno County
33654	Fee-for-Service	1316111909	1316111909	1	1	PAYNE, KATHERINE G MD	10/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	25	Physical Medicine and Rehabilitation	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
33691	Fee-for-Service	1780805002	1780805002	1	1	PROJECT SIX	3/29/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16020 GRESHAM ST	None	NORTH HILLS	CA	91343	4838	19	06037	34.23098117	-118.4815492	Los Angeles County
33697	Fee-for-Service	1952695520	1952695520	1	1	PATHWAY SOCIETY, INC	2/3/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	16433 MONTEREY STREET	SUITE 140	MORGAN HILL	CA	95037	7167	43	06085	37.11826773	-121.6460179	Santa Clara County
33710	Fee-for-Service	1477693513	1477693513	1	1	PET IMAGING OF SAN JOSE	2/1/2002	305R00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2211 MOORPARK AVE	STE 190	SAN JOSE	CA	95128	2632	43	06085	37.31613943	-121.9326665	Santa Clara County
33715	Fee-for-Service	1316021942	1316021942	1	3	PILAR M DE CASTRO & CO	12/16/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	8419 MANGO WAY	None	BUENA PARK	CA	90620	3332	30	06059	33.84056541	-117.9918219	Orange County
33719	Fee-for-Service	1659397743	1659397743	1	1	PIRRUCCELLO, MICHAEL MD	7/31/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42813	08	Family Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
33773	Fee-for-Service	1619255049	1619255049	1	1	PARIKH, PRIYA B PSYD	6/14/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7700 IRVINE CENTER DR	STE 800	IRVINE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange County
33780	Fee-for-Service	1346328051	1346328051	1	1	PHINNEY, PAUL MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	49100	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
33781	Fee-for-Service	1558822908	1558822908	1	1	PARK, SARA H MD	7/13/2023	207L00000X	NA	Other	026	PHYSICIANS	185244	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
33797	Fee-for-Service	1841256948	1841256948	1	1	PATEL, NIRALI A MD	12/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80548	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
33815	Fee-for-Service	1770541476	1770541476	1	1	PLAINS COMMUNITY AMBULANCE I	7/27/2019	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	NC	102 E BLAKE ST	None	PLAINS	MT	59859	0268	00	None	47.459637	-114.879726	Sanders County
33880	Fee-for-Service	1528194818	1528194818	1	1	PATIENTS CHOICE MEDICAL GROU	5/11/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53308	08	Family Practice	0	In state provider	P INC	4950 SAN BERNARDINO ST	218	MONTCLAIR	CA	91763	2328	36	06071	34.07768363	-117.6968874	San Bernardino County
33884	Fee-for-Service	1750564779	1750564779	1	1	PALLAPATI, ARUNA MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98165	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
33932	Fee-for-Service	1346312097	1346312097	1	1	PINE, DANIEL S MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
33950	Fee-for-Service	1649807876	1649807876	1	1	PHAN, KEVIN MD	10/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187042	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
33958	Fee-for-Service	1265658793	1265658793	1	1	PAOLUCCI, UGO MD	12/22/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	151601	13	Neurology (M.D. only)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
33961	Fee-for-Service	1558420695	1558420695	1	1	PLANNED PARENTHOOD OF	12/7/1981	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHERN VALLEY	3100 COHASSET RD	None	CHICO	CA	95973	0962	04	06007	39.77184653	-121.8436243	Butte County
33977	Fee-for-Service	1326370073	1326370073	1	1	PEDIATRIC & FAMILY	4/26/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	1500-30 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
34055	Fee-for-Service	1417402546	1417402546	1	1	PRODIGY HEALTHCARE INC	9/15/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5865 S CLARA AVENUE	None	FRESNO	CA	93706	5805	10	06019	36.64967655	-119.7953485	Fresno County
34067	Fee-for-Service	1710263793	1710263793	1	1	PARKER, CLAIRE E NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
34082	Fee-for-Service	1174740021	1174740021	1	1	PURI, SHEELA PSYD	7/26/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8355 CHURCH ST	None	GILROY	CA	95020	4406	43	06085	37.01873743	-121.5768381	Santa Clara County
34085	Fee-for-Service	1245203538	1245203538	1	1	PARK, LINDA R LCSW	12/7/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1265 CAMINO CORONADO	None	ROHNERT PARK	CA	94928	3423	49	06097	38.34128868	-122.6889664	Sonoma County
34095	Fee-for-Service	1861456238	1861456238	1	1	PRIMA, JUDITH A OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3133 W MARCH LN	STE 2020	STOCKTON	CA	95219	2361	39	06077	37.98412533	-121.3519903	San Joaquin County
34122	Fee-for-Service	1992893234	1992893234	1	1	PEARSON, CHRISTOPHER S	11/20/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23232 PERALTA DR	STE 113	LAGUNA HILLS	CA	92653	1436	30	06059	33.62507998	-117.7250262	Orange County
34130	Fee-for-Service	1861801961	1861801961	1	1	PHILLIPS, MEGAN PSYD	5/1/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11800 CENTRAL AVE	STE 225	CHINO	CA	91710	7200	36	06071	34.0388092	-117.689654	San Bernardino County
34164	Fee-for-Service	1053410506	1053410506	1	2	PEDIATRIC AFFILIATES MEDICAL	7/7/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	29525 CANWOOD ST	#111	AGOURA HILLS	CA	91301	1595	19	06037	34.14724223	-118.7675471	Los Angeles County
34168	Fee-for-Service	1720084395	1720084395	1	1	PU, ANTHONY T MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84795	78	Neoplastic Diseases/Oncology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
34296	Fee-for-Service	1770945057	1770945057	1	1	PIATETSKY, YANA MD	6/25/2019	390200000X	NA	Other	026	PHYSICIANS	155010	41	Internal Medicine	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
34307	Fee-for-Service	1831247667	1831247667	1	1	PHAN, VU Q MD	3/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70377	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
34310	Fee-for-Service	1841270022	1841270022	1	1	PARSLEY, ALLEN L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24908	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
34339	Fee-for-Service	1700919669	1700919669	1	1	PROHEALTH PARTNERS,	10/31/1995	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1040 ELM AVE	STE 300	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
34352	Fee-for-Service	1689714255	1689714255	1	1	PRINCETON HEALTHCARE SYSTEM	11/5/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	253 WITHERSPOON ST	None	PRINCETON	NJ	08540	3211	00	None	40.35712145	-74.6629222	Mercer County
34358	Fee-for-Service	1760559272	1760559272	1	1	PATEL, MINAL C MD	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67601	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
34365	Fee-for-Service	1689019606	1689019606	1	1	PATEL, ANITA C MD	11/22/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	138591	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
34396	Fee-for-Service	1326105313	1326105313	1	1	PACE, GARY J MD	2/8/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	52538	-	NOT APPLICABLE	0	In state provider	None	3555 SONOMA HWY	None	SANTA ROSA	CA	95409	4024	49	06097	38.45375475	-122.6813739	Sonoma County
34397	Fee-for-Service	1609957158	1609957158	1	1	PRUITT, JOSEPH H JR PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7250 FRANKLIN AVE	APT 1115	LOS ANGELES	CA	90046	3046	19	06037	34.10340845	-118.3475514	Los Angeles County
34410	Fee-for-Service	1003009556	1003009556	1	1	PAREKH, MARTINE D	12/4/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
34432	Fee-for-Service	1912282369	1912282369	1	1	PROVIDENCE HEALTH & SERVICES	7/6/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	1500 DIVISON STREET	None	OREGON CITY	OR	97045	1527	00	None	45.35630784	-122.5883649	Clackamas County
34438	Fee-for-Service	1306109442	1306109442	1	1	PARK, CHELSIA OD	6/13/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
34445	Fee-for-Service	1013151695	1013151695	1	1	PENILLA, JOSE G MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118402	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
34455	Fee-for-Service	1720084395	1720084395	1	1	PU, ANTHONY T MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84795	30	Radiology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
34535	Fee-for-Service	1548986078	1548986078	1	1	PLUBELL, HILLARY A PT	12/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
34543	Fee-for-Service	1104336668	1104336668	1	1	PETERSON, KIMBERLY OT	9/8/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
34547	Fee-for-Service	1437301561	1437301561	1	1	PRICE, CHRISTINA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
34592	Fee-for-Service	1548600885	1548600885	1	1	PATEL, YESHA R DO	7/31/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15196	08	Family Practice	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
34620	Fee-for-Service	1811310337	1811310337	1	1	POINT ANESTHESIA SERVICES PC	10/16/2017	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5900 WEST OLYMPIC	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
34648	Fee-for-Service	1356505473	1356505473	1	1	PRODDUTURI, PRATHIMA MD	11/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122943	68	Hematology	0	In state provider	None	265 COHASSET ROAD	None	CHICO	CA	95926	2278	04	06007	39.75090044	-121.8522609	Butte County
34652	Fee-for-Service	1710439187	1710439187	1	1	PETRA DIALYSIS LLC	2/4/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	82900 AVENUE 42	STE E	INDIO	CA	92203	9658	33	06065	33.74414625	-116.2174036	Riverside County
34653	Fee-for-Service	1316571714	1316571714	1	1	PAYNE, JENNIFER A NP	5/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
34673	Fee-for-Service	1942358320	1942358320	1	1	PACKARD, RICHARD V OD	2/13/2019	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	45655 OASIS ST	None	INDIO	CA	92201	4564	33	06065	33.717195	-116.2208695	Riverside County
34693	Fee-for-Service	1396131231	1396131231	1	1	PATIBANDA, VARUN MD	9/16/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	175590	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
34707	Fee-for-Service	1861657751	1861657751	1	1	PRIEST, JAMES R MD	12/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117086	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
34719	Fee-for-Service	1912282369	1912282369	1	1	PROVIDENCE HEALTH & SERVICES	7/6/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	1500 DIVISON STREET	None	OREGON CITY	OR	97045	1527	00	None	45.35630784	-122.5883649	Clackamas County
34733	Fee-for-Service	1386178408	1386178408	1	1	PHAM, ANDY T MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	158075	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
34740	Fee-for-Service	1417518358	1417518358	1	1	PEREZ PINEDA, JAIME CPO	7/3/2019	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	4244 RIVERWALK PKWY	STE 180	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
34746	Fee-for-Service	1821634676	1821634676	1	1	PHADKE, APOORVA D PT	3/13/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
34753	Fee-for-Service	1477972057	1477972057	1	1	PRUTTON, MARIANA LMFT	9/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3231 MORAGA ST	None	SAN FRANCISCO	CA	94122	4043	38	06075	37.75515459	-122.4975396	San Francisco County
34776	Fee-for-Service	1275564296	1275564296	1	13	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1504 CHAMPLAIN DR	None	FRESNO	CA	93720	5624	10	06019	36.86845445	-119.7572681	Fresno County
34779	Fee-for-Service	1275564296	1275564296	1	4	PRECISION REHABILITATION & O	7/14/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	134 SOUTH E ST	None	EXETER	CA	93221	1731	54	06107	36.29571271	-119.1405696	Tulare County
34794	Fee-for-Service	1841336138	1841336138	1	1	PEREYRA, ROBERT MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	34124	02	General Surgery	0	In state provider	None	1560 E CHEVY CHASE DR	None	GLENDALE	CA	91206	4197	19	06037	34.15290734	-118.2302295	Los Angeles County
34797	Fee-for-Service	1184631434	1184631434	1	1	PHILIP VALENTE M.D.	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
34802	Fee-for-Service	1962983536	1962983536	1	1	PERKINS, NYSHAE LMFT	1/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
34806	Fee-for-Service	1508378803	1508378803	1	1	POUYA BENYAMINI MD INC	5/1/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	5901 W OLYMPIC BLVD	STE 504	LOS ANGELES	CA	90036	4633	19	06037	34.05764121	-118.3603115	Los Angeles County
34822	Fee-for-Service	1326143835	1326143835	1	1	PHAM, KRYSTAL Q MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81667	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
34851	Fee-for-Service	1952935231	1952935231	1	1	PASCUAL, JOANA MARIE CNP	1/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
34899	Fee-for-Service	1538497813	1538497813	1	1	PACIFICA HEALTH & WELLNESS	3/16/2010	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CLINIC INC	5524 MISSION BLVD	None	RIVERSIDE	CA	92509	4515	33	06065	33.99605244	-117.4052012	Riverside County
34908	Fee-for-Service	1477738862	1477738862	1	1	PANACEA SERVICES, INC	12/13/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4928 E CLINTON WAY	108	FRESNO	CA	93727	1526	10	06019	36.77211792	-119.7303894	Fresno County
34912	Fee-for-Service	1811310337	1811310337	1	1	POINT ANESTHESIA SERVICES PC	10/3/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5900 WEST OLYMPIC	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
34932	Fee-for-Service	1356505473	1356505473	1	1	PRODDUTURI, PRATHIMA MD	11/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122943	78	Neoplastic Diseases/Oncology	0	In state provider	None	265 COHASSET ROAD	None	CHICO	CA	95926	2278	04	06007	39.75090044	-121.8522609	Butte County
34965	Fee-for-Service	1275887697	1275887697	1	1	PLANET PHARMACY INC	4/9/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	121 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2103	19	06037	34.06771291	-118.3837548	Los Angeles County
35017	Fee-for-Service	1497926729	1497926729	1	1	PARVUS, BRITT J DO	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13051	18	Ophthalmology	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
35020	Fee-for-Service	1457709131	1457709131	1	1	PATEL, ROSHAN MD	11/18/2022	207RR0500X	NA	Other	026	PHYSICIANS	173087	None	None	0	In state provider	None	500 W SAN BERNARDINO RD	STE A	COVINA	CA	91722	3797	19	06037	34.08956356	-117.8993364	Los Angeles County
35051	Fee-for-Service	1497746705	1497746705	1	1	PEREZ, BERNICE MD	6/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78448	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
35096	Fee-for-Service	1538390448	1538390448	1	1	POON, DANIEL A MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113823	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L STREET	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
35116	Fee-for-Service	1700061017	1700061017	1	1	PATEL, MONIKA B DO	1/27/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	19133	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
35118	Fee-for-Service	1003994187	1003994187	1	1	PO, STEPHANIE MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83844	18	Ophthalmology	0	In state provider	None	5600 STONERIDGE DR	None	PLEASANTON	CA	94588	8501	01	06001	37.68867756	-121.8852934	Alameda County
35131	Fee-for-Service	1366408726	1366408726	1	1	POLEVOI, STEVEN K MD	1/16/1990	207P00000X	NA	Other	026	PHYSICIANS	67883	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
35133	Fee-for-Service	1790799708	1790799708	1	1	PIKE, JENNIFER L PHD	10/11/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
35141	Fee-for-Service	1548751456	1548751456	1	1	PLATTER, MITCHELL V DO	6/2/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17661	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
35166	Fee-for-Service	1912919689	1912919689	1	1	PEREZ, MYRZA R MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96172	40	Pediatrics	0	In state provider	None	1451 SECRET RAVINE PKWY	STE 150	ROSEVILLE	CA	95661	6052	31	06061	38.7647101	-121.2431538	Placer County
35180	Fee-for-Service	1174502330	1174502330	1	1	PORISCH, ERIC D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	605 SAINT JOSEPH ST	None	RAPID CITY	SD	57701	2718	00	None	44.08004001	-103.2276574	Pennington County
35220	Fee-for-Service	1356505473	1356505473	1	1	PRODDUTURI, PRATHIMA MD	11/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122943	41	Internal Medicine	0	In state provider	None	265 COHASSET ROAD	None	CHICO	CA	95926	2278	04	06007	39.75090044	-121.8522609	Butte County
35284	Fee-for-Service	1588723217	1588723217	1	1	PATEL, VAISHALI K MD	1/23/2008	2085B0100X	NA	MRI Provider	026	PHYSICIANS	86086	84	Surgery-Head and Neck	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
35304	Fee-for-Service	1578739645	1578739645	1	1	PINELES, STACY L MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94403	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	STE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06489065	-118.4443287	Los Angeles County
35313	Fee-for-Service	1558361139	1558361139	1	1	PUIG PALOMAR, MIGUEL MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	48591	None	None	0	In state provider	None	1430 ESPLANADE	STE 10	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
35324	Fee-for-Service	1184027104	1184027104	1	2	PACIFIC SKIN INSTITUTE	9/16/2019	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	34	06067	38.599524	-121.437738	Sacramento County
35329	Fee-for-Service	1245216811	1245216811	1	1	PHELAN, AIDA S MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62622	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
35357	Fee-for-Service	1508977711	1508977711	1	1	PARK, ERIN Y DPM	6/1/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	222 E ROUTE 66	None	GLENDORA	CA	91740	6241	19	06037	34.12865955	-117.861777	Los Angeles County
35381	Fee-for-Service	1336918507	1336918507	1	1	PAREDES MEDICAL CORPORATION	3/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	49201 GRAPEFRUIT BLVD	STE. 3	COACHELLA	CA	92236	1479	33	06065	33.69216348	-116.1847336	Riverside County
35388	Fee-for-Service	1316145360	1316145360	1	1	PENROSE, BRIAN LMFT	7/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
35412	Fee-for-Service	1851754196	1851754196	1	1	PEREZ, MICHAEL R MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	151861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
35500	Fee-for-Service	1306983077	1306983077	1	1	PIERCE, CHAD PSY	8/17/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26059	-	NOT APPLICABLE	0	In state provider	None	303 41ST STREEET	None	RICHMOND	CA	94805	2221	07	06013	37.93356197	-122.3307418	Contra Costa County
35503	Fee-for-Service	1275505240	1275505240	1	1	POLLARD, NICHOLAS D MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53480	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
35527	Fee-for-Service	1437184777	1437184777	1	1	PATEL, SUNIT R MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49191	66	Emergency Medicine (Urgent Care)	0	In state provider	None	520 W 27TH ST	None	MERCED	CA	95340	2833	24	06047	37.31170395	-120.4784444	Merced County
35532	Fee-for-Service	1861629453	1861629453	1	1	PIERCE, LINDSEY J B MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135090	30	Radiology	0	In state provider	None	105 N BASCOM AVE	STE 104	SAN JOSE	CA	95128	1881	43	06085	37.325853	-121.932068	Santa Clara County
35550	Fee-for-Service	1275018855	1275018855	1	1	POURREAU, LAUREN S	2/5/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1325 HOWE AVE	SUITE 207	SACRAMENTO	CA	95825	3364	34	06067	38.590191	-121.416624	Sacramento County
35648	Fee-for-Service	1215431614	1215431614	1	1	PATEL, SARVAGNA S MD	6/22/2022	207L00000X	NA	Other	026	PHYSICIANS	163488	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35653	Fee-for-Service	1114947892	1114947892	1	1	PANOSIAN, CLAIRE B MD	1/1/1993	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	51595	77	Infectious Disease	0	In state provider	None	200 MED PLAZA #365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
35669	Fee-for-Service	1164868873	1164868873	1	1	PENNELLY, BRENT M MD	7/1/2018	193400000X	NA	Other	026	PHYSICIANS	153934	25	Physical Medicine and Rehabilitation	0	In state provider	None	345 S HALCYON ROAD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
35763	Fee-for-Service	1841305414	1841305414	1	2	PRATT, LISA A MD MPH	4/4/2025	207R00000X	NA	Other	026	PHYSICIANS	68980	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
35815	Fee-for-Service	1437184777	1437184777	1	1	PATEL, SUNIT R MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49191	41	Internal Medicine	0	In state provider	None	520 W 27TH ST	None	MERCED	CA	95340	2833	24	06047	37.31170395	-120.4784444	Merced County
35821	Fee-for-Service	1568996171	1568996171	1	1	PEACE, ALYSSA E MD	10/28/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
35858	Fee-for-Service	1255004347	1255004347	1	1	POPE, LEZAH LMFT	11/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	687 UPLAND RD	None	REDWOOD CITY	CA	94062	2828	41	06081	37.47213818	-122.2520257	San Mateo County
35873	Fee-for-Service	1558429589	1558429589	1	1	PIERSON, CHERYL	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
35897	Fee-for-Service	1952312993	1952312993	1	1	POLLOCK, MARC E MD	2/21/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51983	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
35934	Fee-for-Service	1316041833	1316041833	2	43	PEDIATRIX MEDICAL GROUP OF C	5/20/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ALIFORNIA, P.C., PEDIATR	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
35971	Fee-for-Service	1326576224	1326576224	1	1	POLSUNAS, LILINETE MD	8/29/2023	207L00000X	NA	Other	026	PHYSICIANS	175846	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
35993	Fee-for-Service	1740414382	1740414382	1	1	PAYOR, LUCAS B MD	3/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129233	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
36054	Fee-for-Service	1578578050	1578578050	1	1	PRAKASH, ANITA MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84854	None	None	0	In state provider	None	2660 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4315	43	06085	37.36653288	-122.0778348	Santa Clara County
36105	Fee-for-Service	1437184777	1437184777	1	1	PATEL, SUNIT R MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49191	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	520 W 27TH ST	None	MERCED	CA	95340	2833	24	06047	37.31170395	-120.4784444	Merced County
36185	Fee-for-Service	1952312993	1952312993	1	1	POLLOCK, MARC E MD	2/21/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51983	33	Thoracic Surgery	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
36189	Fee-for-Service	1104991561	1104991561	1	2	PEREZ, JOSE A MD	4/11/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20957	08	Family Practice	0	In state provider	None	3410 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	19	06037	34.02760053	-118.2006123	Los Angeles County
36237	Fee-for-Service	1982953246	1982953246	1	1	POAGE, REBECCA LCSW	5/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
36265	Fee-for-Service	1376045666	1376045666	1	1	PONTE, KRISTEN LMFT	1/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
36272	Fee-for-Service	1437377272	1437377272	1	1	PINTO, SUSAN J	5/9/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
36277	Fee-for-Service	1134241938	1134241938	1	1	PERRIS ELEM SD	6/24/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	143 E 1ST ST	None	PERRIS	CA	92570	2113	33	06065	33.78544554	-117.227115	Riverside County
36331	Fee-for-Service	1073595278	1073595278	1	1	PATEL, DUSHYANTBHAI, MD	9/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	36836	41	Internal Medicine	0	In state provider	None	175 N JACKSON AVE	STE 210	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
36377	Fee-for-Service	1851739478	1851739478	1	1	POST, RACHEL M MD	7/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132330	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
36384	Fee-for-Service	1699257857	1699257857	1	2	PROREHAB PHYSICAL THERAPY AN	6/15/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ND SPORTS PERFORMANCE, I	6512 WESTSIDE ROAD	SUITE B	REDDING	CA	96001	4868	45	06089	40.52111546	-122.3824845	Shasta County
36439	Fee-for-Service	1265852388	1265852388	1	1	PFAFF, MILES J MD	8/2/2021	390200000X	NA	Other	026	PHYSICIANS	143273	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 55	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
36465	Fee-for-Service	1124176243	1124176243	1	1	PASCUA, PHILLIP M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
36473	Fee-for-Service	1013927771	1013927771	1	1	PHILLIPS, MICHAEL W MD	2/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54037	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 EAST CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
36474	Fee-for-Service	1952312993	1952312993	1	1	POLLOCK, MARC E MD	2/21/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
36493	Fee-for-Service	1457533689	1457533689	1	1	PASCUA, VICTOR C MD	7/2/2021	207L00000X	NA	Other	026	PHYSICIANS	113821	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
36508	Fee-for-Service	1467558510	1467558510	1	1	PERILMAN, STEVEN K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
36525	Fee-for-Service	1912198557	1912198557	1	1	PARKER, JOSHUA A MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92097	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36562	Fee-for-Service	1568477933	1568477933	1	1	PAN, WEN K MD	2/2/1987	207L00000X	NA	Other	026	PHYSICIANS	43399	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
36588	Fee-for-Service	1013353804	1013353804	1	1	PATEL, RIMA B MD	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149167	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
36648	Fee-for-Service	1427398320	1427398320	1	1	PERKINS, RACHEL E MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123956	40	Pediatrics	0	In state provider	None	3605 VISTA WAY	BLDG B	OCEANSIDE	CA	92056	4564	37	06073	33.1818929	-117.3104591	San Diego County
36664	Fee-for-Service	1174855738	1174855738	1	1	PARK, JUNG H MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108271	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
36679	Fee-for-Service	1023045317	1023045317	1	1	PILPA-TIONGSON, RUTH MD	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	37013	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	1740 W CAMERON AVE	STE 110	WEST COVINA	CA	91790	2719	19	06037	34.07030019	-117.9445341	Los Angeles County
36710	Fee-for-Service	1982084752	1982084752	1	1	PROMONTORY HOME HEALTH SD,	6/29/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	225 WEST MADISON AVE	SUITE 3	EL CAJON	CA	92020	3454	37	06073	32.80066448	-116.9642655	San Diego County
36717	Fee-for-Service	1942517552	1942517552	1	1	PATEL, SHIRISH MD INC	10/18/2012	193400000X	NA	Other	026	PHYSICIANS	40789	41	Internal Medicine	0	In state provider	None	5720 BELLFLOWER BLVD	None	LAKEWOOD	CA	90713	1422	19	06037	33.859638	-118.1250115	Los Angeles County
36737	Fee-for-Service	1558596494	1558596494	1	1	PASSI, ROHIT MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130443	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
36744	Fee-for-Service	1275600140	1275600140	1	1	POON, ALAN H MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37416	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
36760	Fee-for-Service	1427019983	1427019983	1	1	PATEL, BHARAT J MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	41541	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
36812	Fee-for-Service	1306159116	1306159116	1	1	PATEL, MEGHNA D MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142965	01	General Practice	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36818	Fee-for-Service	1841763240	1841763240	1	1	PHYO, SHWE NP	5/6/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
36823	Fee-for-Service	1396893384	1396893384	1	1	PHAM, LOAN T MD	10/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93554	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
36859	Fee-for-Service	1821054446	1821054446	1	1	PENDLETON, JENNIFER J MD	10/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80748	03	Allergy	0	In state provider	None	6386 ALVARADO CT	STE 210	SAN DIEGO	CA	92120	4907	37	06073	32.77666838	-117.0614255	San Diego County
36919	Fee-for-Service	1265554794	1265554794	1	1	PANIKKATH, PRAMOD V MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115866	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
36938	Fee-for-Service	1851840342	1851840342	1	1	PARK, YEJI NP	10/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
36976	Fee-for-Service	1265410476	1265410476	1	1	PARK, BRIAN C	8/1/1998	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3400 LOMITA BLVD	STE 403	TORRANCE	CA	90505	4930	19	06037	33.81309744	-118.3448635	Los Angeles County
36998	Fee-for-Service	1386104859	1386104859	1	1	PS MEDICAL INC	2/3/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2299 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	3023	33	06065	33.849918	-116.5456075	Riverside County
37004	Fee-for-Service	1194389023	1194389023	1	1	PROPER FIT DIABETIC SHOES	3/19/2020	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10639 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2512	19	06037	34.17216553	-118.3628295	Los Angeles County
37005	Fee-for-Service	1992133391	1992133391	1	1	PINNACLE HOME HEALTH AGENCY	4/22/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1375 LOCUST STREET	SUITE M200	WALNUT CREEK	CA	94596	4591	07	06013	37.89849004	-122.061843	Contra Costa County
37010	Fee-for-Service	1467695056	1467695056	1	1	PYRKO, PETER MD	2/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3312	36	06071	34.04805253	-117.249534	San Bernardino County
37014	Fee-for-Service	1639516057	1639516057	1	1	PARRISH, JENNIFER W DO MD	3/10/2018	208M00000X	NA	Other	026	PHYSICIANS	13589	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
37021	Fee-for-Service	1871501916	1871501916	1	5	PRIME HEALTHCARE ANAHEIM	3/31/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
37039	Fee-for-Service	1467878819	1467878819	1	1	PRATT, DARCY L NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37054	Fee-for-Service	1891957718	1891957718	1	1	PHAN, THAIBINH T MD	4/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115702	01	General Practice	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
37061	Fee-for-Service	1811645294	1811645294	1	1	PHAM, JOHNNY CHIEU T OD	7/17/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	SUITE 101	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
37077	Fee-for-Service	1700126745	1700126745	1	1	PRIMEMED INC	4/5/2013	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	311 N VERDUGO RD	#A	GLENDALE	CA	91206	3944	19	06037	34.15041479	-118.2362431	Los Angeles County
37099	Fee-for-Service	1306159116	1306159116	1	1	PATEL, MEGHNA D MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142965	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
37118	Fee-for-Service	1710343132	1710343132	1	1	PLAINSBURG UNION ELEMENTARY	7/1/2015	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	3708 SOUTH PLAINSBURG RD	None	MERCED	CA	95341	9557	24	06047	37.2338259	-120.324927	Merced County
37120	Fee-for-Service	1689748907	1689748907	1	1	PI, RANDY DUN HSIN MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
37127	Fee-for-Service	1497094114	1497094114	1	1	PLANNED PARENTHOOD PASADENA	8/21/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AND SAN GABRIEL VALLEY	130 W ROUTE 66	STE 100	GLENDORA	CA	91740	6250	19	06037	34.12865951	-117.8651745	Los Angeles County
37150	Fee-for-Service	1093969115	1093969115	1	10	PLANNED PARENTHOOD OF LA	2/2/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14200 VAN NUYS BLVD	None	ARLETA	CA	91331	5103	19	06037	34.25096734	-118.4428041	Los Angeles County
37171	Fee-for-Service	1144320987	1144320987	1	1	POWELL, CHERYL J MD	7/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	58108	18	Ophthalmology	0	In state provider	None	231 W VERNON AVE	STE 104	LOS ANGELES	CA	90037	2778	19	06037	34.0038305	-118.2774195	Los Angeles County
37184	Fee-for-Service	1194803254	1194803254	1	1	PROVDA, MARK J MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37075	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
37240	Fee-for-Service	1033281019	1033281019	1	1	PETERSON, KELSEY C JR MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	17592	20	Orthopedic Surgery	0	In state provider	None	3801 S HARBOR BLVD	SUITE B	SANTA ANA	CA	92704	7901	30	06059	33.69677395	-117.9193475	Orange County
37249	Fee-for-Service	1922291467	1922291467	1	1	POH, MELISSA MD	12/30/2010	390200000X	NA	Other	026	PHYSICIANS	114662	24	Plastic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
37263	Fee-for-Service	1174042980	1174042980	1	1	PERRY, ALIX E MD	9/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159763	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
37339	Fee-for-Service	1891957718	1891957718	1	1	PHAN, THAIBINH T MD	4/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115702	08	Family Practice	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
37361	Fee-for-Service	1356505598	1356505598	1	1	PHILLIPS, WAYNE W LMFT	11/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37383	Fee-for-Service	1699876698	1699876698	1	1	PARIKH, AMEESH S MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94177	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
37391	Fee-for-Service	1972962793	1972962793	1	1	PARTIDA, MARICELA LCSW	4/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
37395	Fee-for-Service	1932841897	1932841897	1	1	PRIME BEING MANAGEMENT LLC	5/17/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1304 15TH ST	STE. 103	SANTA MONICA	CA	90404	1810	19	06037	34.02600773	-118.486172	Los Angeles County
37410	Fee-for-Service	1912266339	1912266339	1	1	PATEL, KRUSHANGI MD	12/22/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	174563	None	None	0	In state provider	None	400 TAYLOR BLVD	SUITE 201	PLEASANT HILL	CA	94523	2163	07	06013	37.96132631	-122.0740275	Contra Costa County
37433	Fee-for-Service	1538210844	1538210844	1	1	PLOOF, DAMIAN M OD	12/8/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
37483	Fee-for-Service	1073630406	1073630406	1	1	PACIFIC HEMATOLOGY ONCOLOGY	8/29/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES	2100 WEBSTER ST	STE 220	SAN FRANCISCO	CA	94115	2376	38	06075	37.7904826	-122.4324477	San Francisco County
37505	Fee-for-Service	1447000138	1447000138	1	1	PELIAS, KATHLEEN M NP	2/24/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	905 S A ST	STE 1	OXNARD	CA	93030	9252	56	06111	34.19225229	-119.178671	Ventura County
37538	Fee-for-Service	1053842781	1053842781	1	1	PATEL, MEGHA R DO	5/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17311	None	None	0	In state provider	None	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
37582	Fee-for-Service	1972090306	1972090306	1	1	PARSONS, MEKRAE L NP	5/11/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
37583	Fee-for-Service	1720406549	1720406549	1	1	PAO, HSING C MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145634	01	General Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
37584	Fee-for-Service	1427140839	1427140839	1	1	POLK, DAVID B	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43654	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
37638	Fee-for-Service	1861433989	1861433989	1	1	PORTALE, ANTHONY A MD	1/1/1990	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	34347	45	Nephrology (Renal-Kidney)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
37643	Fee-for-Service	1578320651	1578320651	1	1	PENSERGA, GIVAHNA	10/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	552 S. PASEO DOROTEA	STE 4	PALM SPRINGS	CA	92264	1437	33	06065	33.81460283	-116.5017722	Riverside County
37664	Fee-for-Service	1942539853	1942539853	1	1	POURZAND, LILA MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109597	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
37671	Fee-for-Service	1386800027	1386800027	1	1	PATRICIA CURRY	6/5/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
37676	Fee-for-Service	1699876698	1699876698	1	1	PARIKH, AMEESH S MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94177	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
37683	Fee-for-Service	1962519868	1962519868	1	2	PROFESSIONAL MED CLINIC	3/30/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4100 E COMMERCE WAY	STE 110	SACRAMENTO	CA	95834	9501	34	06067	38.644866	-121.519188	Sacramento County
37691	Fee-for-Service	1164872982	1164872982	2	1	PEREZ, MARIBEL LMFT	4/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	855 N. LARK ELLEN AVE.	W	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
37714	Fee-for-Service	1811305550	1811305550	1	1	PATEL, SONAM	8/8/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
37770	Fee-for-Service	1073630406	1073630406	1	1	PACIFIC HEMATOLOGY ONCOLOGY	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES	2100 WEBSTER ST	STE 220	SAN FRANCISCO	CA	94115	2376	38	06075	37.7904826	-122.4324477	San Francisco County
37779	Fee-for-Service	1407126139	1407126139	1	1	PALAFOX, JOSE D LMFT	3/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1029 N DEMAREE ST	None	VISALIA	CA	93291	4117	54	06107	36.338409	-119.3335065	Tulare County
37783	Fee-for-Service	1164748521	1164748521	1	1	PECHULIS, GEORGIE J MD	4/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111809	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
37786	Fee-for-Service	1164683538	1164683538	1	1	PARKER, JACKLYN T MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94852	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
37867	Fee-for-Service	1831613975	1831613975	1	5	PAULA VANG, O.D., INC.	1/3/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 HURLEY WAY	SUITE 185	SACRAMENTO	CA	95825	3215	34	06067	38.587752	-121.419468	Sacramento County
37882	Fee-for-Service	1962841452	1962841452	1	1	PATEL, JAY N DO	6/4/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	18210	20	Orthopedic Surgery	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
37927	Fee-for-Service	1861433989	1861433989	1	1	PORTALE, ANTHONY A MD	1/1/1990	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	34347	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
37978	Fee-for-Service	1194086595	1194086595	1	1	PATEL, PARTH P	10/17/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1002 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	15	06029	35.36711975	-119.1118605	Kern County
38061	Fee-for-Service	1538459730	1538459730	1	1	PHAN, DUY L MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122898	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
38089	Fee-for-Service	1952764359	1952764359	1	1	PATEL, VIHARKUMAR MD	8/1/2022	207ZP0102X	NA	Other	026	PHYSICIANS	179633	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
38141	Fee-for-Service	1003863622	1003863622	1	3	PEACH TREE HEALTHCARE	11/24/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
38148	Fee-for-Service	1396778742	1396778742	1	1	POMA MEDICAL CENTER INC	4/30/1994	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	41816	25	Physical Medicine and Rehabilitation	0	In state provider	POMA MEDICAL CENTER INC	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
38153	Fee-for-Service	1144617176	1144617176	1	1	PRODIGY HEALTHCARE, INC	5/4/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2580 W TAHOE AVE	CO AND CR	CARUTHERS	CA	93609	9475	10	06019	36.53885143	-119.837641	Fresno County
38159	Fee-for-Service	1770048951	1770048951	1	1	PALACIOS, MARIO F INC	8/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5556 S CENTINELA AVE	None	LOS ANGELES	CA	90066	6912	19	06037	33.98176635	-118.4096349	Los Angeles County
38216	Fee-for-Service	1679684526	1679684526	1	1	PERERA, PHILLIPS MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85822	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38235	Fee-for-Service	1497893788	1497893788	1	1	PROSTHETIC & ORTHOTIC	8/22/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	12200 E WASHINGTON BLVD	#M	WHITTIER	CA	90606	2583	19	06037	33.96745523	-118.0516703	Los Angeles County
38255	Fee-for-Service	1386291300	1386291300	1	1	PANDEY, UMESH	12/12/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176602	None	None	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
38296	Fee-for-Service	1548958853	1548958853	1	1	PAKHCHIAN, ANNETTE J LCSW	10/10/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
38298	Fee-for-Service	1710031588	1710031588	1	9	PROVIDENCE FACEY MEDICAL FOU	4/23/2021	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
38316	Fee-for-Service	1992760698	1992760698	1	1	PAMELA M PHILLIPS,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 HOSPITAL DR	None	HURRICANE	WV	25526	9202	00	None	38.45165654	-81.95139799	Putnam County
38328	Fee-for-Service	1457720872	1457720872	1	1	PATEL, RIPAL C NP	2/15/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4540 KEARNY VILLARD	106	SAN DIEGO	CA	92123	1571	37	06073	32.82260734	-117.144126	San Diego County
38338	Fee-for-Service	1386934875	1386934875	1	3	PEDIATRIC & FAMILY MEDICAL	6/12/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4650 W OLYMPIC BLVD	ROOM 40	LOS ANGELES	CA	90019	1831	19	06037	34.05649127	-118.332358	Los Angeles County
38401	Fee-for-Service	1467800243	1467800243	1	1	PETERSON, TYLER A DO	1/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18570	None	None	0	In state provider	None	1090 3RD ST	None	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
38409	Fee-for-Service	1801224191	1801224191	1	1	PINEDA-MIRANDA, CLAUDIA LCS	3/12/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
38427	Fee-for-Service	1003863622	1003863622	1	3	PEACH TREE HEALTHCARE	5/4/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
38430	Fee-for-Service	1336914639	1336914639	1	1	PARK, SUNGJU LCSW	3/26/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
38439	Fee-for-Service	1700279361	1700279361	1	1	PETERSON, KRISTA K LCSW	3/23/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
38442	Fee-for-Service	1679625032	1679625032	1	1	PANDYA, ROBERT J MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63952	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
38479	Fee-for-Service	1801156252	1801156252	1	1	PETERS, CHRISTINE A LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
38495	Fee-for-Service	1003194309	1003194309	1	1	PIERRE, JAMES A MD	10/18/2022	207RA0401X	NA	Other	026	PHYSICIANS	180637	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
38551	Fee-for-Service	1083696462	1083696462	1	1	POLEK, VINCENT T MD	9/2/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	58525	30	Radiology	0	In state provider	None	100 OCEANGATE	STE 100	LONG BEACH	CA	90802	4312	19	06037	33.76655046	-118.1989306	Los Angeles County
38580	Fee-for-Service	1932331410	1932331410	1	1	PARK, SEUNG H	3/9/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8110 MANGO AVE	STE 107	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
38584	Fee-for-Service	1962848242	1962848242	1	1	PARIS, ELIAS MD	3/27/2024	2085B0100X	NA	MRI Provider	026	PHYSICIANS	127154	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
38586	Fee-for-Service	1710031588	1710031588	1	9	PROVIDENCE FACEY MEDICAL FOU	3/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
38597	Fee-for-Service	1760809610	1760809610	1	1	PATEL, MINAL C MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140517	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
38615	Fee-for-Service	1275686941	1275686941	1	1	PICARDO-MORTERA, MARIA S PT	4/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
38619	Fee-for-Service	1992932800	1992932800	1	1	PATEL, GARVIN S MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126141	None	None	0	In state provider	None	4445 MAGNOIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
38621	Fee-for-Service	1336199678	1336199678	1	1	PETERSON, DAVID A MD	9/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61388	08	Family Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
38627	Fee-for-Service	1386934875	1386934875	1	3	PEDIATRIC & FAMILY MEDICAL	6/12/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4650 W OLYMPIC BLVD	ROOM 40	LOS ANGELES	CA	90019	1831	19	06037	34.05649127	-118.332358	Los Angeles County
38669	Fee-for-Service	1780651828	1780651828	1	1	PETERSON, KARIN RMS MD	10/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52621	83	Rheumatology	0	In state provider	None	3020 CHILDREN'S WAY	MC5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
38687	Fee-for-Service	1114264371	1114264371	1	1	PETULLO, JENNIFER A LMFT	8/2/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 CRESCENT WAY	STE 3	ARCATA	CA	95521	6781	12	06023	40.85906241	-124.0735719	Humboldt County
38693	Fee-for-Service	1912433301	1912433301	1	1	PARISI, BRANDON MD	8/25/2021	207L00000X	NA	Other	026	PHYSICIANS	159285	None	None	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
38710	Fee-for-Service	1003836495	1003836495	2	1	PENN, GEORGE H II MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	15621	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	SANTA CLARA	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara
38716	Fee-for-Service	1003863622	1003863622	1	3	PEACH TREE HEALTHCARE	5/4/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
38746	Fee-for-Service	1548308489	1548308489	1	1	PREWETT, JOHN R OD INC	2/8/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1429 S BROADWAY	None	SANTA MARIA	CA	93454	6913	42	06083	34.93645316	-120.436196	Santa Barbara County
38769	Fee-for-Service	1376971986	1376971986	1	1	PATEL, PURVI RASHMIKANT MD	9/22/2014	208M00000X	NA	Other	026	PHYSICIANS	82356	01	General Practice	0	In state provider	A MEDICAL CORPORATION	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
38815	Fee-for-Service	1396742524	1396742524	1	1	PITZEN, ROGER J MD	7/1/1978	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37034	01	General Practice	0	In state provider	None	555 PETALUMA AVE	STE A	SEBASTOPOL	CA	95472	4224	49	06097	38.39744712	-122.8206197	Sonoma County
38819	Fee-for-Service	1659138444	1659138444	1	1	PRIME URGENT CARE INC	4/22/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	17609 VENTURA BLVD	STE 106	ENCINO	CA	91316	3866	19	06037	34.16197507	-118.5167485	Los Angeles County
38830	Fee-for-Service	1326764499	1326764499	1	1	PARK, ASHLEY PT	8/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
38836	Fee-for-Service	1083696462	1083696462	1	1	POLEK, VINCENT T MD	9/2/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	58525	01	General Practice	0	In state provider	None	100 OCEANGATE	STE 100	LONG BEACH	CA	90802	4312	19	06037	33.76655046	-118.1989306	Los Angeles County
38844	Fee-for-Service	1497109680	1497109680	1	1	PHAM, VIVIAN MD	4/22/2022	207LP2900X	NA	Other	026	PHYSICIANS	154042	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
38866	Fee-for-Service	1316041833	1316041833	2	16	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
38871	Fee-for-Service	1780878991	1780878991	1	1	PAK, JAE P MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
38874	Fee-for-Service	1710031588	1710031588	1	9	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
38891	Fee-for-Service	1053328575	1053328575	1	1	POTH, JAMES L MD INC	7/1/1976	207RH0000X	NA	Hematology	026	PHYSICIANS	14210	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 110	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
38906	Fee-for-Service	1750796371	1750796371	1	1	PHAN, ALEXANDER DO	2/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14386	08	Family Practice	0	In state provider	None	830 SCENIC DRIVE	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
38913	Fee-for-Service	1336199678	1336199678	1	1	PETERSON, DAVID A MD	9/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61388	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
38929	Fee-for-Service	1689234924	1689234924	1	1	POWER, MATTHEW MD	2/14/2025	207R00000X	NA	Other	026	PHYSICIANS	180414	41	Internal Medicine	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
38932	Fee-for-Service	1235601444	1235601444	1	1	PEPRAH, GRACE LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10718 WHITE OAK AVE.	6	GRANADA HILLS	CA	91344	4628	19	06037	34.265538	-118.519724	Los Angeles County
38964	Fee-for-Service	1780651828	1780651828	1	1	PETERSON, KARIN RMS MD	10/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52621	43	Pediatric Allergy	0	In state provider	None	3020 CHILDREN'S WAY	MC5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
38970	Fee-for-Service	1639640758	1639640758	1	1	POSADA-ESTRADA, PATRICIA E	1/7/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	490 S FARRELL DR	SUITE C208	PALM SPRINGS	CA	92262	7944	33	06065	33.81651	-116.5180015	Riverside County
38990	Fee-for-Service	1922328947	1922328947	1	1	PERENS, ELLIOT A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108840	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
39003	Fee-for-Service	1003863622	1003863622	1	3	PEACH TREE HEALTHCARE	5/4/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
39004	Fee-for-Service	1467409110	1467409110	1	1	PINCUS, DAVID W MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148171	40	Pediatrics	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
39005	Fee-for-Service	1215311105	1215311105	1	1	PACHECO-NAVARRO, ANA E MD	6/27/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	161620	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39017	Fee-for-Service	1114064714	1114064714	2	1	PARAG MEDICAL INC	8/15/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	657 CAMINO DE LOS MARES	STE 243	SAN CLEMENTE	CA	92673	2811	30	06059	33.4575611	-117.6492697	Orange County
39091	Fee-for-Service	1265652242	1265652242	1	1	PETROSYAN, MIKAEL MD	12/26/2007	208600000X	NA	General Surgery	026	PHYSICIANS	93485	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
39098	Fee-for-Service	1205856598	1205856598	1	1	PHAM, DIEU MD	8/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85351	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39132	Fee-for-Service	1033106562	1033106562	1	1	PATEL, GIRIBALA R MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43865	68	Hematology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
39154	Fee-for-Service	1679879639	1679879639	1	1	PINON, DENISE MD	10/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153126	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
39194	Fee-for-Service	1578838520	1578838520	1	9	PACIFIC COAST MEDICAL CENTER	12/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INCORPORATED APC	421 N CHURCH ST	None	VISALIA	CA	93291	5006	54	06107	36.333594	-119.2915485	Tulare County
39244	Fee-for-Service	1255030813	1255030813	1	1	POINT BREAK RECOVERY LLC	8/13/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2100 PIERPONT BLVD	None	VENTURA	CA	93001	3861	56	06111	34.26711733	-119.2746188	Ventura County
39248	Fee-for-Service	1780651828	1780651828	1	1	PETERSON, KARIN RMS MD	10/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52621	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
39254	Fee-for-Service	1477115970	1477115970	1	1	PERRY, MARK LCSW	11/14/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	674 COUNTY SQUARE DR	STE 106	VENTURA	CA	93003	0439	56	06111	34.26954195	-119.2148249	Ventura County
39278	Fee-for-Service	1922328947	1922328947	1	1	PERENS, ELLIOT A MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108840	45	Nephrology (Renal-Kidney)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
39288	Fee-for-Service	1467409110	1467409110	1	1	PINCUS, DAVID W MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148171	79	Neurology-Child	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
39325	Fee-for-Service	1992897771	1992897771	1	1	PETERSON, STEPHEN D MD	2/28/1988	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	31968	02	General Surgery	0	In state provider	None	185 E 7TH AVE	STE D	CHICO	CA	95926	3356	04	06007	39.74473059	-121.8488381	Butte County
39334	Fee-for-Service	1861596819	1861596819	1	1	PACIFIC MEDICAL PHARMACY	2/23/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1101 N PACIFIC AVE	None	GLENDALE	CA	91202	4310	19	06037	34.16078708	-118.2644824	Los Angeles County
39341	Fee-for-Service	1609286418	1609286418	1	1	PLANNED PARENTHOOD SHASTA	8/4/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIABLO INC	3225 TIMBERFALL COURT	SUITE B	EUREKA	CA	95503	4892	12	06023	40.778955	-124.1356445	Humboldt County
39416	Fee-for-Service	1821644766	1821644766	1	1	PERNG, YUNG-EN PT	8/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
39445	Fee-for-Service	1154568947	1154568947	1	1	PARKIN, ANGELA MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108193	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
39461	Fee-for-Service	1992721161	1992721161	1	1	PRIME HEALTHCARE SERVICES	9/6/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MONTCLAIR, LLC	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
39502	Fee-for-Service	1003963299	1003963299	1	1	PENNINGTON, GENA C MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34152	01	General Practice	0	In state provider	None	2773 HARRIS ST	STE F	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
39518	Fee-for-Service	1275699258	1275699258	1	1	PIERRE-LOUIS, MONIQUE PHD	1/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
39577	Fee-for-Service	1467409110	1467409110	1	1	PINCUS, DAVID W MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148171	85	Surgery-Pediatric	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
39614	Fee-for-Service	1992897771	1992897771	1	1	PETERSON, STEPHEN D MD	2/28/1988	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	31968	01	General Practice	0	In state provider	None	185 E 7TH AVE	STE D	CHICO	CA	95926	3356	04	06007	39.74473059	-121.8488381	Butte County
39625	Fee-for-Service	1417689480	1417689480	1	1	PREMIER HEARING AID & AUDIOL	6/22/2023	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	STE 201A	REDLANDS	CA	92373	4881	36	06071	34.03788441	-117.2055761	San Bernardino County
39631	Fee-for-Service	1689837403	1689837403	1	1	PATRICK, LISA G MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117374	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
39635	Fee-for-Service	1316041833	1316041833	2	25	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	300 WEST HUNTINGTON DRIV	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
39661	Fee-for-Service	1780810564	1780810564	2	1	PHYSICIANS CHOICE MEDICAL I	10/30/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	NC	1627 S CENTRAL AVE	None	GLENDALE	CA	91204	2734	19	06037	34.12625776	-118.2589942	Los Angeles County
39713	Fee-for-Service	1336446954	1336446954	1	1	PINTO, ANGELA LAC	7/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	13711 BURBANK BLVD	None	VAN NUYS	CA	91401	4734	19	06037	34.1721565	-118.4318325	Los Angeles County
39729	Fee-for-Service	1154430460	1154430460	1	1	PEARLMAN, JOEL A MD	9/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78783	18	Ophthalmology	0	In state provider	None	3939 J ST	STE 104	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
39736	Fee-for-Service	1295024842	1295024842	1	1	PEREZ, XOCHITL E LCSW	6/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE #614	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
39738	Fee-for-Service	1215357793	1215357793	1	1	PRUITT, CRYSTAL N MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143165	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
39743	Fee-for-Service	1861568750	1861568750	1	1	PACHYNSKI, RUSSELL K MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88936	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
39746	Fee-for-Service	1992721161	1992721161	1	1	PRIME HEALTHCARE SERVICES	9/6/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MONTCLAIR, LLC	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
39756	Fee-for-Service	1699752956	1699752956	1	1	PERRY, IRA J IV MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69184	41	Internal Medicine	0	In state provider	None	18370 BURBANK BLVD	STE 707	TARZANA	CA	91356	2830	19	06037	34.17173059	-118.5331881	Los Angeles County
39773	Fee-for-Service	1467401042	1467401042	1	1	PRABAKER, VENUGOPAL MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42653	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	7339 EL CAJON BLVD	STE C	LA MESA	CA	91941	3473	37	06073	32.76875533	-117.0388333	San Diego County
39775	Fee-for-Service	1861544223	1861544223	1	1	PAPANEK, PAUL J JR MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38268	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
39786	Fee-for-Service	1528229374	1528229374	1	1	PARSAEIAN, ALI M MD	2/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109642	08	Family Practice	0	In state provider	None	26991 CROWN VALLEY PRKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
39840	Fee-for-Service	1457549339	1457549339	1	1	PARTOVI, DIANA A PHD	10/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
39855	Fee-for-Service	1174142004	1174142004	1	1	PIIBE, QUINN MD	9/23/2023	207P00000X	NA	Other	026	PHYSICIANS	178434	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
39870	Fee-for-Service	1538288311	1538288311	1	1	PISIMISIS, GEORGE	6/14/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	175395	None	None	0	In state provider	None	2720 HARBOR BLVD	STE 140	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
39875	Fee-for-Service	1619905189	1619905189	1	1	PERSICHINO, JON G DO	8/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8923	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
39878	Fee-for-Service	1245299379	1245299379	1	1	PANDYA, AMIT G MD	1/2/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	166658	07	Dermatology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
39887	Fee-for-Service	1558313213	1558313213	1	1	PRINCETON, COMM HOSP	12/12/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PRINCETON COMM HOSP	122 TWELFTH ST	None	PRINCETON	WV	24740	2312	00	None	37.36255743	-81.11276218	Mercer County
39894	Fee-for-Service	1700950847	1700950847	1	1	PATAKI, GYORGY MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74189	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
39898	Fee-for-Service	1053637942	1053637942	1	1	PONGRACZ, BRIAN A NP	2/6/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
39917	Fee-for-Service	1417051145	1417051145	1	1	PYSHER,LANCE W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 WESTWOOD DRIVE	None	HAMILTON	MT	59840	0000	00	None	46.248102	-114.1718175	Ravalli County
39937	Fee-for-Service	1235910746	1235910746	1	1	PLEASANT HILL VILLA HOME CAR	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3021 PUTNAM BLVD	None	PLEASANT HILL	CA	94523	4627	07	06013	37.930194	-122.073549	Contra Costa County
39942	Fee-for-Service	1053143875	1053143875	1	1	PARKER, LESLIE D	9/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
39968	Fee-for-Service	1174674089	1174674089	1	1	PHILLIPS, JEFFREY W DC	1/31/1992	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	620 ALABAMA ST	None	REDLANDS	CA	92373	8059	36	06071	34.061841	-117.208804	San Bernardino County
39987	Fee-for-Service	1851553804	1851553804	1	2	PATEL, NIKUNJ MD	3/5/2025	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	114074	-	NOT APPLICABLE	0	In state provider	None	1775 CHESTNUT AVE	None	LONG BEACH	CA	90813	1674	19	06037	33.78936169	-118.1964259	Los Angeles County
39995	Fee-for-Service	1922699271	1922699271	1	1	PHUNG, THI PHUONG THUY OD	2/11/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1689 ARDEN WAY	STE 1091	SACRAMENTO	CA	95815	4096	34	06067	38.601549	-121.4274825	Sacramento County
40016	Fee-for-Service	1639152333	1639152333	1	1	PHILLIPS, THOMAS J MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85057	20	Orthopedic Surgery	0	In state provider	None	12522 LAMBERT RD	STE A	WHITTIER	CA	90606	2758	19	06037	33.96495228	-118.0466484	Los Angeles County
40043	Fee-for-Service	1699752956	1699752956	1	1	PERRY, IRA J IV MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18370 BURBANK BLVD	STE 707	TARZANA	CA	91356	2830	19	06037	34.17173059	-118.5331881	Los Angeles County
40045	Fee-for-Service	1356352108	1356352108	1	1	PINE, STEPHEN MD	11/30/1990	174400000X	NA	Other	026	PHYSICIANS	33483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11500 ELDRIDGE AVE	STE 101	SYLMAR	CA	91342	6523	19	06037	34.27944492	-118.3828796	Los Angeles County
40056	Fee-for-Service	1659563864	1659563864	1	1	PARTRIDGE, JOAN M CNM	10/21/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	22550 E SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
40057	Fee-for-Service	1467401042	1467401042	1	1	PRABAKER, VENUGOPAL MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42653	41	Internal Medicine	0	In state provider	INC	7339 EL CAJON BLVD	STE C	LA MESA	CA	91941	3473	37	06073	32.76875533	-117.0388333	San Diego County
40085	Fee-for-Service	1366652786	1366652786	1	1	POKORNY, CORINNA M MD	6/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98455	18	Ophthalmology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
40105	Fee-for-Service	1417092404	1417092404	1	1	PROGRESS HOUSE, INC	6/1/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	838 BEACH COURT	None	COLOMA	CA	95613	0437	09	06017	38.80779414	-120.9070843	El Dorado County
40106	Fee-for-Service	1609042274	1609042274	1	1	PENN, RENEE J MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103316	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90095	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
40151	Fee-for-Service	1023154622	1023154622	1	1	PATEL, GITANJALI J DPM	2/14/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
40157	Fee-for-Service	1740666759	1740666759	1	1	PATTERSON, REBEKAH	8/22/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	136 GLOBE AVENUE	None	SACRAMENTO	CA	95815	3539	34	06067	38.600721	-121.4643015	Sacramento County
40201	Fee-for-Service	1033435466	1033435466	1	1	PARAGAS, JOSEPH CRNA	6/24/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
40202	Fee-for-Service	1033498761	1033498761	1	1	PLOWEY, EDWARD D MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118836	01	General Practice	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40217	Fee-for-Service	1184185548	1184185548	1	1	PREFERRED HOME HEALTH	5/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	9608 VAN NUYS BLVD	STE 206	PANORAMA CITY	CA	91402	1043	19	06037	34.24485892	-118.4502135	Los Angeles County
40227	Fee-for-Service	1063860575	1063860575	1	1	PACE, JODI NP	9/19/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
40242	Fee-for-Service	1023036589	1023036589	1	1	PAIGE, MICHAEL T MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80349	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
40260	Fee-for-Service	1518415546	1518415546	1	1	PARADA, JACQUELINE M CNP	4/6/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
40265	Fee-for-Service	1407526098	1407526098	1	1	PINNEKE, STACEY LMFT	12/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
40277	Fee-for-Service	1245722495	1245722495	1	1	PHAM, TUONG MD	9/1/2023	207P00000X	NA	Other	026	PHYSICIANS	186646	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
40281	Fee-for-Service	1265874374	1265874374	1	1	PISANO, FRANCESCO LMFT	10/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
40308	Fee-for-Service	1528649225	1528649225	1	1	PATNALA, SRAVYA MD	8/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188355	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40324	Fee-for-Service	1770623712	1770623712	1	1	PAUTZ, MICHAEL PHD	7/14/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49456	-	NOT APPLICABLE	0	In state provider	None	2060 CAMPUS DRIVE	None	YREKA	CA	96097	9538	47	06093	41.7050458	-122.6481121	Siskiyou County
40336	Fee-for-Service	1932196813	1932196813	1	1	PUPLAMPU, OUANZA A MD	12/28/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54264	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
40344	Fee-for-Service	1932454709	1932454709	1	1	PATEL, SHEENA P PA-C	11/29/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21163	-	NOT APPLICABLE	0	In state provider	None	1000 FAIRVIEW RD	None	HOLLISTER	CA	95023	9644	35	06069	36.83036035	-121.3636084	San Benito County
40346	Fee-for-Service	1902903180	1902903180	1	2	PRIMARY PEDIATRIC MEDICAL	5/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP	1332 PARK ST	STE 200	ALAMEDA	CA	94501	4553	01	06001	37.76330843	-122.2435444	Alameda County
40383	Fee-for-Service	1639178247	1639178247	1	1	PLUMLEY, THOMAS F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3900 CAPITOL MALL DR SW	None	OLYMPIA	WA	98502	8654	00	None	47.04174423	-122.9516179	Thurston County
40446	Fee-for-Service	1740666759	1740666759	1	1	PATTERSON, REBEKAH	8/22/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	136 GLOBE AVENUE	None	SACRAMENTO	CA	95815	3539	34	06067	38.600721	-121.4643015	Sacramento County
40457	Fee-for-Service	1376513754	1376513754	1	4	PALOMAR HEALTH	11/6/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15611 POMERADO RD	STE 100 SPACE 106	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
40478	Fee-for-Service	1972757326	1972757326	1	1	PENG, DANIEL C MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111281	38	Geriatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
40501	Fee-for-Service	1023447737	1023447737	1	1	POWELL, JONATHAN L MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132545	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
40581	Fee-for-Service	1023063492	1023063492	1	1	PULMONARY CRITICAL CARE	1/28/2016	207R00000X	NA	Other	026	PHYSICIANS	43194	41	Internal Medicine	0	In state provider	ASSOCIATES INC	1172 SWALLOW LANE	None	SIMI VALLEY	CA	93065	3154	56	06111	34.26008797	-118.7941068	Ventura County
40622	Fee-for-Service	1689331779	1689331779	1	1	PASTERNAK-MARTIN, LYDIA PT	2/24/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2260 TAPO ST	B117	SIMI VALLEY	CA	93063	3022	56	06111	34.27695447	-118.7089305	Ventura County
40650	Fee-for-Service	1659013381	1659013381	1	1	PRZYBYSZMED	3/20/2023	207LP2900X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	MANAGEMENT	5355 WARNER AVENUE	STE 102	HUNTINGTON BEACH	CA	92649	4097	30	06059	33.71544849	-118.0362015	Orange County
40683	Fee-for-Service	1972590107	1972590107	1	1	PINSINSKI, DAVID L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	499 E HAMPDEN AVE	STE 320	ENGLEWOOD	CO	80113	2793	00	None	39.65319046	-104.982129	Arapahoe County
40685	Fee-for-Service	1679357065	1679357065	1	1	PETERSON, LEAH AU	2/5/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
40740	Fee-for-Service	1356685218	1356685218	1	8	PACIFIC NEUROPSYCHIATRIC SPE	1/4/2022	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	999 N. TUSTIN AVE	UNIT # 216	SANTA ANA	CA	92705	3528	30	06059	33.754167	-117.834191	Orange County
40753	Fee-for-Service	1588616791	1588616791	1	3	PHARMEDCARE, LLC	12/24/2018	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 S RAYMOND	None	ALHAMBRA	CA	91801	3166	19	06037	34.08926073	-118.1450118	Los Angeles County
40820	Fee-for-Service	1740470707	1740470707	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	PEDIATRIC RHEUMATOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
40831	Fee-for-Service	1538178561	1538178561	1	1	POOPAT, CHAD MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 PALOMINO LANE	#100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
40868	Fee-for-Service	1023063492	1023063492	1	1	PULMONARY CRITICAL CARE	1/28/2016	207R00000X	NA	Other	026	PHYSICIANS	43194	29	Pulmonary Diseases (M.D. only)	0	In state provider	ASSOCIATES INC	1172 SWALLOW LANE	None	SIMI VALLEY	CA	93065	3154	56	06111	34.26008797	-118.7941068	Ventura County
40890	Fee-for-Service	1235299231	1235299231	1	1	PATRIZI, DEBRA	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
40893	Fee-for-Service	1053608208	1053608208	1	1	PARULKAR, SURAJ MD	10/15/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
40895	Fee-for-Service	1497383756	1497383756	1	1	PEER, JERRY A MD	11/8/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
40911	Fee-for-Service	1750670899	1750670899	1	1	POST, ANNALISA L MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158504	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40992	Fee-for-Service	1619153251	1619153251	1	1	PINNACLE EMERG PHYS OF	5/1/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
41013	Fee-for-Service	1427269422	1427269422	1	1	POON, HENRY G LMFT	7/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	310 8TH ST	SUITE 201	OAKLAND	CA	94607	4210	01	06001	37.79894269	-122.2704172	Alameda County
41051	Fee-for-Service	1497905749	1497905749	1	1	PATEL, PRANAV J MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	102822	36	Psychiatry	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
41058	Fee-for-Service	1588619399	1588619399	1	1	PATHMAN, JAMES K PHD	12/2/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1975 VERDUGO BLVD	SUITE A	LA CANADA FLINTRI	CA	91011	3024	19	06037	34.20501855	-118.219857	Los Angeles County
41063	Fee-for-Service	1396354510	1396354510	1	1	PANALIGAN, CHRISTIAN CRNA	10/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
41066	Fee-for-Service	1164458188	1164458188	1	1	PANUSH, RICHARD S MD	12/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33656	83	Rheumatology	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
41093	Fee-for-Service	1952331720	1952331720	1	1	PATELLA, DAVID MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48078	41	Internal Medicine	0	In state provider	None	4770 ROCKLIN RD	STE 2	ROCKLIN	CA	95677	3334	31	06061	38.7885107	-121.2156429	Placer County
41105	Fee-for-Service	1740470707	1740470707	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC RHEUMATOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
41106	Fee-for-Service	1124316138	1124316138	1	1	PATH MD INC	8/31/2015	291U00000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	8158 BEVERLY BLVD	None	LOS ANGELES	CA	90048	4513	19	06037	34.0760665	-118.367352	Los Angeles County
41139	Fee-for-Service	1437322377	1437322377	1	1	PRIME HEALTHCARE SRVS	6/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
41150	Fee-for-Service	1548367063	1548367063	2	3	PRISM MEDICAL PRODUCTS, LLC	1/26/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4705 N.SONORA AVE	110	FRESNO	CA	93722	3947	10	06019	36.806112	-119.8659475	Fresno County
41197	Fee-for-Service	1235508110	1235508110	1	1	POSPYCHALLA, JACOB LMFT	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2617 K ST	260	SACRAMENTO	CA	95816	5116	34	06067	38.573595	-121.4715825	Sacramento County
41207	Fee-for-Service	1841653409	1841653409	1	1	PABLO, MICHELLE COLLEEN T MD	6/3/2019	390200000X	NA	Other	026	PHYSICIANS	158055	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
41230	Fee-for-Service	1497234033	1497234033	1	1	PADVEEN, NATALIE PT	2/28/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
41237	Fee-for-Service	1174876270	1174876270	1	1	PARRAS, CRYSTAL V LCSW	10/24/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
41251	Fee-for-Service	1649403155	1649403155	1	1	PRICE, ELISSA R MD	6/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114772	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
41308	Fee-for-Service	1811914674	1811914674	1	1	PLANNED PARENTHOOD	11/1/1979	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA CENTER COAST	415 E CHAPEL ST	None	SANTA MARIA	CA	93454	4517	42	06083	34.95431543	-120.4307344	Santa Barbara County
41317	Fee-for-Service	1386169142	1386169142	1	1	PATON, JUSTIN C CRNA	6/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
41353	Fee-for-Service	1164458188	1164458188	1	1	PANUSH, RICHARD S MD	12/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	33656	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
41375	Fee-for-Service	1275564296	1275564296	1	3	PRECISION REHABILITATION & O	6/27/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1425 E PROSPERITY AVE	None	TULARE	CA	93274	8051	54	06107	36.22582254	-119.3255267	Tulare County
41377	Fee-for-Service	1831270362	1831270362	1	3	PENUNURI, RAFAEL A MD	2/26/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50737	None	None	0	In state provider	None	13939 SAN ANTONIO DRIVE	None	NORWALK	CA	90650	4036	19	06037	33.90444257	-118.0803356	Los Angeles County
41380	Fee-for-Service	1982135729	1982135729	1	1	PAW, NEIMAN T MD	5/25/2022	208M00000X	NA	Other	026	PHYSICIANS	157598	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
41389	Fee-for-Service	1932488848	1932488848	1	1	PATTERSON, SIMIE-LAVERN A MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115438	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
41393	Fee-for-Service	1124316138	1124316138	1	1	PATH MD INC	11/12/2013	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	8158 BEVERLY BLVD	None	LOS ANGELES	CA	90048	4513	19	06037	34.0760665	-118.367352	Los Angeles County
41421	Fee-for-Service	1457438822	1457438822	1	1	PERLMAN, RICHARD MD INC	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	11577	20	Orthopedic Surgery	0	In state provider	None	8008 FROST ST	STE 403	SAN DIEGO	CA	92123	4209	37	06073	32.80027859	-117.1524832	San Diego County
41436	Fee-for-Service	1700082013	1700082013	1	1	PATEL, AMISH MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123994	30	Radiology	0	In state provider	None	9080 COLIMA ROAD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
41445	Fee-for-Service	1891102174	1891102174	1	1	PURE HOSPICE, INC	10/31/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12011 VICTORY BLVD	SUITE 204	NORTH HOLLYWOOD	CA	91606	3330	19	06037	34.18670845	-118.394784	Los Angeles County
41523	Fee-for-Service	1548238660	1548238660	1	1	PATEL, DILIP C	10/1/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	45937	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
41538	Fee-for-Service	1376635383	1376635383	1	1	PEARCE, DANIEL DYSART DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	5464	01	General Practice	0	In state provider	None	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	2878	33	06065	33.93890182	-117.3977958	Riverside County
41542	Fee-for-Service	1518951714	1518951714	1	1	PAREDEZ, EDWARD C MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87900	10	Gastroenterology (M.D. only)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
41547	Fee-for-Service	1578030359	1578030359	1	1	PM PEDIATRICS OF CALIFORNIA	9/22/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
41585	Fee-for-Service	1003377854	1003377854	1	1	PADILLA, MIKELA M MD	10/18/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181327	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
41599	Fee-for-Service	1497807184	1497807184	1	1	PEDIATRIC GASTROENTEROLOGY	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48942	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL CENTER INC	16661 VENTURA BLVD	STE 718	ENCINO	CA	91436	1995	19	06037	34.15820737	-118.496492	Los Angeles County
41626	Fee-for-Service	1205079910	1205079910	1	1	PARK, RENEE E MD	8/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135401	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
41654	Fee-for-Service	1043480346	1043480346	1	1	PATEL, PARUL I MD	3/10/2009	207L00000X	NA	Other	026	PHYSICIANS	94288	05	Anesthesiology	0	In state provider	None	FILE 55799	None	LOS ANGELES	CA	90074	5799	19	06037	0	0	None
41672	Fee-for-Service	1336324920	1336324920	1	1	PANOSYAN, EDUARDO H MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101164	40	Pediatrics	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
41684	Fee-for-Service	1427363225	1427363225	1	1	PACIFIC SLEEP MEDICINE A MED	1/3/2019	261QS1200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ICAL CORPORATION	1180 INDIAN CANYON DR	W-304	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
41691	Fee-for-Service	1215013735	1215013735	1	1	PALI, MICHAEL J MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65595	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
41695	Fee-for-Service	1467150524	1467150524	1	1	PATEL, SONIA J NP	5/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
41707	Fee-for-Service	1962870634	1962870634	1	1	PARAGON COMPOUNDING PHARMACY	3/10/2016	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1585 WEST BROADWAY	SUITE A	ANAHEIM	CA	92802	1358	30	06059	33.82896331	-117.9364135	Orange County
41734	Fee-for-Service	1891102174	1891102174	1	1	PURE HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12011 VICTORY BLVD	SUITE 204	NORTH HOLLYWOOD	CA	91606	3330	19	06037	34.18670845	-118.394784	Los Angeles County
41735	Fee-for-Service	1013987015	1013987015	1	1	PFEIFFER,ERIC A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 HOSPITAL AVE	None	STUART	FL	34994	0000	00	None	27.19941518	-80.24299355	Martin County
41754	Fee-for-Service	1407833254	1407833254	1	1	PALASCAK, JOSEPH B MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102187	10	Gastroenterology (M.D. only)	0	In state provider	None	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98796413	-121.9825327	Santa Cruz County
41757	Fee-for-Service	1821668443	1821668443	1	1	PRIMARY SELECTION HOME	4/16/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE INC	15125 VENTURA BLVD	SUITE 2-28	SHERMAN OAKS	CA	91403	3306	19	06037	34.15324933	-118.4626202	Los Angeles County
41768	Fee-for-Service	1114901386	1114901386	1	1	PROVIDENCE PORTLAND MEDICAL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN STREET	None	PORTLAND	OR	97213	0000	00	None	45.52655191	-122.6121355	Multnomah County
41783	Fee-for-Service	1679924724	1679924724	1	1	PHAN, TRAM H NP	9/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
41819	Fee-for-Service	1376635383	1376635383	1	1	PEARCE, DANIEL DYSART DO	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	5464	41	Internal Medicine	0	In state provider	None	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	2878	33	06065	33.93890182	-117.3977958	Riverside County
41830	Fee-for-Service	1518951714	1518951714	1	1	PAREDEZ, EDWARD C MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87900	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
41833	Fee-for-Service	1578030359	1578030359	1	1	PM PEDIATRICS OF CALIFORNIA	5/16/2022	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
41837	Fee-for-Service	1558508648	1558508648	1	2	PROVIDENT HOME HEALTHCARE	5/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	7950 SILVERTON AVE	SUITE 114	SAN DIEGO	CA	92126	6343	37	06073	32.89086742	-117.1501901	San Diego County
41858	Fee-for-Service	1275943441	1275943441	1	1	POLOTSKY, MIKHAEL MD	1/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183611	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
41863	Fee-for-Service	1538776471	1538776471	1	1	PADILLA, AMBER LMFT	7/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 MANGROVE AVE	STE D	CHICO	CA	95926	3500	04	06007	39.74217522	-121.8384743	Butte County
41888	Fee-for-Service	1497807184	1497807184	1	1	PEDIATRIC GASTROENTEROLOGY	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48942	40	Pediatrics	0	In state provider	MEDICAL CENTER INC	16661 VENTURA BLVD	STE 718	ENCINO	CA	91436	1995	19	06037	34.15820737	-118.496492	Los Angeles County
41889	Fee-for-Service	1295876860	1295876860	1	1	PODOLIN, RICHARD A MD	9/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50038	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
41908	Fee-for-Service	1841213220	1841213220	1	1	PLUMMER, GLENN O MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	35293	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
41925	Fee-for-Service	1225569866	1225569866	1	1	PUENTE, NICELE E MD	2/16/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170386	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
41928	Fee-for-Service	1508967563	1508967563	1	1	PABST III, THEODORE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	206 CORNELIA ST	STE 104	PLATTSBURGH	NY	12901	2779	00	None	44.699868	-73.469142	Clinton County
41942	Fee-for-Service	1396928040	1396928040	1	1	PARK, DAVID S MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88937	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
41948	Fee-for-Service	1801557061	1801557061	1	1	PRUSHANSKY, ABIGAIL CNM	6/7/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1045 ATLANTIC AVENUE	SUITE 712	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
41968	Fee-for-Service	1689960189	1689960189	1	1	PHALEN, SHAWN E LMFT	4/10/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
42004	Fee-for-Service	1255412474	1255412474	1	3	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	INLAND EMPIRE INC	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
42032	Fee-for-Service	1679537377	1679537377	1	1	PUBLICOVER, LAURIE D MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
42065	Fee-for-Service	1467798223	1467798223	1	1	POWERS, DANAE LMFT	11/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
42072	Fee-for-Service	1518184886	1518184886	1	2	PATTIE J DIMMETTE M D A PROF	8/30/1991	193200000X	NA	Other	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FESSIONAL MEDICAL CORPOR	25405 HANCOCK AVE	STE 101	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
42085	Fee-for-Service	1194933853	1194933853	1	1	PADUGA, REMIA S MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113451	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3907 WARING ROAD	SUITE 2	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
42112	Fee-for-Service	1174923411	1174923411	1	1	PENA, JONERIK	10/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
42114	Fee-for-Service	1265419519	1265419519	1	1	POPA, REMUS I MD	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107795	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42121	Fee-for-Service	1326585209	1326585209	1	1	PRIANO-ENGLISH, DONNA T LCSW	6/23/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42151	Fee-for-Service	1841263951	1841263951	1	1	PROMED PHARMACIES INC	5/31/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	701 N TAYLOR ST	None	AMARILLO	TX	79107	5279	00	None	35.2206483	-101.8331997	Potter County
42152	Fee-for-Service	1336387505	1336387505	1	1	PARAYNO, MARIA L MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105761	30	Radiology	0	In state provider	None	1150 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.1321457	-117.9805798	Los Angeles County
42156	Fee-for-Service	1376755181	1376755181	1	1	PEARSON, JUSTIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 W 800 N	None	OREM	UT	84057	3660	00	None	40.31373134	-111.7150045	Utah County
42157	Fee-for-Service	1588645659	1588645659	1	1	PETROFF, PETER A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2833 BABCOCK RD	STE 435	SAN ANTONIO	TX	78229	4850	00	None	29.5134237	-98.59173413	Bexar County
42171	Fee-for-Service	1962625327	1962625327	1	1	PACHECO, MARY J PHD	7/26/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
42186	Fee-for-Service	1487764106	1487764106	1	1	PORTERFIELD, LAURA	8/6/2008	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
42194	Fee-for-Service	1063777589	1063777589	1	1	PAK, JANIE O MD	7/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126574	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42203	Fee-for-Service	1376690156	1376690156	1	1	PARK, HANNAH OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
42205	Fee-for-Service	1215541628	1215541628	1	1	PACIFIC CARE II INC	9/16/2021	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1024 JAYHAWK WAY	None	MODESTO	CA	95358	6714	50	06099	37.64910826	-121.0339458	Stanislaus County
42212	Fee-for-Service	1518253988	1518253988	1	2	PEARCE, SHANE M MD	3/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
42252	Fee-for-Service	1487674412	1487674412	1	1	PECORA, KAREN A LM	10/11/2016	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	577 E ELDER ST	SUITE H	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
42256	Fee-for-Service	1689960189	1689960189	1	1	PHALEN, SHAWN E LMFT	4/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97914	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
42260	Fee-for-Service	1588642516	1588642516	1	1	PADMANABHAN, MADRAS MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	31106	06	Cardiovascular Disease (M.D. only)	0	In state provider	BALBOA PLAZA	10515 BALBOA BLVD	STE 290	GRANADA HILLS	CA	91344	6362	19	06037	34.261497	-118.502318	Los Angeles County
42275	Fee-for-Service	1992267587	1992267587	1	1	PARK, BENJAMIN MD	8/5/2024	390200000X	NA	Other	026	PHYSICIANS	179743	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
42288	Fee-for-Service	1154601086	1154601086	1	1	PINAL, CRISTINA M LCSW	12/19/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	75205	-	NOT APPLICABLE	0	In state provider	None	10603 DOWNEY AVE	10615 AND 10621	DOWNEY	CA	90241	3426	19	06037	33.94617788	-118.1295872	Los Angeles County
42291	Fee-for-Service	1255412474	1255412474	1	3	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INLAND EMPIRE INC	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
42313	Fee-for-Service	1265894877	1265894877	1	1	PUCHALSKI, ADAM MD	8/11/2022	207R00000X	NA	Other	026	PHYSICIANS	141192	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
42322	Fee-for-Service	1174598346	1174598346	1	1	PAULSEN, PATRICIA I MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41141	40	Pediatrics	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
42329	Fee-for-Service	1164833166	1164833166	1	1	PATTON, ELIZABETH R CRNA	8/9/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42356	Fee-for-Service	1003677816	1003677816	1	1	PACIS, NOAH S NP	10/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42386	Fee-for-Service	1427088806	1427088806	1	1	PIERSON, TYLER MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55175	79	Neurology-Child	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
42395	Fee-for-Service	1689699712	1689699712	1	1	PRUSAKOWSKI, MELANIE K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1906 BELLEVIEW AVE SE	None	ROANOKE	VA	24014	1838	00	None	37.25200121	-79.94241857	Roanoke city
42396	Fee-for-Service	1043241136	1043241136	1	1	PRYOR, ELLSWORTH P III	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29880	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 208	SANTA CLARITA	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
42463	Fee-for-Service	1588100168	1588100168	1	1	PATEL, KALPESH MD INC	2/3/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	101127	01	General Practice	0	In state provider	None	17075 DEVONSHIRE ST	STE 303	NORTHRIDGE	CA	91325	1600	19	06037	34.25755945	-118.50471	Los Angeles County
42476	Fee-for-Service	1093328064	1093328064	1	1	PASCUAL, CHRISTOPHER PT	3/5/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1392 E PALOMAR ST	503	CHULA VISTA	CA	91913	1892	37	06073	32.62360793	-116.9969964	San Diego County
42521	Fee-for-Service	1023359569	1023359569	1	1	PORTER, LEANNE P LMFT	4/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	840 HINCKLEY ROAD	235	BURLINGAME	CA	94010	1516	41	06081	37.59825831	-122.3684871	San Mateo County
42532	Fee-for-Service	1992193783	1992193783	1	1	PARK, CAROL Y CCC-SLP	2/9/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
42536	Fee-for-Service	1518970235	1518970235	1	1	PETERSON, KAREN L MD	1/18/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	53128	None	None	0	In state provider	None	960 E. GREEN ST	SUITE 208	PASADENA	CA	91106	2422	19	06037	34.14451994	-118.1301695	Los Angeles County
42577	Fee-for-Service	1265484877	1265484877	1	1	PIN, MICHAEL MD	4/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45813	08	Family Practice	0	In state provider	None	27235 TOURNEY	2500	VALENCIA	CA	91355	5908	19	06037	34.41755702	-118.5772646	Los Angeles County
42580	Fee-for-Service	1255412474	1255412474	1	3	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INLAND EMPIRE INC	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
42592	Fee-for-Service	1538270806	1538270806	1	1	PASCUAL, MATILDE MD INC	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	26392	05	Anesthesiology	0	In state provider	None	3857 BIRCH ST	STE 709	NEWPORT BEACH	CA	92660	2616	30	06059	33.66332364	-117.8712141	Orange County
42598	Fee-for-Service	1659569226	1659569226	1	1	PAIN REHAB & CRITICAL	5/23/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CARE MEDICAL GROUP INC	400 NORTH PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
42611	Fee-for-Service	1851461297	1851461297	1	1	PEPITONE, CELESTE C	3/26/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
42667	Fee-for-Service	1336151232	1336151232	1	1	PACE, JAMES L MD	7/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110862	20	Orthopedic Surgery	0	In state provider	None	4650 SUNSET BLVD.	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
42696	Fee-for-Service	1609402973	1609402973	1	1	PLESCIA, DEBORAH M CPO	5/10/2022	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 WATT AVE	151	SACRAMENTO	CA	95821	2670	34	06067	38.634417	-121.3818435	Sacramento County
42725	Fee-for-Service	1730306085	1730306085	1	1	PARK, SUNNY S MD	2/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114528	04	Otology, Laryngology, Rhinology	0	In state provider	None	12462 PUTNAM ST	STE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
42736	Fee-for-Service	1861408338	1861408338	1	1	PLAZA PHARMACY INC	1/18/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	PLAZA PHARMACY INC	4399 NW 124TH AVE	None	CORAL SPRINGS	FL	33065	9867	00	None	26.282529	-80.2911735	Broward County
42746	Fee-for-Service	1053790824	1053790824	1	1	PORTUGAL, THERESA M DO	2/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
42752	Fee-for-Service	1043229305	1043229305	1	1	PAYNE, ELIZABETH E MD	1/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74067	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
42813	Fee-for-Service	1013954080	1013954080	1	1	PRATT, THEODORE C MD	11/14/2019	208G00000X	NA	General Surgery	026	PHYSICIANS	98742	33	Thoracic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
42819	Fee-for-Service	1073605366	1073605366	1	1	PROFESSIONAL HOME HEALTH	7/2/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	2155 E GARVEY AVE N	SUITE B-12	WEST COVINA	CA	91791	1455	19	06037	34.07280989	-117.8995249	Los Angeles County
42833	Fee-for-Service	1114695012	1114695012	1	1	PON, ASIA N	3/22/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 WILLOW LANE	STE 218	THOUSAND OAKS	CA	91361	4992	56	06111	34.16552629	-118.8390377	Ventura County
42834	Fee-for-Service	1629789631	1629789631	1	1	PARK, ANDREW	10/18/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	7602 E CHAPMAN AVE	None	ORANGE	CA	92869	4505	30	06059	33.79541811	-117.7723847	Orange County
42836	Fee-for-Service	1881631539	1881631539	1	1	PATEL, NIRAV S MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79448	13	Neurology (M.D. only)	0	In state provider	None	3791 KATELLA AVE	STE 106	LOS ALAMITOS	CA	90720	2000	30	06059	33.80318449	-118.0672965	Orange County
42846	Fee-for-Service	1922105964	1922105964	1	1	PHILIS-TSIMIKAS, ATHENA	8/1/1994	207RE0101X	NA	Endocrinology	026	PHYSICIANS	50477	01	General Practice	0	In state provider	MD	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
42865	Fee-for-Service	1780944918	1780944918	1	1	PATEL, ABHISHEK DO	9/4/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	16483	25	Physical Medicine and Rehabilitation	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
42877	Fee-for-Service	1013203157	1013203157	1	1	PARTRIDGE, ELIZABETH H MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124157	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
42894	Fee-for-Service	1700881448	1700881448	1	1	PAUL, VIMALI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53520	41	Internal Medicine	0	In state provider	None	85 DECLARATION DR	# 110	CHICO	CA	95973	4902	04	06007	39.77209524	-121.8720514	Butte County
42899	Fee-for-Service	1326636960	1326636960	1	1	PLEASANT HAVEN HOME CARE LLC	2/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	129 MOUNTAIN VIEW DR	None	TUSTIN	CA	92780	3072	30	06059	33.74635399	-117.8292453	Orange County
42970	Fee-for-Service	1790145894	1790145894	1	1	POURDAVOUD, CATHERINE MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166202	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
42985	Fee-for-Service	1245214279	1245214279	1	1	PETTIT, THERON M MD	1/27/2022	207R00000X	NA	Other	026	PHYSICIANS	175441	None	None	0	In state provider	None	8078 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1108	30	06059	33.86628	-117.750789	Orange County
42988	Fee-for-Service	1356873897	1356873897	1	1	PHAM, CHRISTINE P DO	9/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16800	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
43004	Fee-for-Service	1730139353	1730139353	1	1	PHAN, ANTHONY T MD INC	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83470	41	Internal Medicine	0	In state provider	None	2925 SYCAMORE DR	STE 304	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
43042	Fee-for-Service	1043539885	1043539885	1	1	PEDIATRIC EYE CARE & SURGERY	10/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54031	18	Ophthalmology	0	In state provider	MEDICAL CORPORATION	302 W LA VETA AVE	STE 101	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
43044	Fee-for-Service	1457394173	1457394173	1	1	PETER MCCARTHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5325 FARAON ST	None	SAINT JOSEPH	MO	64506	3488	00	None	39.77271	-94.770648	Buchanan County
43099	Fee-for-Service	1043735079	1043735079	1	1	PLUMMER, SHELBY PT	6/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	615 N NASH ST	STE 306	EL SEGUNDO	CA	90245	2825	19	06037	33.92533619	-118.3874815	Los Angeles County
43127	Fee-for-Service	1508099508	1508099508	1	1	PUNDI, RAMESH S MD	3/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151744	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
43128	Fee-for-Service	1427585280	1427585280	1	1	PINNACLE SURGERY CENTER INC.	11/13/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	100 N WIGET LN	140	WALNUT CREEK	CA	94598	5917	07	06013	37.92514495	-122.0237725	Contra Costa County
43131	Fee-for-Service	1780832923	1780832923	1	1	PARISH, DAYNA J MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102052	40	Pediatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
43135	Fee-for-Service	1922105964	1922105964	1	1	PHILIS-TSIMIKAS, ATHENA	8/1/1994	207RE0101X	NA	Endocrinology	026	PHYSICIANS	50477	67	Endocrinology	0	In state provider	MD	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
43138	Fee-for-Service	1285609396	1285609396	1	1	PARK, YUNG-MEE S MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86084	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
43151	Fee-for-Service	1689965774	1689965774	1	1	PROFESSIONAL MAMMOGRAPHY	10/3/2011	261QR0208X	NA	Mammography Provider	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	IMAGING INCORPORATED	18429 SHERMAN WAY	None	RESEDA	CA	91335	4358	19	06037	34.20120553	-118.5349545	Los Angeles County
43164	Fee-for-Service	1013203157	1013203157	1	1	PARTRIDGE, ELIZABETH H MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124157	77	Infectious Disease	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
43168	Fee-for-Service	1568420685	1568420685	1	1	PORURI, RUKMINI SR MD	8/10/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	36385	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
43169	Fee-for-Service	1124157474	1124157474	1	1	PORTEN, SIMA P MD	4/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101590	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVE	RM 3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
43219	Fee-for-Service	1447395728	1447395728	1	1	PASADENA UNIFIED SCHOOL	6/8/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	351 S HUDSON AVE	RM 126	PASADENA	CA	91101	3507	19	06037	34.1397867	-118.1338422	Los Angeles County
43283	Fee-for-Service	1962692699	1962692699	1	1	PARELLO, JILL P MD	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100311	40	Pediatrics	0	In state provider	None	204 E BEACH STREET	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
43308	Fee-for-Service	1295893550	1295893550	1	1	PLANNED PARENTHOOD	7/17/1981	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHASTA-DIABLO INC	200 PORTER DRIVE	SUITE 200	SAN RAMON	CA	94583	1524	07	06013	37.77372204	-121.9911155	Contra Costa County
43323	Fee-for-Service	1780438135	1780438135	1	1	PEREZ, DOMINIC PT	4/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1625 EAST MAIN ST.	STE 104	EL CAJON	CA	92021	5223	37	06073	32.80969963	-116.9203429	San Diego County
43328	Fee-for-Service	1174918536	1174918536	1	1	POOSTI, KASSRA MD	1/5/2021	207R00000X	NA	Other	026	PHYSICIANS	151379	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
43351	Fee-for-Service	1639141682	1639141682	2	1	PLOSKER, ARI D MD	3/18/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55964	30	Radiology	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
43361	Fee-for-Service	1386980415	1386980415	1	1	PINNACLE EMERGENCY PHYSICIAN	2/1/2013	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF BAKERSFIELD APC	2215 TRUXTUN AVENUE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
43370	Fee-for-Service	1780941302	1780941302	1	1	PRASLA, ZOHRA MD	10/9/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	170389	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
43378	Fee-for-Service	1487031100	1487031100	1	1	PHAN, LISE MD	3/19/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	147823	None	None	0	In state provider	None	630 S RAYMOND AVE	STE 310	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
43402	Fee-for-Service	1437272440	1437272440	1	1	PEREIRA, BETHANIE E MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55815	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
43452	Fee-for-Service	1891815171	1891815171	1	1	PATEL, RONAK B MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131076	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43458	Fee-for-Service	1669035374	1669035374	1	1	PHAM, BRIAN OT	10/28/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
43466	Fee-for-Service	1952628653	1952628653	1	1	PRESTIGIOUS HEALTH SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	750 TERRADO PLAZA	STE 122	COVINA	CA	91723	3411	19	06037	34.07598226	-117.8892839	Los Angeles County
43468	Fee-for-Service	1508826363	1508826363	1	1	PADILLA, LESTER D MD	2/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	71629	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39600 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3265	33	06065	33.7614267	-116.4080191	Riverside County
43493	Fee-for-Service	1508203159	1508203159	1	1	PATEL, MARIZABEL O MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133180	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
43495	Fee-for-Service	1962021667	1962021667	1	1	PULLEY, NICOLE M MD	6/13/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43505	Fee-for-Service	1447395728	1447395728	1	1	PASADENA UNIFIED SCHOOL	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	351 S HUDSON AVE	RM 126	PASADENA	CA	91101	3507	19	06037	34.1397867	-118.1338422	Los Angeles County
43506	Fee-for-Service	1295362317	1295362317	1	1	POLADIAN-TONER, KATLIN MD	1/10/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	186312	07	Dermatology	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
43516	Fee-for-Service	1457568123	1457568123	1	1	PRABHU, ASHWIN V MD	9/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88014	None	None	0	In state provider	None	44725 10TH ST WEST	STE 150	LANCASTER	CA	93535	3000	19	06037	34.695693	-118.1480965	Los Angeles County
43546	Fee-for-Service	1144046749	1144046749	1	1	PATEL, SONALI PT	4/11/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
43564	Fee-for-Service	1760565303	1760565303	1	1	PIPER ROOKE MD	12/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
43568	Fee-for-Service	1578876140	1578876140	1	1	PATEL, MINAL MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116745	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
43572	Fee-for-Service	1184761090	1184761090	1	1	PROCTOR, ROGER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46210	05	Anesthesiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
43637	Fee-for-Service	1215406905	1215406905	1	1	PROSPECT HOME HEALTHCARE INC	12/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7120 HAYVENHURST AVE	SUITE 206	VAN NUYS	CA	91406	3813	19	06037	34.200018	-118.492384	Los Angeles County
43660	Fee-for-Service	1780941302	1780941302	1	1	PRASLA, ZOHRA MD	10/9/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	170389	41	Internal Medicine	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
43670	Fee-for-Service	1528231545	1528231545	1	1	PARKER, MAUREEN OT	4/9/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2200 E. MAPLE AVE	None	EL SEGUNDO	CA	90245	6507	19	06037	33.92690475	-118.3857342	Los Angeles County
43671	Fee-for-Service	1457713471	1457713471	1	1	PATTON, EMILY DO	10/28/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	22949	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
43742	Fee-for-Service	1396760575	1396760575	1	1	PATEL, PRAFUL B MD	2/23/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	183919	None	None	0	In state provider	None	585 W COLLEGE AVE	STE A	SANTA ROSA	CA	95401	5060	49	06097	38.445903	-122.735601	Sonoma County
43755	Fee-for-Service	1952628653	1952628653	1	1	PRESTIGIOUS HEALTH SERVICES	1/25/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	750 TERRADO PLAZA	STE 122	COVINA	CA	91723	3411	19	06037	34.07598226	-117.8892839	Los Angeles County
43761	Fee-for-Service	1710031588	1710031588	1	11	PROVIDENCE FACEY MEDICAL FOU	9/15/2009	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
43764	Fee-for-Service	1104947936	1104947936	1	1	PENN, SASHA OD	9/9/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
43789	Fee-for-Service	1780621524	1780621524	1	1	PEMA, MEHUL DO	1/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10423	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
43814	Fee-for-Service	1477724797	1477724797	1	1	PARMAR, SHOBHNA DO	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10361	41	Internal Medicine	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
43819	Fee-for-Service	1427042001	1427042001	1	1	PATHOLOGY ASSOCIATES OF	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	VALENCIA MEDICAL GROUP	405 LINDA VISTA	None	PASADENA	CA	91105	1237	19	06037	34.15245055	-118.1675197	Los Angeles County
43855	Fee-for-Service	1578876140	1578876140	1	1	PATEL, MINAL MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116745	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
43865	Fee-for-Service	1003055401	1003055401	1	1	PENRY, JACKSON W MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114302	None	None	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
43868	Fee-for-Service	1467551127	1467551127	1	1	PAL, SUNITA MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69883	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
43894	Fee-for-Service	1255490967	1255490967	1	1	PRAGER, JOSHUA D OD	1/13/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10917 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
43905	Fee-for-Service	1831378199	1831378199	1	1	PANDEY, JAY MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137153	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
43927	Fee-for-Service	1215370960	1215370960	1	1	PHILLIPS, COURTNEY E A MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123258	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
43945	Fee-for-Service	1770090508	1770090508	1	1	PEOPLES, AMANDA NP	10/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
43996	Fee-for-Service	1417213554	1417213554	1	1	PERCHA DIALYSIS LLC	5/16/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	74 CAMARITAS AVENUE	None	S SAN FRANCISCO	CA	94080	3133	41	06081	37.65465504	-122.4367321	San Mateo County
44015	Fee-for-Service	1194749507	1194749507	1	1	PALTIN, DAVID M PSYD	7/11/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
44042	Fee-for-Service	1952628653	1952628653	1	1	PRESTIGIOUS HEALTH SERVICES	9/29/2022	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	INC	750 TERRADO PLAZA	STE 122	COVINA	CA	91723	3411	19	06037	34.07598226	-117.8892839	Los Angeles County
44047	Fee-for-Service	1710031588	1710031588	1	11	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
44089	Fee-for-Service	1962410506	1962410506	1	1	PAREDES, JOE L MD	9/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70392	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
44130	Fee-for-Service	1689990905	1689990905	1	1	POLEN, LAUREN A MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119094	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
44147	Fee-for-Service	1114304110	1114304110	1	1	PICKL, COLBI R LCSW	4/14/2021	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
44187	Fee-for-Service	1790309672	1790309672	1	1	PORCIELLO-DONNARUMMA, MARIO	3/30/2023	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	G DPM	333 CORPORATE DRIVE	230	LADERA RANCH	CA	92694	2180	30	06059	33.55836094	-117.6292574	Orange County
44188	Fee-for-Service	1972949774	1972949774	1	1	PRECISION PERSONAL CARE	1/1/2012	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	17610 BELLFLOWER BLVD	A211	BELLFLOWER	CA	90706	8000	19	06037	33.8727183	-118.1250615	Los Angeles County
44197	Fee-for-Service	1841236072	1841236072	1	1	PETERSON, WILLIAM J MD	6/1/1995	207P00000X	NA	Other	026	PHYSICIANS	56798	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
44222	Fee-for-Service	1376033746	1376033746	1	1	PETTUS, JENNA NP	12/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
44225	Fee-for-Service	1891701413	1891701413	1	1	PACELLI, JOSEPH J DC	3/1/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4342 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3573	30	06059	33.80294143	-118.057265	Orange County
44280	Fee-for-Service	1760485429	1760485429	1	1	PATTISON, DEBRA C	11/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 VERNON ST	None	ROSEVILLE	CA	95678	2632	31	06061	38.74964779	-121.2830927	Placer County
44291	Fee-for-Service	1649593609	1649593609	1	1	PATIENT HOME MONITORING INC	10/21/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	550 KEARNY STREET	STE 300	SAN FRANCISCO	CA	94108	2597	38	06075	37.79330002	-122.4044916	San Francisco County
44296	Fee-for-Service	1114304110	1114304110	1	2	PICKL, COLBI R LCSW	9/6/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E. CARNEGIE DR.	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
44300	Fee-for-Service	1710183074	1710183074	1	1	PERLA, RENUKA MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99467	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
44334	Fee-for-Service	1528228186	1528228186	1	1	PARAMPREET GHUMAN MD	4/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1111 PACIFIC AVE	STE B	EVERETT	WA	98201	4200	00	None	47.97646853	-122.2148565	Snohomish County
44337	Fee-for-Service	1710031588	1710031588	1	11	PROVIDENCE FACEY MEDICAL FOU	9/15/2009	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
44353	Fee-for-Service	1326441817	1326441817	1	1	POLEVOY, SHOSHANA NP	1/22/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	575 E HARDY ST	215	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
44393	Fee-for-Service	1861902611	1861902611	1	1	PRIMER HEALTHCARE INC.	7/22/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	164 W HOSPITALITY LN	STE 100	SAN BERNARDINO	CA	92408	3316	36	06071	34.06586648	-117.2866005	San Bernardino County
44428	Fee-for-Service	1194813956	1194813956	1	1	PINTO, HARLAN A MD	4/30/1990	207RX0202X	NA	Oncology	026	PHYSICIANS	63197	41	Internal Medicine	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
44439	Fee-for-Service	1861484040	1861484040	1	1	PELTOLA, THOMAS MD	1/3/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
44440	Fee-for-Service	1861564312	1861564312	1	1	PENN, ANDREW D NP	3/18/2022	364SP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44449	Fee-for-Service	1043223431	1043223431	1	1	PATEL, VIJAYKUMAR B MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62509	01	General Practice	0	In state provider	None	432 LEXINGTON ST	STE C	DELANO	CA	93215	3696	15	06029	35.762706	-119.2407725	Kern County
44566	Fee-for-Service	1881665545	1881665545	1	1	PAYSON HOSPITAL CORP	6/5/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	807 S PONDEROSA ST	None	PAYSON	AZ	85541	5542	00	None	34.230393	-111.321099	Gila County
44602	Fee-for-Service	1649667569	1649667569	1	1	PAN, MICHAEL MD	7/22/2020	208800000X	NA	Other	026	PHYSICIANS	168404	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
44627	Fee-for-Service	1710031588	1710031588	1	11	PROVIDENCE FACEY MEDICAL FOU	7/31/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
44632	Fee-for-Service	1447587050	1447587050	1	1	PACIFIC SHORES MEDICAL GROUP	7/5/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	INC	16300 SAND CANYON AVE	STE 207	IRVINE	CA	92618	3711	30	06059	33.66115075	-117.7742405	Orange County
44633	Fee-for-Service	1699866061	1699866061	1	1	PEREZ, ROBERT G MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58842	02	General Surgery	0	In state provider	None	1800 SULLIVAN AVE	RM 507	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
44662	Fee-for-Service	1104856335	1104856335	1	1	PAREDES, POTENCIANO R MD	4/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82810	40	Pediatrics	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
44669	Fee-for-Service	1831418805	1831418805	1	1	PORCH, EMILY L MD	2/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118939	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
44679	Fee-for-Service	1336155597	1336155597	1	1	PATEL, SANATKUMAR D MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48222	41	Internal Medicine	0	In state provider	None	10251 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6719	19	06037	33.87290452	-118.1154735	Los Angeles County
44780	Fee-for-Service	1710902036	1710902036	1	1	PAUL H HARFORD M.D.	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 34TH ST	STE 400	AUSTIN	TX	78705	1922	00	None	30.30410411	-97.74771241	Travis County
44799	Fee-for-Service	1235316761	1235316761	1	1	PARK, JYUNG KYUNG	3/17/2022	225400000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 170-16	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
44804	Fee-for-Service	1255757027	1255757027	1	1	POLATOGLU, GAREN M MD	12/14/2020	207R00000X	NA	Other	026	PHYSICIANS	167868	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
44839	Fee-for-Service	1649304403	1649304403	1	1	PINA, AMILCAR LCSW	12/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12021 WILMINGTON AVE	BUILDING 11, SUITE 1000	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
44852	Fee-for-Service	1679562680	1679562680	1	1	PETRUS, LEONARD V MD	6/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52292	30	Radiology	0	In state provider	None	65 N MADISON AVE	None	PASADENA	CA	91101	2035	19	06037	34.14705803	-118.1384317	Los Angeles County
44855	Fee-for-Service	1881665545	1881665545	1	1	PAYSON HOSPITAL CORP	6/5/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	807 S PONDEROSA ST	None	PAYSON	AZ	85541	5542	00	None	34.230393	-111.321099	Gila County
44869	Fee-for-Service	1851525091	1851525091	1	1	PLESA, MONICA L MD	6/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114578	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
44886	Fee-for-Service	1437181856	1437181856	1	1	PRICE MEDICAL CORPORATION	3/12/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55084	08	Family Practice	0	In state provider	None	5030 J ST	STE 201	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
44913	Fee-for-Service	1710031588	1710031588	1	11	PROVIDENCE FACEY MEDICAL FOU	9/15/2009	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
44917	Fee-for-Service	1215965900	1215965900	1	1	PEREZ, NANNETTE C NP	8/21/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44920	Fee-for-Service	1447587050	1447587050	1	1	PACIFIC SHORES MEDICAL GROUP	7/5/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	INC	16300 SAND CANYON AVE	STE 207	IRVINE	CA	92618	3711	30	06059	33.66115075	-117.7742405	Orange County
44930	Fee-for-Service	1245527043	1245527043	1	1	PHAM, JENNIFER L MD	5/8/2020	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
44944	Fee-for-Service	1144563735	1144563735	1	1	PORTILLO, ELYSE N	7/1/2021	207PP0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
44955	Fee-for-Service	1265464739	1265464739	1	1	PACIFIC EYE ASSOCIATES	8/31/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL CORPORATION	2100 WEBSTER ST	STE 214	SAN FRANCISCO	CA	94115	2375	38	06075	37.7904826	-122.4324477	San Francisco County
44998	Fee-for-Service	1265933154	1265933154	1	1	POLIS, SARAH N	1/25/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
45006	Fee-for-Service	1285992438	1285992438	1	1	PALM SPRINGS TREATMENT CENTE	5/14/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1910 S CAMINO REAL	None	PALM SPRINGS	CA	92264	9290	33	06065	33.797259	-116.539091	Riverside County
45007	Fee-for-Service	1891228946	1891228946	1	1	PERKINS, BRYAN G MD	9/6/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	177689	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
45017	Fee-for-Service	1942418249	1942418249	1	1	PEDRO QUIROGA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
45080	Fee-for-Service	1235372889	1235372889	1	1	PAE, SUSIE MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	106288	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
45094	Fee-for-Service	1053549212	1053549212	1	1	PETIRS, MOIRA P MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120516	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3127	27	06053	36.696987	-121.633164	Monterey County
45100	Fee-for-Service	1164963369	1164963369	1	1	PIERCE, SCOTT W MD	7/14/2020	207P00000X	NA	Other	026	PHYSICIANS	159956	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
45110	Fee-for-Service	1861894909	1861894909	1	2	PETTERSSON-ROSENBUSCH,	12/2/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	KRISTINE K MFT	3490 BUSKIRK AVE	STE A	PLEASANT HILL	CA	94523	4339	07	06013	37.93988429	-122.0590516	Contra Costa County
45114	Fee-for-Service	1396841995	1396841995	1	1	PAPAPETRU, TAMARA L	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
45148	Fee-for-Service	1043728041	1043728041	1	1	PARSI-KANEMOTO, MARYAM	5/31/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	STE 165	IRVINE	CA	92618	3194	30	06059	33.66719598	-117.7642461	Orange County
45216	Fee-for-Service	1568847077	1568847077	1	1	PAYNE, AMY M CNM	4/19/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
45224	Fee-for-Service	1861505265	1861505265	1	1	PARAZO, DON V MD	3/31/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40645	08	Family Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
45236	Fee-for-Service	1124595632	1124595632	1	1	PAULE, ROSANNA A PT	12/19/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
45250	Fee-for-Service	1356699417	1356699417	1	1	PATEL, JIGAR MD MPH	2/26/2018	207R00000X	NA	Other	026	PHYSICIANS	126881	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
45269	Fee-for-Service	1568744852	1568744852	1	1	PALLEKONDA, INDUPRIYA MD	1/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144037	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
45278	Fee-for-Service	1114009230	1114009230	1	1	PALANISAMY, AKILESH MD	10/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91569	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
45296	Fee-for-Service	1346399771	1346399771	1	1	PIETROMONACO, JOSEPH P HD	9/6/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
45302	Fee-for-Service	1083932024	1083932024	1	1	PHENG, BAKHENG MD	11/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112415	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
45305	Fee-for-Service	1417322314	1417322314	1	1	PYKE, MAX CRNA	2/6/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
45316	Fee-for-Service	1356401095	1356401095	1	1	PACHMAN, MARVIN S OD	6/28/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
45328	Fee-for-Service	1750504577	1750504577	1	1	PEDDI, PARVIN F MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121192	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
45338	Fee-for-Service	1205219029	1205219029	1	1	PHYU, PAN MD	8/12/2022	207R00000X	NA	Other	026	PHYSICIANS	159382	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
45345	Fee-for-Service	1295230910	1295230910	1	1	PATEL, EKTA	8/20/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166941	None	None	0	In state provider	None	30492 GATEWAY PLACE	SUITE 110	RANCHO MISSION VI	CA	92694	1862	30	06059	33.52139226	-117.6168345	Orange County
45399	Fee-for-Service	1689135071	1689135071	1	1	PINTO, VANESSA K DO	9/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20372	08	Family Practice	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
45415	Fee-for-Service	1821165705	1821165705	1	1	PHAN, MICHAEL L MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70056	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
45417	Fee-for-Service	1346673555	1346673555	1	1	PENG, YUE MD	11/28/2022	390200000X	NA	Other	026	PHYSICIANS	138205	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
45418	Fee-for-Service	1134274012	1134274012	1	1	PATEL, SUNIL H DO	12/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11335	None	None	0	In state provider	None	12675 HESPERIA RD	None	VICTORVILLE	CA	92395	5878	36	06071	34.48143043	-117.2906246	San Bernardino County
45431	Fee-for-Service	1609065572	1609065572	1	1	POLITANO, SETH A DO	12/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11374	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
45432	Fee-for-Service	1548371982	1548371982	1	1	PATEL, RITESH D MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96354	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
45442	Fee-for-Service	1154388585	1154388585	1	1	POWERS, PIUS J MD	1/7/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	162968	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
45451	Fee-for-Service	1649325655	1649325655	1	1	PICK, JUDITH	2/8/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	5406 THORNWOOD DR	#145	SAN JOSE	CA	95123	1221	43	06085	37.25447848	-121.8642255	Santa Clara County
45495	Fee-for-Service	1851341028	1851341028	1	1	PIRRUCCELLO, SAMUEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
45496	Fee-for-Service	1265495626	1265495626	1	1	PERSINGER, JOE M PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
45504	Fee-for-Service	1891307617	1891307617	1	1	PARK, SUN HEE	9/4/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10048 BRIANTOWN CT	None	SACRAMENTO	CA	95827	2945	34	06067	38.562246	-121.318758	Sacramento County
45528	Fee-for-Service	1760475669	1760475669	1	2	PASTORELLO, MICHELLE M	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76222	40	Pediatrics	0	In state provider	None	39400 PASWE PADRE PKWY	None	FREMONT	CA	94538	0000	01	06001	0	0	None
45535	Fee-for-Service	1477664217	1477664217	1	1	PELTA, JACOB B MD	1/1/1979	207RR0500X	NA	Other	026	PHYSICIANS	23606	83	Rheumatology	0	In state provider	None	6360 WILSHIRE BLVD	STE 501	LOS ANGELES	CA	90048	5601	19	06037	34.06363617	-118.3676811	Los Angeles County
45539	Fee-for-Service	1356699417	1356699417	1	1	PATEL, JIGAR MD MPH	2/26/2018	207R00000X	NA	Other	026	PHYSICIANS	126881	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
45584	Fee-for-Service	1043701980	1043701980	1	1	PRICE, KIMBERLY M LMFT	12/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 EAST AVE	STE 4A	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
45593	Fee-for-Service	1215164223	1215164223	1	2	PRX PHARMACORP	3/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RMACY	8536 WILSHIRE BLVD	STE 101	BEVERLY HILLS	CA	90211	3103	19	06037	34.06550726	-118.3775199	Los Angeles County
45595	Fee-for-Service	1205445350	1205445350	1	1	PEOPLE'S CHOICE HOSPICE INC	4/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	120 N VICTORY BLVD	STE 202	BURBANK	CA	91502	0001	19	06037	34.17426705	-118.3168333	Los Angeles County
45602	Fee-for-Service	1174520761	1174520761	1	1	PATEL, SHAILESH MD INC	2/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42502	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2625 W ALAMEDA AVE	STE 506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
45619	Fee-for-Service	1811351729	1811351729	1	1	PHAM, CORY H MD	9/8/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	152221	None	None	0	In state provider	None	3851 KATELLA AVENUE	SUITE 150	LOS ALAMITOS	CA	90720	3363	30	06059	33.80319053	-118.0657305	Orange County
45630	Fee-for-Service	1750504577	1750504577	1	1	PEDDI, PARVIN F MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121192	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
45635	Fee-for-Service	1235429069	1235429069	1	1	PATTERSON, KELLY M MD	2/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2801 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25271647	-121.787181	Klamath County
45665	Fee-for-Service	1043773930	1043773930	1	1	PASSARO, RYAN C MD	6/14/2022	390200000X	NA	Other	026	PHYSICIANS	179594	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
45688	Fee-for-Service	1356050595	1356050595	1	1	PETROSSIAN PHARMACY INC	4/6/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2701 W ALAMEDA AVE	STE 100	BURBANK	CA	91505	4402	19	06037	34.15751343	-118.3303715	Los Angeles County
45700	Fee-for-Service	1184027104	1184027104	1	5	PACIFIC SKIN INSTITUTE	9/15/2022	207NS0135X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9291 LAGUNA SPRINGS DR	120	ELK GROVE	CA	95758	7843	34	06067	38.420397	-121.396392	Sacramento County
45705	Fee-for-Service	1821165705	1821165705	1	1	PHAN, MICHAEL L MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70056	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
45714	Fee-for-Service	1508883356	1508883356	1	1	PENA, JOSE R MD PC	11/17/2010	207R00000X	NA	Other	026	PHYSICIANS	50688	41	Internal Medicine	0	In state provider	None	374 H ST	STE 201	CHULA VISTA	CA	91910	5547	37	06073	32.63351338	-117.080293	San Diego County
45754	Fee-for-Service	1518197938	1518197938	1	1	PARK, DANIEL S MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120791	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
45764	Fee-for-Service	1083384994	1083384994	1	1	PARK, LORIE	9/24/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
45771	Fee-for-Service	1750427381	1750427381	1	1	PACHECO, GUADALUPE D LCSW	12/19/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
45792	Fee-for-Service	1891307617	1891307617	1	1	PARK, SUN HEE	9/4/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10048 BRIANTOWN CT	None	SACRAMENTO	CA	95827	2945	34	06067	38.562246	-121.318758	Sacramento County
45851	Fee-for-Service	1811063795	1811063795	1	1	PALO ALTO COUNTY HOSPITAL	3/8/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	1	Border provider	None	109 WEST ROBINS AVE	None	GRAETTINGER	IA	51342	7732	00	None	43.23780813	-94.75084362	Palo Alto County
45864	Fee-for-Service	1710351747	1710351747	1	1	PE, JONATHAN B	4/4/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45873	Fee-for-Service	1083723852	1083723852	1	1	PROCHAZKA, JAMES V MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	32992	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
45875	Fee-for-Service	1881068633	1881068633	1	1	PARTOVI, SAYEH PA	12/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53039	-	NOT APPLICABLE	0	In state provider	None	7232 CANBY AVENUE	STE 4, 5, 6	RESEDA	CA	91335	3006	19	06037	34.2021268	-118.5347602	Los Angeles County
45880	Fee-for-Service	1275196081	1275196081	1	1	PIAMONTE, JEREMI JOHN L NP	6/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
45884	Fee-for-Service	1356598627	1356598627	1	1	PICCIRILLO, CAROL PHD	11/6/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1926 S PACIFIC COAST HWY	SUITE 201	REDONDO BEACH	CA	90277	6145	19	06037	33.81591202	-118.3755728	Los Angeles County
45886	Fee-for-Service	1205445350	1205445350	1	1	PEOPLE'S CHOICE HOSPICE INC	4/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	120 N VICTORY BLVD	STE 202	BURBANK	CA	91502	0001	19	06037	34.17426705	-118.3168333	Los Angeles County
45908	Fee-for-Service	1750504577	1750504577	1	1	PEDDI, PARVIN F MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121192	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
45919	Fee-for-Service	1558761890	1558761890	1	1	PU, CHAN YEU MD	1/9/2025	207RC0200X	NA	Other	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
45928	Fee-for-Service	1861670291	1861670291	1	1	PHAM, HANNAH N OD IN	12/10/2007	207RG0100X	NA	Gastroenterology	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	748 S HARBOR BLVD	None	SANTA ANA	CA	92704	2337	30	06059	33.73760656	-117.9201704	Orange County
45942	Fee-for-Service	1356001440	1356001440	1	1	PERCEPTION OPTOMETRY	6/6/2022	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	845 FOOTHILL BLVD	None	LA CANADA FLINTRI	CA	91011	3337	19	06037	34.20320018	-118.1972961	Los Angeles County
45989	Fee-for-Service	1659767093	1659767093	1	1	PARE, CHRISTOPHER J DO	7/20/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18351	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45998	Fee-for-Service	1891324810	1891324810	1	1	PATEL, AMIR A DO	5/23/2024	207R00000X	NA	Other	026	PHYSICIANS	20913	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
46018	Fee-for-Service	1124190079	1124190079	1	1	PATEL, PREETESH P MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94696	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
46053	Fee-for-Service	1548311855	1548311855	1	1	PHOO, AUNG-ZAW	11/20/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16255 VENTURA BLVD	STE 705	ENCINO	CA	91436	2311	19	06037	34.15693902	-118.4876816	Los Angeles County
46112	Fee-for-Service	1699835082	1699835082	1	1	PACIFICA OF THE VALLEY	1/4/1994	282E00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
46121	Fee-for-Service	1922334341	1922334341	1	1	PHILLIPS, ANNA LMFT	5/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	83288	-	NOT APPLICABLE	0	In state provider	None	3209 GALINDO STREET	None	OAKLAND	CA	94601	2507	01	06001	37.78673159	-122.2212171	Alameda County
46142	Fee-for-Service	1811063795	1811063795	1	1	PALO ALTO COUNTY HOSPITAL	3/8/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	1	Border provider	None	109 WEST ROBINS AVE	None	GRAETTINGER	IA	51342	7732	00	None	43.23780813	-94.75084362	Palo Alto County
46163	Fee-for-Service	1083723852	1083723852	1	1	PROCHAZKA, JAMES V MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	32992	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
46175	Fee-for-Service	1912932740	1912932740	1	1	PAN, DAVID C MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60454	41	Internal Medicine	0	In state provider	None	1140 W LA VETA AVE	STE 640	ORANGE	CA	92868	4228	30	06059	33.7802984	-117.8651669	Orange County
46204	Fee-for-Service	1558761890	1558761890	1	1	PU, CHAN YEU MD	1/9/2025	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
46230	Fee-for-Service	1346458197	1346458197	1	1	POPPE RIES, ANGELA MD	6/23/2023	207R00000X	NA	Other	026	PHYSICIANS	184985	None	None	0	In state provider	None	517 3RD STREET	22	EUREKA	CA	95501	3203	12	06023	40.80367671	-124.166036	Humboldt County
46235	Fee-for-Service	1265878516	1265878516	1	1	PARK, JENNIFER M PHD	5/6/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
46272	Fee-for-Service	1205886108	1205886108	1	1	PACIFIC COAST CARDIAC &	11/5/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	VASCULAR SURGEONS	2900 WHIPPLE AVE	STE 210	REDWOOD CITY	CA	94062	2851	41	06081	37.4783072	-122.2551089	San Mateo County
46296	Fee-for-Service	1164433645	1164433645	1	1	PULLARKAT, VINOD A MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63417	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
46302	Fee-for-Service	1568474096	1568474096	1	2	PATTERSON AND TEDFORD PEDIAT	1/10/2024	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RICS	7700 MORRO RD	None	ATASCADERO	CA	93422	4435	40	06079	35.47579542	-120.6678702	San Luis Obispo County
46315	Fee-for-Service	1629537352	1629537352	1	1	PLATINUM DIGESTIVE HEALTH	4/25/2023	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9481 PITTSBURGH AVE	200	RANCHO CUCAMONGA	CA	91730	9021	36	06071	34.08094188	-117.5559944	San Bernardino County
46338	Fee-for-Service	1477705341	1477705341	1	1	PREMIER HOME HEALTH	3/1/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	1095 BIRD AVE	STE 4	SAN JOSE	CA	95125	1640	43	06085	37.31129937	-121.896186	Santa Clara County
46353	Fee-for-Service	1104287242	1104287242	1	1	PIPPENGER, KATHERINE OT	12/20/2024	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
46450	Fee-for-Service	1083723852	1083723852	1	1	PROCHAZKA, JAMES V MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	32992	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
46513	Fee-for-Service	1932362423	1932362423	1	1	PETERSON, NATHANIEL R MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124355	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
46517	Fee-for-Service	1194144436	1194144436	1	1	POST, JENNIFER M MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
46521	Fee-for-Service	1275739047	1275739047	1	1	PREMIER NURSING, INC	8/13/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2000 W MAGNOLIA BLVD	STE 206	BURBANK	CA	91506	1744	19	06037	34.17361386	-118.3297964	Los Angeles County
46523	Fee-for-Service	1780908558	1780908558	1	1	PROHEALTH HOME CARE SERVICES	9/1/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4221 WILSHIRE BLVD	SUITE 135	LOS ANGELES	CA	90010	3626	19	06037	34.06177566	-118.320844	Los Angeles County
46555	Fee-for-Service	1821246125	1821246125	1	1	PARASRAM RAMDEO MD	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	30 E APPLE ST	STE NW3300	DAYTON	OH	45409	2939	00	None	39.7465384	-84.18635983	Montgomery County
46556	Fee-for-Service	1053522664	1053522664	1	1	PRIVILEGE HOME HEALTH CARE	2/9/2015	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	500 E OLIVE AVE	SUITE 850	BURBANK	CA	91501	2132	19	06037	34.1845331	-118.3048131	Los Angeles County
46557	Fee-for-Service	1578917175	1578917175	1	1	PATHAK, NIMESH JITENDRA MD	5/3/2016	207W00000X	NA	Ophthalmology	026	PHYSICIANS	113231	18	Ophthalmology	0	In state provider	INC	5175 E PACIFIC COAST HWY	STE 102	LONG BEACH	CA	90804	3314	19	06037	33.7831289	-118.1331777	Los Angeles County
46575	Fee-for-Service	1982759668	1982759668	1	1	PARK, JONGSOO MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85314	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
46577	Fee-for-Service	1912199472	1912199472	1	1	PARELLO, CORY J MD	6/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100658	40	Pediatrics	0	In state provider	None	204 E BEACH STREET	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
46581	Fee-for-Service	1164433645	1164433645	1	1	PULLARKAT, VINOD A MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63417	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
46588	Fee-for-Service	1568474096	1568474096	1	2	PATTERSON AND TEDFORD PEDIAT	1/10/2024	2251P0200X	NA	Physical Therapist	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	RICS	7700 MORRO RD	None	ATASCADERO	CA	93422	4435	40	06079	35.47579542	-120.6678702	San Luis Obispo County
46689	Fee-for-Service	1679621635	1679621635	1	1	PECKHAM, PATWIN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50469	07	Dermatology	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
46690	Fee-for-Service	1013526680	1013526680	1	1	PINNACLE CARE HOSPICE INC	6/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6934 CANBY AVE	STE 111	RESEDA	CA	91335	8772	19	06037	34.1956047	-118.5345561	Los Angeles County
46730	Fee-for-Service	1174543581	1174543581	1	1	PURCHIN, ANDREW LCSW	1/6/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST	C2	SANTA CRUZ	CA	95060	4124	44	06087	36.98046158	-122.018718	Santa Cruz County
46744	Fee-for-Service	1164460382	1164460382	1	1	PATEL, DEEPAK N MD	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92067	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
46759	Fee-for-Service	1750840070	1750840070	1	1	PHAM, JEFFREY DO	4/22/2024	207P00000X	NA	Other	026	PHYSICIANS	20724	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
46763	Fee-for-Service	1497854806	1497854806	1	1	PICO LIFECARE, INC	1/9/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8827 W PICO BLVD	None	LOS ANGELES	CA	90035	3301	19	06037	34.05494197	-118.3844736	Los Angeles County
46783	Fee-for-Service	1407272636	1407272636	1	1	PACIFIC CENTRAL COAST HEALTH	2/26/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SPECIALTY CENTER	316 SOUTH STRATFORD AVE	STE B	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
46785	Fee-for-Service	1932239357	1932239357	1	1	PEREZ, EVELYN L LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
46786	Fee-for-Service	1992861629	1992861629	1	1	PEDROTTY, JOHN R JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80234	08	Family Practice	0	In state provider	None	1121 10TH ST	None	CORONADO	CA	92118	3401	37	06073	32.68574262	-117.1793083	San Diego County
46796	Fee-for-Service	1245208727	1245208727	1	1	PAUL, RUSSELL K MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88519	30	Radiology	0	In state provider	None	9602 STOCKDALE HWY	None	BAKERSFIELD	CA	93311	3618	15	06029	35.35453351	-119.1091725	Kern County
46803	Fee-for-Service	1619016052	1619016052	1	1	PRASAD, ARUN MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98960	18	Ophthalmology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
46875	Fee-for-Service	1366812133	1366812133	1	1	PARAKLETOS BY YOUR SIDE	2/14/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RATION	317 E FOOTHILL BLVD	STE 208	ARCADIA	CA	91006	2600	19	06037	34.15112348	-118.0221697	Los Angeles County
46886	Fee-for-Service	1366762106	1366762106	1	1	PUDER, DAVID J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120199	36	Psychiatry	0	In state provider	None	1689 BARTON RD	None	REDLANDS	CA	92373	7761	36	06071	34.0481397	-117.2138746	San Bernardino County
46887	Fee-for-Service	1427475649	1427475649	1	1	PATEL, SIRI J MD	9/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148531	None	None	0	In state provider	None	1315 S GRAND AVE	150	GLENDORA	CA	91740	5050	19	06037	34.11549628	-117.8727712	Los Angeles County
46891	Fee-for-Service	1871621102	1871621102	1	1	PRINCE-LING, STEPHANIE L LMF	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
46907	Fee-for-Service	1003550583	1003550583	1	1	PEL, ANGELIKA F PT	9/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12150 INDUSTRY BLVD	42	JACKSON	CA	95642	9375	03	06005	38.36994515	-120.7997294	Amador County
46927	Fee-for-Service	1487079307	1487079307	1	1	PALACIO SALAZAR, ELIANA LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE	UNIT 6	MISSION HILLS	CA	91345	3205	19	06037	34.25726849	-118.4664285	Los Angeles County
46946	Fee-for-Service	1295146108	1295146108	1	1	PATEL, VIRAL DO	3/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18684	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
46957	Fee-for-Service	1144252040	1144252040	1	2	PETERSEN, GRETI I MD	3/8/2024	207R00000X	NA	Other	026	PHYSICIANS	93553	None	None	0	In state provider	None	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2305	15	06029	35.39046051	-119.0092725	Kern County
46960	Fee-for-Service	1356685218	1356685218	1	4	PACIFIC NEUROPSYCHIATRIC SPE	4/27/2020	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	27	Psychiatry Neurology (D.O. only)	0	In state provider	CIALISTS INC.	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	30	06059	33.67783408	-117.8720921	Orange County
46966	Fee-for-Service	1376503755	1376503755	1	1	PATEL,JIGNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 D DOBSON RD	None	MESA	AZ	85202	0000	00	None	33.38982	-111.8760885	Maricopa County
46970	Fee-for-Service	1215056460	1215056460	1	1	PEERY, SHELLEY PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
46976	Fee-for-Service	1285977215	1285977215	1	1	PATEL, SHAUN DO	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	15399	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
46979	Fee-for-Service	1013526680	1013526680	1	1	PINNACLE CARE HOSPICE INC	6/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6934 CANBY AVE	STE 111	RESEDA	CA	91335	8772	19	06037	34.1956047	-118.5345561	Los Angeles County
47016	Fee-for-Service	1376864793	1376864793	1	1	PIARULLI, DAWN MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120853	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
47053	Fee-for-Service	1497972400	1497972400	1	1	PINO, NELLY M LCSW	5/16/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
47073	Fee-for-Service	1992861629	1992861629	1	1	PEDROTTY, JOHN R JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80234	01	General Practice	0	In state provider	None	1121 10TH ST	None	CORONADO	CA	92118	3401	37	06073	32.68574262	-117.1793083	San Diego County
47083	Fee-for-Service	1124603071	1124603071	1	1	PHENOMICS HEALTH INC	5/12/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	46701 COMMERCE CENTER DR	None	PLYMOUTH	MI	48170	2475	00	None	42.38504801	-83.50510703	Wayne County
47120	Fee-for-Service	1548324700	1548324700	1	1	PATTERSON, STANLEY C MD	9/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72314	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
47133	Fee-for-Service	1205824547	1205824547	1	1	PUROHIT, SURENDAR S MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86170	18	Ophthalmology	0	In state provider	None	550 WASHINGTON ST	STE 723	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
47196	Fee-for-Service	1235160979	1235160979	1	1	POLICE, ALICE M MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44292	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
47200	Fee-for-Service	1447485701	1447485701	1	1	PHILLIPS, DONALD J MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114716	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
47243	Fee-for-Service	1811514011	1811514011	1	1	PHAM, ASIA LMFT	2/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
47254	Fee-for-Service	1356685218	1356685218	1	6	PACIFIC NEUROPSYCHIATRIC SPE	10/22/2020	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	27	Psychiatry Neurology (D.O. only)	0	In state provider	CIALISTS INC.	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	30	06059	33.67718578	-117.9887516	Orange County
47255	Fee-for-Service	1356685218	1356685218	1	10	PACIFIC NEUROPSYCHIATRIC SPE	10/24/2024	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	1760 TERMINO AVE	STE G21	LONG BEACH	CA	92626	4624	19	06037	33.78889871	-118.1458784	Los Angeles County
47281	Fee-for-Service	1316041833	1316041833	2	22	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
47315	Fee-for-Service	1578990552	1578990552	1	1	PETALUMA EYE CARE OPTOMETRIC	9/22/2014	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES INC APC	1225 N MCDOWELL BLVD	None	PETALUMA	CA	94954	1112	49	06097	38.2702492	-122.6613983	Sonoma County
47352	Fee-for-Service	1003843863	1003843863	1	1	PATEL, CHOUDHARY B MD	8/23/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	127780	None	None	0	In state provider	None	4525 E ATHERTON STREET	None	LONG BEACH	CA	90815	3700	19	06037	33.78988246	-118.1397653	Los Angeles County
47380	Fee-for-Service	1679741565	1679741565	1	1	PIYA, BINA MD	1/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105290	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
47397	Fee-for-Service	1356872436	1356872436	1	1	PRASAD, PUJA R	1/17/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
47422	Fee-for-Service	1770316176	1770316176	1	1	PE, JOSHUA A OD	11/1/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
47457	Fee-for-Service	1487852497	1487852497	1	1	PERETZ, CHRISTINA L MD	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110938	08	Family Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
47488	Fee-for-Service	1447485701	1447485701	1	1	PHILLIPS, DONALD J MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114716	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
47522	Fee-for-Service	1053364208	1053364208	1	1	POCHERT, JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	80 68TH ST SE	None	GRAND RAPIDS	MI	49548	6980	00	None	42.84065955	-85.662657	Kent County
47541	Fee-for-Service	1356685218	1356685218	1	10	PACIFIC NEUROPSYCHIATRIC SPE	1/28/2025	2084B0040X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CIALISTS INC.	1760 TERMINO AVE	STE G21	LONG BEACH	CA	92626	4624	19	06037	33.78889871	-118.1458784	Los Angeles County
47542	Fee-for-Service	1356685218	1356685218	1	6	PACIFIC NEUROPSYCHIATRIC SPE	1/28/2025	2084B0040X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CIALISTS INC.	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	30	06059	33.67718578	-117.9887516	Orange County
47622	Fee-for-Service	1164950523	1164950523	1	1	PHAM, SEAN THANG N DO	1/19/2021	390200000X	NA	Other	026	PHYSICIANS	17321	None	None	0	In state provider	None	3200 INLAND EMPIRE	STE 100	ONTARIO	CA	91764	5513	36	06071	34.070841	-117.580734	San Bernardino County
47661	Fee-for-Service	1033695820	1033695820	1	1	PRIMUS, JOEL	1/8/2025	207R00000X	NA	Other	026	PHYSICIANS	167316	41	Internal Medicine	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
47688	Fee-for-Service	1609286418	1609286418	1	2	PLANNED PARENTHOOD SHASTA	11/8/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1 HARPST STREET	None	ARCATA	CA	95521	8222	12	06023	40.87420204	-124.0791833	Humboldt County
47698	Fee-for-Service	1700048279	1700048279	1	1	PARK, MIN J MD	8/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125606	20	Orthopedic Surgery	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
47717	Fee-for-Service	1386924504	1386924504	1	1	PEREZ, VANESSA G MD	2/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118698	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD.	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
47718	Fee-for-Service	1366633141	1366633141	1	1	PANG, MEI-LIN T MD	1/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93591	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
47725	Fee-for-Service	1407856545	1407856545	1	1	PAEL, BINITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3929 E BELL RD	None	PHOENIX	AZ	85032	2112	00	None	33.639579	-111.996918	Maricopa County
47726	Fee-for-Service	1457489569	1457489569	1	1	PATERSON, MEGAN D LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3017 DOUGLAS BLVD	STE 300	ROSEVILLE	CA	95661	3848	31	06061	38.74412077	-121.232331	Placer County
47727	Fee-for-Service	1972549236	1972549236	1	1	PETERSON, JON W PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30011 IVY GLENN DR	STE 205	LAGUNA NIGUEL	CA	92677	5017	30	06059	33.52732273	-117.715146	Orange County
47736	Fee-for-Service	1861751638	1861751638	1	1	PARTNERS OF PENNSYLVANIA LLC	3/12/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	3036 EMRICK BOULEVARD	None	BETHLEHEM	PA	18020	8018	00	None	40.66414794	-75.29490285	Northampton County
47740	Fee-for-Service	1184871345	1184871345	1	1	PETER YANG MA MEDICAL INC	9/1/2000	207R00000X	NA	Other	026	PHYSICIANS	53050	41	Internal Medicine	0	In state provider	None	624 W DUARTE RD	STE 208	ARCADIA	CA	91007	7603	19	06037	34.12637452	-118.0527313	Los Angeles County
47752	Fee-for-Service	1386936524	1386936524	1	1	PATEL, CAJAL K MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142523	18	Ophthalmology	0	In state provider	None	275 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
47755	Fee-for-Service	1003046095	1003046095	1	1	PYTIAK, ANDREW V MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130217	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
47818	Fee-for-Service	1225546237	1225546237	1	1	PARKINSON, PAMELA D LMFT	10/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
47853	Fee-for-Service	1902034168	1902034168	1	1	PARSA, ELYAS DO	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12334	08	Family Practice	0	In state provider	None	500 W. HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
47863	Fee-for-Service	1437109865	1437109865	1	1	PLASS, ROBERT MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
47864	Fee-for-Service	1619900065	1619900065	1	1	PANKAJ KULSHRESTHA	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1741 MESQUITE AVE	STE 200A	LK HAVASU CTY	AZ	86403	5689	00	None	34.478874	-114.340437	Mohave County
47871	Fee-for-Service	1295940054	1295940054	1	1	PEREZ, ANGEL G MD	11/13/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79348	01	General Practice	0	In state provider	SHALOM MEDICAL CLINIC	1721 N WILMINGTON BLVD	None	WILMINGTON	CA	90744	1261	19	06037	33.79755756	-118.2753059	Los Angeles County
47873	Fee-for-Service	1548262751	1548262751	1	1	PACIFIC EYE SURGEONS	11/30/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A CALIFORNIA PMC	628 CALIFORNIA BLVD	STE B	SAN LUIS OBISPO	CA	93401	2554	40	06079	35.28917428	-120.6578269	San Luis Obispo County
47881	Fee-for-Service	1710914783	1710914783	1	1	PINEDA, SANDY E CNM	2/21/2006	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
47886	Fee-for-Service	1043442650	1043442650	1	1	PORTER, SCOTT M MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115504	20	Orthopedic Surgery	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6217	57	06113	38.56287659	-121.7715536	Yolo County
47895	Fee-for-Service	1649220559	1649220559	1	1	PIZANO-HAZAMA, RAQUEL B LCSW	11/15/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	200 E DEL MAR BLVD	208	PASADENA	CA	91105	2544	19	06037	34.14047497	-118.1464685	Los Angeles County
47916	Fee-for-Service	1184783797	1184783797	1	1	PARKS, JAMES R MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51670	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
47939	Fee-for-Service	1952735185	1952735185	1	1	PALVOLGYI, ROLAND MD	6/6/2020	208800000X	NA	Other	026	PHYSICIANS	134261	34	Urology and Urological Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
47941	Fee-for-Service	1831613975	1831613975	1	4	PAULA VANG, O.D., INC.	3/28/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6833 STOCKTON BLVD	STE 440	SACRAMENTO	CA	95823	2372	34	06067	38.502684	-121.430124	Sacramento County
48031	Fee-for-Service	1952595985	1952595985	1	1	PEACE, SANDRA L PHD	1/12/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	633 W 5TH ST	SUITE 2640	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
48048	Fee-for-Service	1760633036	1760633036	1	1	PERDON, MICHAEL ARDEN G MD	7/5/2018	207R00000X	NA	Other	026	PHYSICIANS	153349	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
48063	Fee-for-Service	1396193546	1396193546	1	1	PACIFIC POINT HEALTH CARE	3/25/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	6170 CORNERSTONE CT E	STE 200B	SAN DIEGO	CA	92121	3767	37	06073	32.89597579	-117.1880762	San Diego County
48119	Fee-for-Service	1710243209	1710243209	1	1	PATEL, ANISH J MD	9/19/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	149077	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
48143	Fee-for-Service	1801022140	1801022140	2	1	PRESTIGIOUS HOME HEALTH INC	3/3/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1074 PARK VIEW DRIVE	SUITE 103	COVINA	CA	91724	3749	19	06037	34.0703244	-117.8613993	Los Angeles County
48157	Fee-for-Service	1295940054	1295940054	1	1	PEREZ, ANGEL G MD	11/13/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	79348	08	Family Practice	0	In state provider	SHALOM MEDICAL CLINIC	1721 N WILMINGTON BLVD	None	WILMINGTON	CA	90744	1261	19	06037	33.79755756	-118.2753059	Los Angeles County
48159	Fee-for-Service	1548262751	1548262751	1	1	PACIFIC EYE SURGEONS	1/6/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A CALIFORNIA PMC	628 CALIFORNIA BLVD	STE B	SAN LUIS OBISPO	CA	93401	2554	40	06079	35.28917428	-120.6578269	San Luis Obispo County
48177	Fee-for-Service	1609362367	1609362367	1	1	PATEL, ASHMI DPM	8/30/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
48178	Fee-for-Service	1093969115	1093969115	1	4	PLANNED PARENTHOOD OF LA	8/12/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3351 FIRESTONE BOULEVARD	None	SOUTH GATE	CA	90280	2937	19	06037	33.95467597	-118.2098272	Los Angeles County
48185	Fee-for-Service	1558471540	1558471540	1	1	PRASAD, RAJESH MD	10/2/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50724	41	Internal Medicine	0	In state provider	None	18550 DE PAUL DR	STE 107	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
48222	Fee-for-Service	1578030359	1578030359	1	3	PM PEDIATRICS OF CALIFORNIA	3/11/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	18555 VENTURA BLVD	B	TARZANA	CA	91356	4101	19	06037	34.16958413	-118.5380552	Los Angeles County
48277	Fee-for-Service	1598969255	1598969255	1	1	PHELPS, PAULA J LCSW	10/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
48298	Fee-for-Service	1548831373	1548831373	1	1	PALO, HASMIN OT	8/22/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
48385	Fee-for-Service	1609100825	1609100825	1	1	PARSA, POURIA MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117349	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
48427	Fee-for-Service	1740293778	1740293778	1	1	PARENTE, MARIA G MD	1/31/1992	207N00000X	NA	Dermatology	026	PHYSICIANS	76212	07	Dermatology	0	In state provider	SHARP REES-STEALY MEDICA	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
48468	Fee-for-Service	1598858284	1598858284	1	1	PROSTHETIC SOLUTIONS INC	2/29/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3350 SCOTT BLVD	SUITE 6301	SANTA CLARA	CA	95054	3125	43	06085	37.38038774	-121.9830034	Santa Clara County
48475	Fee-for-Service	1558471540	1558471540	1	1	PRASAD, RAJESH MD	10/2/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50724	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18550 DE PAUL DR	STE 107	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
48501	Fee-for-Service	1124461850	1124461850	1	1	PARK, GRACE J MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134704	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
48508	Fee-for-Service	1578030359	1578030359	1	3	PM PEDIATRICS OF CALIFORNIA	10/26/2022	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	18555 VENTURA BLVD	B	TARZANA	CA	91356	4101	19	06037	34.16958413	-118.5380552	Los Angeles County
48512	Fee-for-Service	1568514917	1568514917	1	1	POLLACK, DANIEL R OD	6/19/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5452	19	06037	34.22078654	-118.4326211	Los Angeles County
48547	Fee-for-Service	1871882704	1871882704	1	1	PERTZ, SANDRA V MD	8/26/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	129906	40	Pediatrics	0	In state provider	None	4968 BOOTH	106	IRVINE	CA	92604	3360	30	06059	33.68590715	-117.7855253	Orange County
48559	Fee-for-Service	1144389248	1144389248	1	1	PAYVANDI, OMID	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
48564	Fee-for-Service	1841786779	1841786779	1	1	PAVLOGIANIS, JOHANNA E LMFT	5/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
48579	Fee-for-Service	1639392095	1639392095	1	1	PELLUM, JAMES G LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
48615	Fee-for-Service	1184736977	1184736977	1	1	PETRINI, JOHN L MD	3/31/1993	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	43408	41	Internal Medicine	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4355	42	06083	34.42967671	-119.7228362	Santa Barbara County
48649	Fee-for-Service	1124091798	1124091798	1	1	PATEL, ASHOK M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 PINELLAS ST	None	CLEARWATER	FL	33756	3804	00	None	27.95185108	-82.80319546	Pinellas County
48665	Fee-for-Service	1063478402	1063478402	1	1	PHAN, PHUONG-CHI T MD	10/1/1998	207R00000X	NA	Other	026	PHYSICIANS	76835	41	Internal Medicine	0	In state provider	None	14571 MAGNOLIA AVE	STE 207	WESTMINSTER	CA	92683	5576	30	06059	33.75097286	-117.9723502	Orange County
48691	Fee-for-Service	1649236001	1649236001	1	1	PODELL, TERRY E MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	34995	None	None	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
48732	Fee-for-Service	1275564296	1275564296	1	15	PRECISION REHABILITATION & O	10/28/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1401 EL MONTE WAY	None	DINUBA	CA	93618	9165	54	06107	36.54610751	-119.4108615	Tulare County
48779	Fee-for-Service	1164691069	1164691069	1	1	POPOVSKI, ELIZABETH MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121042	30	Radiology	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
48788	Fee-for-Service	1265777247	1265777247	1	1	PHILLIPS, DAVID B LMFT	4/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2023 N ST	100	SACRAMENTO	CA	95811	4240	34	06067	38.572353	-121.4808975	Sacramento County
48861	Fee-for-Service	1285769307	1285769307	1	1	PAHED, MARK J CRNA	7/16/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	607 N CENTRAL AVENUE	None	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
48862	Fee-for-Service	1154684827	1154684827	1	1	PATEL, FORUM B MD	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127613	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
48870	Fee-for-Service	1306127246	1306127246	1	1	PELOT, JORDAN G LMFT	12/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
48898	Fee-for-Service	1215591409	1215591409	1	1	PATEL, DIVYA V MD	4/26/2023	207R00000X	NA	Other	026	PHYSICIANS	183353	None	None	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
48902	Fee-for-Service	1770652216	1770652216	1	1	PENINSULA EYE SURGERY CENTER	10/7/2005	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1128 W EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2518	43	06085	37.38761858	-122.0874556	Santa Clara County
48904	Fee-for-Service	1679597942	1679597942	1	1	PHAMDO, DANGKHOA MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105257	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
48924	Fee-for-Service	1669584801	1669584801	1	1	PEMBROOK, LLORENS J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37585	41	Internal Medicine	0	In state provider	None	4849 VAN NUYS BLVD	STE 102	SHERMAN OAKS	CA	91403	2117	19	06037	34.159113	-118.4487465	Los Angeles County
48954	Fee-for-Service	1376905406	1376905406	1	1	PROHEALTH PARTNERS	5/17/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	A MEDICAL GROUP	685 N 13TH AVE	STE 7,8,9	UPLAND	CA	91786	4963	36	06071	34.10202219	-117.6339091	San Bernardino County
48973	Fee-for-Service	1962963470	1962963470	1	1	PRUDENCE HOME HEALTH INC	5/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1924 W OLIVE AVE	None	BURBANK	CA	91506	2438	19	06037	34.16515248	-118.3253372	Los Angeles County
48986	Fee-for-Service	1912971615	1912971615	1	1	PETERSON, KARL A MD	4/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80642	08	Family Practice	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
48991	Fee-for-Service	1891742441	1891742441	1	1	PADMANABHAN, A MD	10/1/1987	207RH0003X	NA	Oncology	026	PHYSICIANS	31247	68	Hematology	0	In state provider	None	347 E BARSTOW AVE	STE 108	FRESNO	CA	93710	6039	10	06019	36.81571648	-119.782494	Fresno County
48999	Fee-for-Service	1780858308	1780858308	1	1	POLA, SURESH MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103390	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
49012	Fee-for-Service	1275943078	1275943078	1	2	PICCIRILLO, VINCENZO I PSYD	1/16/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD	SUITE 428	PASADENA	CA	91101	2039	19	06037	34.14588202	-118.1380722	Los Angeles County
49020	Fee-for-Service	1275564296	1275564296	1	16	PRECISION REHABILITATION & O	10/30/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	606 N MAGNOLIA AVE	None	CLOVIS	CA	93611	9206	10	06019	36.83952584	-119.666151	Fresno County
49056	Fee-for-Service	1558651372	1558651372	1	2	PAYNE, VAJEZATHA Z	6/21/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1656 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1604668	Los Angeles County
49079	Fee-for-Service	1568482859	1568482859	1	1	POA, HYUNAH L MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76907	None	None	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	5655	19	06037	34.06527974	-118.4462792	Los Angeles County
49087	Fee-for-Service	1710512124	1710512124	1	1	PATEL, MAMATABEN	10/8/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7999 GATEWAY BLVD	SUITE 200	NEWARK	CA	94560	1188	01	06001	37.53814232	-122.0629661	Alameda County
49091	Fee-for-Service	1811137219	1811137219	1	1	PARTO, MINA CAA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CLINIC	1582 W SAN MARCOS BLVD	STE 101 B	SAN MARCOS	CA	92078	4081	37	06073	33.13145446	-117.202167	San Diego County
49152	Fee-for-Service	1225599434	1225599434	1	1	PHAN, JOY L DO	5/17/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19410	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
49198	Fee-for-Service	1134689797	1134689797	1	1	PATEL, SAMAY MD	1/13/2023	390200000X	NA	Other	026	PHYSICIANS	182799	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
49233	Fee-for-Service	1891980165	1891980165	1	1	PAK, SUNNY K MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113552	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
49277	Fee-for-Service	1891742441	1891742441	1	1	PADMANABHAN, A MD	10/1/1987	207RH0003X	NA	Oncology	026	PHYSICIANS	31247	73	Unknown	0	In state provider	None	347 E BARSTOW AVE	STE 108	FRESNO	CA	93710	6039	10	06019	36.81571648	-119.782494	Fresno County
49343	Fee-for-Service	1306617386	1306617386	1	1	PORRECO, ANTONIO L PT	4/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
49391	Fee-for-Service	1649615881	1649615881	1	1	POURMAND, ANNAHITA MD	3/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138378	41	Internal Medicine	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
49410	Fee-for-Service	1205124781	1205124781	1	1	PETROVIC, NATALY S LCSW	4/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
49415	Fee-for-Service	1093820474	1093820474	1	1	PATEL, CHETAN A MD	7/6/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53272	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1424 S AZUSA AVE	STE G-2	WEST COVINA	CA	91791	4178	19	06037	34.04820521	-117.9078857	Los Angeles County
49435	Fee-for-Service	1790862639	1790862639	1	1	PRODANY, KARLA K MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89129	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
49465	Fee-for-Service	1104842129	1104842129	1	1	PERRICONE, ANTHONY MD	6/30/1991	208G00000X	NA	General Surgery	026	PHYSICIANS	65464	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
49483	Fee-for-Service	1568954113	1568954113	1	1	PILLAY, SITA-MARIE K PSYD	5/9/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
49487	Fee-for-Service	1154417772	1154417772	1	1	PAGE, DAWNIEL LMFT	10/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 GATEWAY DR	210 AND 230	LINCOLN	CA	95648	3306	31	06061	38.88433725	-121.2931529	Placer County
49589	Fee-for-Service	1962902544	1962902544	1	1	PEEVYHOUSE, VANESSA L	4/17/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
49608	Fee-for-Service	1518040914	1518040914	1	1	PALISOC, ADORACION M MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42825	36	Psychiatry	0	In state provider	None	5224 E VERSAILLE CT	None	ORANGE	CA	92867	8607	30	06059	33.83197988	-117.7977159	Orange County
49627	Fee-for-Service	1376691360	1376691360	1	1	PARKER, JOHN P MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	20674	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
49661	Fee-for-Service	1972560043	1972560043	1	1	PHAM,HIEU DUC MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70740	None	None	0	In state provider	None	513 PARNASSUS AVE	# S738	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
49689	Fee-for-Service	1447206321	1447206321	1	1	PLANNED PARENTHOOD MAR MONTE	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	729 SUNRISE AVE	STE 900	ROSEVILLE	CA	95661	4525	31	06061	38.73444822	-121.2720033	Placer County
49691	Fee-for-Service	1861015984	1861015984	1	1	PITRE, FELICIA LCSW	7/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5502 FOXVIEW WAY	None	ELK GROVE	CA	95757	2843	34	06067	38.395125	-121.44069	Sacramento County
49719	Fee-for-Service	1154785517	1154785517	1	3	PROVIDENT PRIMARY CARE INC	11/18/2024	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	410 E. YOSEMITE AVE.	A	MERCED	CA	95340	8429	24	06047	37.33211247	-120.462489	Merced County
49720	Fee-for-Service	1609251925	1609251925	1	1	PATIL, PRATIBHA MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154869	40	Pediatrics	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
49728	Fee-for-Service	1215062153	1215062153	1	1	PATEL, KRISHNA G MD	6/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98836	18	Ophthalmology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
49744	Fee-for-Service	1376743625	1376743625	1	1	PACHECO, CRISTINA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 N SMITH AVE	None	ST PAUL	MN	55102	2346	00	None	44.94251219	-93.1074995	Ramsey County
49751	Fee-for-Service	1174718134	1174718134	1	3	PARK, RICHARD MD	4/15/2021	208D00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	111560	-	NOT APPLICABLE	0	In state provider	None	955 E THOMPSON BLVD	None	VENTURA	CA	93001	3008	56	06111	34.27831162	-119.286174	Ventura County
49774	Fee-for-Service	1548317126	1548317126	1	1	POLIYEDATH, ANUPAMA MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55333	41	Internal Medicine	0	In state provider	None	2828 FRESNO STREET	SUITE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
49809	Fee-for-Service	1871566778	1871566778	1	1	PEREZ, BENITO B JR MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52990	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
49810	Fee-for-Service	1881882355	1881882355	1	1	PRICE, ARTHUR E CPO	6/1/1995	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6377 RIVERSIDE AVE	STE B100	RIVERSIDE	CA	92506	3133	33	06065	33.9516	-117.387977	Riverside County
49830	Fee-for-Service	1568293744	1568293744	1	1	PHILIP KORSUN D O INC	9/23/2024	193200000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	5650 RESEDA BLVD	None	TARZANA	CA	91356	2230	19	06037	34.17395562	-118.5359786	Los Angeles County
49841	Fee-for-Service	1902918667	1902918667	1	1	PHAM, DIEN-VAN MD	4/16/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39768	08	Family Practice	0	In state provider	None	855 E ANAHEIM ST	None	LONG BEACH	CA	90813	3550	19	06037	33.78263447	-118.1827035	Los Angeles County
49859	Fee-for-Service	1497938070	1497938070	1	1	PINEDO, VINCENT E MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55381	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
49912	Fee-for-Service	1376691360	1376691360	1	1	PARKER, JOHN P MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	20674	01	General Practice	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
49925	Fee-for-Service	1952726242	1952726242	1	1	PETERSON, BRADLEY M MD INC	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	21961	05	Anesthesiology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
49958	Fee-for-Service	1356352108	1356352108	1	2	PINE, STEPHEN MD	10/26/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	33483	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1300 N VERMONT AVE	STE 304	LOS ANGELES	CA	90027	6061	19	06037	34.0956033	-118.2916918	Los Angeles County
49963	Fee-for-Service	1093969115	1093969115	1	22	PLANNED PARENTHOOD OF LA	4/6/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6125 PINE AVE	None	MAYWOOD	CA	90270	3110	19	06037	33.98305585	-118.1884975	Los Angeles County
49982	Fee-for-Service	1164570180	1164570180	1	1	PARK, JUSTINE H MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88512	07	Dermatology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
50009	Fee-for-Service	1467947143	1467947143	1	1	PATEL, HIREN V MD	6/16/2023	208800000X	NA	Other	026	PHYSICIANS	183213	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
50056	Fee-for-Service	1801984315	1801984315	1	1	PHAM, THI N OD	8/5/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12302 GARDEN GROVE BLVD	STE 6	GARDEN GROVE	CA	92843	1802	30	06059	33.77428392	-117.9181185	Orange County
50068	Fee-for-Service	1932706637	1932706637	1	1	POWELL, ASHLEY M OT	10/21/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
50116	Fee-for-Service	1568293744	1568293744	1	1	PHILIP KORSUN D O INC	9/23/2024	193200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5650 RESEDA BLVD	None	TARZANA	CA	91356	2230	19	06037	34.17395562	-118.5359786	Los Angeles County
50121	Fee-for-Service	1902243934	1902243934	1	1	PARVARESH, KEVIN C MD	12/1/2021	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	131955	None	None	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
50166	Fee-for-Service	1902492341	1902492341	1	1	PARENTS HOME HEALTH CARE INC	11/7/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 505	N HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
50211	Fee-for-Service	1871764134	1871764134	1	1	PALISADES COMPOUNDING	10/14/2009	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	540 PALISADES DR	None	PACIFIC PALISADES	CA	90272	3829	19	06037	34.04541168	-118.5519269	Los Angeles County
50216	Fee-for-Service	1952726242	1952726242	1	1	PETERSON, BRADLEY M MD INC	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	21961	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
50222	Fee-for-Service	1225545924	1225545924	1	1	PARKVIEW JULIAN LLC	5/13/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1801 JULIAN AVE	None	BAKERSFIELD	CA	93304	6419	15	06029	35.32349193	-119.0222425	Kern County
50234	Fee-for-Service	1346402054	1346402054	1	1	PALLICKAL, LEEJOE K MD	12/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117289	66	Emergency Medicine (Urgent Care)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
50316	Fee-for-Service	1043310436	1043310436	1	1	PUREWAL, SARABJIT MD	6/17/1994	208G00000X	NA	General Surgery	026	PHYSICIANS	39435	02	General Surgery	0	In state provider	None	1711 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477652	-119.0217045	Kern County
50365	Fee-for-Service	1265737043	1265737043	1	1	PUEBLO MEDICAL CENTER INC	6/14/2019	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8045 CERRITOS AVE	None	STANTON	CA	90680	2436	30	06059	33.8102313	-117.9922545	Orange County
50368	Fee-for-Service	1528139508	1528139508	1	1	PAI, CHARLES H DO	6/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6737	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
50378	Fee-for-Service	1962733998	1962733998	1	1	PANERO, ALBERTO J DO	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12853	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
50392	Fee-for-Service	1225309685	1225309685	1	1	PATRICK BERGIN M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
50415	Fee-for-Service	1255894127	1255894127	1	1	PANJWANI, SHAMILA A DO	2/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23482	70	Clinic (mixed specialty)	0	In state provider	None	3100 TELEGRAPH AVE	None	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
50453	Fee-for-Service	1215297767	1215297767	1	1	PHUNG, PETER G MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133228	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
50468	Fee-for-Service	1356536841	1356536841	1	1	PEREZ-ESPEJO, RAFAEL MD	10/25/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	140733	-	NOT APPLICABLE	0	In state provider	None	1235 MISSION STREET	None	SAN FRANCISCO	CA	94103	2705	38	06075	37.77694643	-122.4137861	San Francisco County
50469	Fee-for-Service	1073533311	1073533311	1	1	PERRY, THOMAS J MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	32506	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2148 COURT ST	# 3	REDDING	CA	96001	2530	45	06089	40.5772287	-122.3932353	Shasta County
50475	Fee-for-Service	1851553804	1851553804	1	1	PATEL, NIKUNJ M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114074	01	General Practice	0	In state provider	None	4477 WHITTIER BLVD	None	LOS ANGELES	CA	90022	1535	19	06037	34.02343297	-118.1714844	Los Angeles County
50493	Fee-for-Service	1730373366	1730373366	1	1	PEREIRA, CLIFFORD T MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101130	02	General Surgery	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
50504	Fee-for-Service	1952726242	1952726242	1	1	PETERSON, BRADLEY M MD INC	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	21961	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
50513	Fee-for-Service	1093969115	1093969115	1	23	PLANNED PARENTHOOD OF LA	4/6/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	300 E 53RD ST	None	LOS ANGELES	CA	90011	4522	19	06037	33.99421318	-118.2697787	Los Angeles County
50523	Fee-for-Service	1477809093	1477809093	1	1	PETERSON, SNOW DO	9/29/2021	207RS0012X	NA	Other	026	PHYSICIANS	16799	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
50526	Fee-for-Service	1346402054	1346402054	1	1	PALLICKAL, LEEJOE K MD	12/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117289	41	Internal Medicine	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
50548	Fee-for-Service	1720162449	1720162449	1	1	PER E. DANIELSSON MD	3/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5300 TALLMAN AVE NW	None	SEATTLE	WA	98107	3932	00	None	47.6671795	-122.3799151	King County
50605	Fee-for-Service	1043310436	1043310436	1	1	PUREWAL, SARABJIT MD	6/17/1994	208G00000X	NA	General Surgery	026	PHYSICIANS	39435	33	Thoracic Surgery	0	In state provider	None	1711 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477652	-119.0217045	Kern County
50607	Fee-for-Service	1760580062	1760580062	1	1	PLATZKER, ARNOLD MD	7/1/1996	2080P0214X	NA	Pulmonology	026	PHYSICIANS	9412	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
50610	Fee-for-Service	1194782789	1194782789	1	1	POWERS, GLENN R PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
50617	Fee-for-Service	1679626469	1679626469	1	1	PELZNER, MARK I OD	8/31/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
50653	Fee-for-Service	1750796371	1750796371	1	2	PHAN, ALEXANDER M DO	3/15/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	14386	-	NOT APPLICABLE	0	In state provider	None	800 SCENIC DR	BLDG 4	MODESTO	CA	95350	6131	50	06099	37.64722447	-120.9836925	Stanislaus County
50678	Fee-for-Service	1003074550	1003074550	1	1	PICKHAM, DANIELLE M MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	103773	02	General Surgery	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
50682	Fee-for-Service	1689629982	1689629982	1	1	PADUA, ROSEMARIE R MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49652	40	Pediatrics	0	In state provider	None	125 N JACKSON AVE	STE 109	SAN JOSE	CA	95116	1915	43	06085	37.36117713	-121.8462226	Santa Clara County
50701	Fee-for-Service	1255894127	1255894127	1	1	PANJWANI, SHAMILA A DO	2/3/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23482	08	Family Practice	0	In state provider	None	3100 TELEGRAPH AVE	None	OAKLAND	CA	94609	3239	01	06001	37.82037533	-122.2667839	Alameda County
50703	Fee-for-Service	1548556707	1548556707	1	1	PATEL, NINA P MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125051	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
50704	Fee-for-Service	1184665473	1184665473	2	1	PECK, DALLAS D MD	5/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185132	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
50719	Fee-for-Service	1699941914	1699941914	1	1	PREGNANCY COUNSELING CTR	10/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	750 MENDOCINO AVE	STE 1	SANTA ROSA	CA	95401	4822	49	06097	38.447091	-122.7171555	Sonoma County
50728	Fee-for-Service	1649426123	1649426123	1	1	PONCE, PHILLIP O MD	1/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104091	41	Internal Medicine	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
50731	Fee-for-Service	1558567164	1558567164	1	1	PATTUGALAN, THERESA D J MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109767	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
50798	Fee-for-Service	1578892626	1578892626	1	1	PHELAN, DARCY J NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
50803	Fee-for-Service	1457409278	1457409278	1	1	PUSAVAT, KEVIN P MD	1/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65052	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
50809	Fee-for-Service	1770997033	1770997033	1	1	PACIFIC CENTER COAST HEALTH	2/6/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	220 S PALISADE DRIVE	STE 201, 202, 203B, 204B	SANTA MARIA	CA	93454	8904	42	06083	34.95143521	-120.412098	Santa Barbara County
50871	Fee-for-Service	1316006927	1316006927	1	1	PHAM, KHUE N MD	9/30/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40569	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
50875	Fee-for-Service	1356685218	1356685218	1	5	PACIFIC NEUROPSYCHIATRIC SPE	9/6/2019	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	705 W. LA VETA AVE	SUITE 111	ORANGE	CA	92868	4447	30	06059	33.78062272	-117.8600738	Orange County
50889	Fee-for-Service	1689735854	1689735854	1	1	POLLACK, ADAM PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
50907	Fee-for-Service	1811213549	1811213549	1	1	PEDIATRIC ORTHOTIC &	5/16/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PROSTHETIC SERVICES LLC	2425 STOCKTON BLVD	#236	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
50922	Fee-for-Service	1265430417	1265430417	1	1	PLATT, RICHARD R MD	8/18/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	26928	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	130 LA CASA VIA	None	WALNUT CREEK	CA	94598	3045	07	06013	37.91175467	-122.0414101	Contra Costa County
50942	Fee-for-Service	1205025178	1205025178	1	1	PAN AND HSU PEDIATRICS	2/14/2008	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1045 ATLANTIC AVE	STE 605	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
50945	Fee-for-Service	1407806417	1407806417	1	1	PALACIOS, JORGE L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69353	None	None	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
50987	Fee-for-Service	1447805049	1447805049	1	1	POGGENSEE, ANNA L CCC-SLP	7/4/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
50988	Fee-for-Service	1134651334	1134651334	1	1	PAMPORI, ADAM MD	10/13/2023	208M00000X	NA	Other	026	PHYSICIANS	191418	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51019	Fee-for-Service	1396076469	1396076469	1	1	PALMORE, DAVID A MD INC	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	49263	41	Internal Medicine	0	In state provider	None	1187 E HERNDON AVE	#104	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
51036	Fee-for-Service	1700865052	1700865052	1	1	PARK, DONG J MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98835	24	Plastic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
51056	Fee-for-Service	1205997111	1205997111	1	1	PITTMAN, MARIA H	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
51062	Fee-for-Service	1235446543	1235446543	1	1	PASCUAL GARRIDO, CECILIA MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	212 ELKS POINT RD	STE 200	ZEPHYR COVE	NV	89448	9800	00	None	38.98585115	-119.9417018	Douglas County
51074	Fee-for-Service	1962667790	1962667790	1	1	PATEL, RAVI A MD	3/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115902	13	Neurology (M.D. only)	0	In state provider	None	15963 QUANTICO ROAD	SUITE C	APPLE VALLEY	CA	92307	0840	36	06071	34.54122514	-117.2706519	San Bernardino County
51079	Fee-for-Service	1487158705	1487158705	1	1	PARSIAN, FATEMEH M	8/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176914	None	None	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
51085	Fee-for-Service	1801186689	1801186689	1	1	PATEL, SAGAR M DO	2/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19031	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
51106	Fee-for-Service	1093969115	1093969115	1	14	PLANNED PARENTHOOD OF LA	9/14/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	24300 WESTERN AVENUE	None	HARBOR CITY	CA	90710	1742	19	06037	33.802947	-118.3073705	Los Angeles County
51127	Fee-for-Service	1215164223	1215164223	1	3	PRX PHARMACORP	3/6/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8631 W 3RD ST	STE 320E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
51132	Fee-for-Service	1336698141	1336698141	1	1	PHILLIPS, SOMMER L NP	12/17/2021	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51166	Fee-for-Service	1306871397	1306871397	1	1	PLANNED PARENTHOOD OF	10/22/1980	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO COUNTY	7035 CONVOY COURT	None	SAN DIEGO	CA	92111	1016	37	06073	32.8346295	-117.165015	San Diego County
51210	Fee-for-Service	1720024060	1720024060	1	1	PERRY BROWN MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 E IDAHO ST	None	BOISE	ID	83712	6267	00	None	43.61191085	-116.1938523	Ada County
51215	Fee-for-Service	1760838650	1760838650	1	1	PRZYBYLO, JENNIFER A MD	12/11/2020	207P00000X	NA	Other	026	PHYSICIANS	170288	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
51218	Fee-for-Service	1386722163	1386722163	1	1	PUGASHETTI, GEETHA MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40486	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
51231	Fee-for-Service	1770500316	1770500316	1	1	PHAM, PHUONG-CHI T MD	1/31/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	76601	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
51248	Fee-for-Service	1710509500	1710509500	1	1	PATEL-JOSHI, ANAR MD	8/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187855	None	None	0	In state provider	None	8311 FLORENCE AVE	None	DOWNEY	CA	90240	3928	19	06037	33.95103918	-118.1247373	Los Angeles County
51258	Fee-for-Service	1073635173	1073635173	1	1	PATEL, KIRTIKA R MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	60627	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	PASADENA	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
51260	Fee-for-Service	1407894652	1407894652	1	2	PULIDO, VICTOR I DO	3/20/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5737	01	General Practice	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
51277	Fee-for-Service	1124128517	1124128517	1	1	PECK, ERIC A MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91071	33	Thoracic Surgery	0	In state provider	None	1711 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477652	-119.0217045	Kern County
51330	Fee-for-Service	1700062007	1700062007	1	1	PATEL, NIMESH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19422 N US HIGHWAY 281	STE 106	SAN ANTONIO	TX	78258	7615	00	None	29.62279422	-98.46350079	Bexar County
51364	Fee-for-Service	1487771119	1487771119	1	2	POISSON, SHARON N MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	13199 MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
51370	Fee-for-Service	1457391922	1457391922	1	1	POREE, LAWRENCE R MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66092	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
51388	Fee-for-Service	1649255027	1649255027	1	1	PEARSON, ERIK D MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89434	9641	00	None	39.52483792	-119.7968314	Washoe County
51429	Fee-for-Service	1942835269	1942835269	1	1	PURE HEART HOSPICE, INC	2/4/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 357	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
51470	Fee-for-Service	1629509005	1629509005	1	1	PERKINS, SCOTT MD	10/18/2023	2085R0204X	NA	Other	026	PHYSICIANS	188225	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
51508	Fee-for-Service	1629110333	1629110333	1	1	PAYTON, KURLEN S E MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108788	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
51511	Fee-for-Service	1417016833	1417016833	1	1	PATHOLOGY MEDICAL GROUP OF R	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	IVERSIDE	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
51526	Fee-for-Service	1407143464	1407143464	1	1	PRIMA VIDA MEDICAL CLINIC	9/10/2012	261QP2300X	NA	Other	026	PHYSICIANS	66742	08	Family Practice	0	In state provider	None	8706 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	3406	19	06037	33.91802345	-118.1407927	Los Angeles County
51551	Fee-for-Service	1679161392	1679161392	1	1	PHAMILY HOME ELDERLY CARE	3/11/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	704 E VISTA DEL PLAYA	AVE	ORANGE	CA	92865	3438	30	06059	33.8261441	-117.8467776	Orange County
51557	Fee-for-Service	1972772275	1972772275	1	1	PUPPALA, VIVEK J MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101984	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
51599	Fee-for-Service	1346027422	1346027422	1	1	PHAM, ATHENA NP	1/8/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
51612	Fee-for-Service	1962840082	1962840082	1	1	PANCIO, STEVEN I II MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155710	20	Orthopedic Surgery	0	In state provider	None	1139 THIRD ST	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
51644	Fee-for-Service	1144336769	1144336769	1	1	PISANO, CRESCENZO MD INC	2/27/1997	207R00000X	NA	Other	026	PHYSICIANS	42081	41	Internal Medicine	0	In state provider	None	1294 W 6TH ST	None	SAN PEDRO	CA	90731	2987	19	06037	33.73885348	-118.3056165	Los Angeles County
51680	Fee-for-Service	1417171703	1417171703	1	1	PISKOVA, RAYNA MD INC	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52376	18	Ophthalmology	0	In state provider	None	509 S I STREET	STE C	MADERA	CA	93637	4660	20	06039	36.95460782	-120.0589258	Madera County
51699	Fee-for-Service	1396807046	1396807046	1	1	POURZIAEE, BOBBY DPM INC	4/26/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	421 N RODEO DR	SUITE G-12	BEVERLY HILLS	CA	90210	4500	19	06037	34.06967423	-118.4034633	Los Angeles County
51716	Fee-for-Service	1942835269	1942835269	1	1	PURE HEART HOSPICE, INC	2/4/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 357	CANOGA PARK	CA	91303	3395	19	06037	34.203222	-118.605988	Los Angeles County
51733	Fee-for-Service	1376545863	1376545863	1	1	PETERSON, JAMES A DO	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	8715	30	Radiology	0	In state provider	None	15725 POMERADO ROAD	SUITE 100	POWAY	CA	92064	2057	37	06073	33.00037882	-117.0580735	San Diego County
51782	Fee-for-Service	1093969115	1093969115	1	5	PLANNED PARENTHOOD OF LA	8/12/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2720 TWEEDY BOULEVARD	None	SOUTH GATE	CA	90280	5539	19	06037	33.9459986	-118.2230278	Los Angeles County
51800	Fee-for-Service	1629110333	1629110333	1	1	PAYTON, KURLEN S E MD	1/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108788	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
51822	Fee-for-Service	1073519443	1073519443	1	2	PIONEERS MEMORIAL HEALTH	1/24/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	205 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.96000025	-115.5530125	Imperial County
51837	Fee-for-Service	1053033498	1053033498	1	1	PROTTO, IGNACIO F PT	11/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	312 W J ST	None	LOS BANOS	CA	93635	4069	24	06047	37.06221105	-120.8570564	Merced County
51849	Fee-for-Service	1912079765	1912079765	1	1	PLAUTZ, WILLIAM MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63847	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
51878	Fee-for-Service	1942247291	1942247291	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN PEDRO HOSPITAL	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
51915	Fee-for-Service	1073519443	1073519443	1	1	PIONEERS MEMORIAL HEALTH	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CARE DISTRICT	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
51932	Fee-for-Service	1093969115	1093969115	1	20	PLANNED PARENTHOOD OF LA	4/6/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6020 MILES AVE	None	HUNTINGTON PARK	CA	90255	3109	19	06037	33.98758215	-118.2192765	Los Angeles County
51970	Fee-for-Service	1366077786	1366077786	1	1	PEKNY, CARISSA J	7/29/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51983	Fee-for-Service	1780762492	1780762492	1	1	PAPPAS, CONRAD T MD	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72195	14	Neurological Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
51993	Fee-for-Service	1134178999	1134178999	1	1	PEACEHEALTH SOUTHWEST	2/12/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	400 NE MOTHER JOSEPH PL	None	VANCOUVER	WA	98664	3200	00	None	45.624609	-122.5814175	Clark County
52030	Fee-for-Service	1265151336	1265151336	1	1	PRIYA, KANOO NP	10/4/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
52034	Fee-for-Service	1780971333	1780971333	1	1	PAVITRA KOTINI-SHAH	4/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	808 S WOOD ST	None	CHICAGO	IL	60612	7300	00	None	41.8714195	-87.67152062	Cook County
52046	Fee-for-Service	1447317128	1447317128	1	3	POLLOCK PINES ESD	7/1/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	6181 PINE STREET	None	POLLOCK PINES	CA	95726	9608	09	06017	38.7648517	-120.58837	El Dorado County
52058	Fee-for-Service	1972792729	1972792729	1	1	PHILIPP, RONALD J DO APC	5/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2255 N LAKEWOOD BLVD	None	LONG BEACH	CA	90815	2507	19	06037	33.79654624	-118.1432226	Los Angeles County
52088	Fee-for-Service	1972832152	1972832152	1	1	PHAM, HENRY D MD	10/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106024	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
52119	Fee-for-Service	1780425454	1780425454	1	1	PETERSEN, KATHERINE PT	10/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
52130	Fee-for-Service	1093393951	1093393951	1	1	POLO, ANDREA CNP	2/8/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
52135	Fee-for-Service	1144358581	1144358581	1	1	PETERSON, DAVID L MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	39409	None	None	0	In state provider	OF SAN JOSE	393 BLOSSOM HILL RD	STE 260A	SAN JOSE	CA	95123	1655	43	06085	37.25148009	-121.8269584	Santa Clara County
52136	Fee-for-Service	1710030564	1710030564	1	1	PIKE, SUZANNE G	10/12/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1090 THIRD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
52166	Fee-for-Service	1578900585	1578900585	1	1	PHARES, AMANDA	9/1/2024	390200000X	NA	Other	026	PHYSICIANS	146286	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
52169	Fee-for-Service	1942247291	1942247291	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	SAN PEDRO HOSPITAL	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
52203	Fee-for-Service	1073519443	1073519443	1	1	PIONEERS MEMORIAL HEALTH	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CARE DISTRICT	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
52215	Fee-for-Service	1316148125	1316148125	1	1	PLANNED PARENTHOOD OF THE PA	4/12/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CIFIC SOUTHWEST LABORATO	2017 1ST AVE	STE 300	SAN DIEGO	CA	92101	2033	37	06073	32.72646147	-117.1638767	San Diego County
52249	Fee-for-Service	1922176411	1922176411	1	1	PALMER, NANCY K MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89329	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
52255	Fee-for-Service	1528028248	1528028248	1	1	PETROVICH, LINDA M MD	7/26/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52590	30	Radiology	0	In state provider	MD	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
52256	Fee-for-Service	1629193586	1629193586	1	1	PONTIOUS, LORI E LMFT	7/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	55 SHAW AVE	STE 120	CLOVIS	CA	93612	3819	10	06019	36.80859553	-119.708505	Fresno County
52268	Fee-for-Service	1811001381	1811001381	1	1	PHILLIPS, WILLIAM L MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98794	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
52279	Fee-for-Service	1760482996	1760482996	1	1	PHAM, MINO T MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82929	08	Family Practice	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
52280	Fee-for-Service	1134178999	1134178999	1	1	PEACEHEALTH SOUTHWEST	2/12/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	400 NE MOTHER JOSEPH PL	None	VANCOUVER	WA	98664	3200	00	None	45.624609	-122.5814175	Clark County
52301	Fee-for-Service	1972595692	1972595692	1	1	PERCIVAL, PAUL J MD INC	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83115	01	General Practice	0	In state provider	None	930 SUNSET DR	None	HOLLISTER	CA	95023	5780	35	06069	36.83510073	-121.385707	San Benito County
52313	Fee-for-Service	1700654217	1700654217	1	1	POOL, COURTNEY NP	1/8/2025	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
52317	Fee-for-Service	1366404923	1366404923	1	1	PIGEON, RAYMOND G MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62257	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
52322	Fee-for-Service	1578650594	1578650594	1	1	PIERCE, JONATHAN L MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49836	08	Family Practice	0	In state provider	None	715 ZION ST	None	NEVADA CITY	CA	95959	2920	29	06057	39.25425524	-121.0256396	Nevada County
52325	Fee-for-Service	1801842315	1801842315	1	1	PUSHKIN, RICHARD I MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73838	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52327	Fee-for-Service	1063737567	1063737567	1	1	PATEL, SANJEET MD	8/3/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	111664	33	Thoracic Surgery	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
52346	Fee-for-Service	1972792729	1972792729	1	1	PHILIPP, RONALD J DO APC	5/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	2255 N LAKEWOOD BLVD	None	LONG BEACH	CA	90815	2507	19	06037	33.79654624	-118.1432226	Los Angeles County
52358	Fee-for-Service	1134160211	1134160211	1	1	PATEL, RAJESH V MD	11/30/1993	207L00000X	NA	Other	026	PHYSICIANS	47817	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
52434	Fee-for-Service	1235128919	1235128919	1	1	PARKER, B ANNE	2/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65116	40	Pediatrics	0	In state provider	None	1332 PARK ST	STE 202	ALAMEDA	CA	94501	4554	01	06001	37.76330843	-122.2435444	Alameda County
52454	Fee-for-Service	1942247291	1942247291	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN PEDRO HOSPITAL	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
52484	Fee-for-Service	1477751907	1477751907	1	1	PATEL, NEIL MD	2/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
52494	Fee-for-Service	1659390847	1659390847	1	1	PERNG, JIUNN C MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32126	41	Internal Medicine	0	In state provider	None	3125 SAVIERS RD	None	OXNARD	CA	93033	5310	56	06111	34.171101	-119.1777065	Ventura County
52519	Fee-for-Service	1457057119	1457057119	1	1	PACIFICA HOME CARE LLC	3/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	23711 VIA LA CORUNA	None	MISSION VIEJO	CA	92691	3523	30	06059	33.61826513	-117.6600996	Orange County
52566	Fee-for-Service	1154344927	1154344927	1	1	PENTSCHEV, STEFAN I MD	3/31/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43893	02	General Surgery	0	In state provider	None	125 N CRESPI AVE	None	EXETER	CA	93221	1301	54	06107	36.29810973	-119.1325861	Tulare County
52598	Fee-for-Service	1033807318	1033807318	1	1	PAN, MICHELLE SHAOJUAN	8/18/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5809 20TH AVE	None	SACRAMENTO	CA	95820	3107	34	06067	38.533545	-121.4380125	Sacramento County
52615	Fee-for-Service	1801842315	1801842315	1	1	PUSHKIN, RICHARD I MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73838	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52624	Fee-for-Service	1831327055	1831327055	1	1	PAIN MEDICINE CONSULTANTS	7/14/2010	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	100 NORTH WIGET LANE	SUITE 160	WALNUT CREEK	CA	94598	5917	07	06013	37.92514495	-122.0237725	Contra Costa County
52663	Fee-for-Service	1386765105	1386765105	1	1	PARK, PAUL J MD	4/7/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
52688	Fee-for-Service	1376607101	1376607101	1	1	PEREZ, LEAH H	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
52691	Fee-for-Service	1427314400	1427314400	1	1	PAGE, RACHEL LMFT	12/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	131 STONY CIR	1600	SANTA ROSA	CA	95401	9520	49	06097	38.439477	-122.7451095	Sonoma County
52707	Fee-for-Service	1376973776	1376973776	1	1	PETERS, NATALIE C NP	12/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
52729	Fee-for-Service	1962495408	1962495408	1	1	PENNINO, ANNA M OD	1/1/1994	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
52733	Fee-for-Service	1164677464	1164677464	1	1	PARK, GRACE J DO	9/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10562	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
52754	Fee-for-Service	1316041833	1316041833	2	18	PEDIATRIX MEDICAL GROUP OF C	4/21/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
52769	Fee-for-Service	1437458379	1437458379	1	1	PARKER, BARBARA J	12/2/2010	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1060 UNIVERSITY AVE	SUITE A-215	SAN DIEGO	CA	92103	7343	37	06073	32.7485561	-117.1537582	San Diego County
52854	Fee-for-Service	1154344927	1154344927	1	1	PENTSCHEV, STEFAN I MD	3/31/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43893	01	General Practice	0	In state provider	None	125 N CRESPI AVE	None	EXETER	CA	93221	1301	54	06107	36.29810973	-119.1325861	Tulare County
52880	Fee-for-Service	1639583438	1639583438	1	1	PATEL, KEVAL A MD	9/1/2019	207R00000X	NA	Other	026	PHYSICIANS	150360	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
52885	Fee-for-Service	1518363407	1518363407	1	1	PAULSON, KERRY L NP	8/22/2017	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
52895	Fee-for-Service	1033807318	1033807318	1	1	PAN, MICHELLE SHAOJUAN	8/18/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5809 20TH AVE	None	SACRAMENTO	CA	95820	3107	34	06067	38.533545	-121.4380125	Sacramento County
52931	Fee-for-Service	1801406350	1801406350	1	1	PATEL, MANDAR PT	12/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	134 SOUTH E ST	None	EXETER	CA	93221	1731	54	06107	36.29571271	-119.1405696	Tulare County
52935	Fee-for-Service	1447505284	1447505284	1	1	PHAN, HUNG C MD	12/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
52953	Fee-for-Service	1982065108	1982065108	1	1	POMONA DIALYSIS CENTER INC	6/15/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
52969	Fee-for-Service	1386706240	1386706240	2	1	PATEL, YOGENDRA B MD	12/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	40908	10	Gastroenterology (M.D. only)	0	In state provider	None	12980 FREDERICK STREET	SUITE J	MORENO VALLEY	CA	92553	5263	33	06065	33.931872	-117.2613835	Riverside County
52990	Fee-for-Service	1306847611	1306847611	1	1	PAWLIK, NANCY A MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	54852	02	General Surgery	0	In state provider	None	437 MARSH ST	None	SAN LUIS OBISPO	CA	93401	3822	40	06079	35.27592533	-120.667358	San Luis Obispo County
53002	Fee-for-Service	1174626683	1174626683	1	1	PUTHENVEETIL, GEETHA MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72517	69	Unknown	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
53024	Fee-for-Service	1316967888	1316967888	1	1	PETER S LENZ MD	7/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE & C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.778496	-111.8805615	Salt Lake County
53060	Fee-for-Service	1497373641	1497373641	1	1	PLANNED PARENTHOOD LOS	1/12/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	661 E UNIVERSITY AVE	None	CARSON	CA	90746	1966	19	06037	33.85832615	-118.2640232	Los Angeles County
53080	Fee-for-Service	1245284843	1245284843	1	1	PACIFIC COAST CARDIOLOGY	10/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP	3300 W COAST HIGHWAY	None	NEWPORT BEACH	CA	92663	4007	30	06059	33.62136043	-117.9274297	Orange County
53089	Fee-for-Service	1144575614	1144575614	1	1	PROSSER, JENNIFER	11/8/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
53129	Fee-for-Service	1093210692	1093210692	1	1	PALOMINO DE LOS SANTOS, SUSA	4/4/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1711 W FRANCISQUITO AVE	None	WEST COVINA	CA	91790	4434	19	06037	34.05667392	-117.9578805	Los Angeles County
53137	Fee-for-Service	1396812285	1396812285	1	1	PARKS, PAUL F JR MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68764	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53161	Fee-for-Service	1669539375	1669539375	1	1	PARK, JAMES J MD	4/7/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87360	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53165	Fee-for-Service	1184936023	1184936023	1	1	PHYSICIANS FOR HEALTHY	11/30/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITALS INC	371 NORTH WESTON PLACE	None	HEMET	CA	92543	3006	33	06065	33.75245412	-116.95978	Riverside County
53234	Fee-for-Service	1093969115	1093969115	1	12	PLANNED PARENTHOOD OF LA	9/14/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1527 LAKME AVENUE	None	WILMINGTON	CA	90744	3925	19	06037	33.79415516	-118.2608087	Los Angeles County
53251	Fee-for-Service	1629827084	1629827084	1	1	PANTEA PAHLAVAN	10/27/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	5140 BUSINESS CENTER DR	103	FAIRFIELD	CA	94534	1793	48	06095	38.21632832	-122.1450436	Solano County
53292	Fee-for-Service	1174626683	1174626683	1	1	PUTHENVEETIL, GEETHA MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72517	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
53299	Fee-for-Service	1639349301	1639349301	1	1	PLISKO, ANDY MD INC	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50741	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
53342	Fee-for-Service	1104921691	1104921691	1	2	PRICE-HANSON, DOUGLAS R MD	3/19/2025	207R00000X	NA	Other	026	PHYSICIANS	76984	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53385	Fee-for-Service	1275720146	1275720146	1	1	PATEL, SAMIR M MD	1/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99087	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
53417	Fee-for-Service	1093210692	1093210692	1	1	PALOMINO DE LOS SANTOS, SUSA	4/4/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1711 W FRANCISQUITO AVE	None	WEST COVINA	CA	91790	4434	19	06037	34.05667392	-117.9578805	Los Angeles County
53422	Fee-for-Service	1871796433	1871796433	1	1	PEDELABORDE, JENNIFER A LMFT	7/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	445 BELLEVUE AVE	SUITE 101	OAKLAND	CA	94610	4923	01	06001	37.80910261	-122.2526914	Alameda County
53425	Fee-for-Service	1396812285	1396812285	1	1	PARKS, PAUL F JR MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68764	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53449	Fee-for-Service	1669539375	1669539375	1	1	PARK, JAMES J MD	4/7/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87360	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
53478	Fee-for-Service	1558755934	1558755934	1	1	POST, REBECCA MD	2/15/2018	390200000X	NA	Other	026	PHYSICIANS	145905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53489	Fee-for-Service	1043537954	1043537954	1	1	PENROSE, SARAH M NP	8/14/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
53495	Fee-for-Service	1356685218	1356685218	1	12	PACIFIC NEUROPSYCHIATRIC SPE	3/26/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	CIALISTS INC.	900 S MAIN ST	SUITE 209	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
53527	Fee-for-Service	1093969115	1093969115	1	24	PLANNED PARENTHOOD OF LA	1/11/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	13000 OXNARD ST	None	VAN NUYS	CA	91401	4114	19	06037	34.17936869	-118.4165254	Los Angeles County
53534	Fee-for-Service	1083366702	1083366702	1	1	PLUMAS LAKE ELEMENTARY	7/1/2022	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	2743 PLUMAS SCHOOL RD	None	PLUMAS LAKE	CA	95961	8827	58	06115	39.02688913	-121.5166935	Yuba County
53559	Fee-for-Service	1467984674	1467984674	1	1	PARRA GUERRERO, CINDY E MD	10/18/2023	207ND0101X	NA	Dermatology	026	PHYSICIANS	189782	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
53582	Fee-for-Service	1609652304	1609652304	1	1	PASITO X PASITO LLC	9/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
53608	Fee-for-Service	1992033237	1992033237	1	1	PREMMER, KAREEN D MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122554	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53618	Fee-for-Service	1083754089	1083754089	1	1	PRICE, ALAN D PHD	4/20/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30423 CANWOOD ST	SUITE 138	AGOURA HILLS	CA	91301	4315	19	06037	34.14710182	-118.7842501	Los Angeles County
53654	Fee-for-Service	1144251042	1144251042	1	1	PARSA, MICHAEL D MD	5/3/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79011	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 ALAMO PINTADO RD	None	SOLVANG	CA	93463	2269	42	06083	34.60203	-120.1262085	Santa Barbara County
53658	Fee-for-Service	1164838231	1164838231	1	1	PATEL, NISHA A LMFT	11/14/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
53661	Fee-for-Service	1144681073	1144681073	1	1	PALAPAZ, RYAN J MD	6/6/2022	2080P0203X	NA	Other	026	PHYSICIANS	151731	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
53705	Fee-for-Service	1609596741	1609596741	1	1	PACK, PAULA	3/24/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
53710	Fee-for-Service	1629796438	1629796438	1	1	PHAM, ANTHONY B NP	11/28/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1131 6TH ST	STE 232	ONTARIO	CA	91762	1121	36	06071	34.084404	-117.6717015	San Bernardino County
53731	Fee-for-Service	1912467887	1912467887	1	1	PENALOZA, ROSA L	7/18/2023	207R00000X	NA	Other	026	PHYSICIANS	179060	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
53734	Fee-for-Service	1710031588	1710031588	1	18	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5525 ETIWANDA AVE	STE 212	TARZANA	CA	91356	6118	19	06037	34.17046451	-118.5308463	Los Angeles County
53760	Fee-for-Service	1245619428	1245619428	1	1	PRIDE, ELSIE M LMFT	3/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BARRANCA ST	746	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
53774	Fee-for-Service	1649587205	1649587205	1	1	PICAZO, RONALD A MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109248	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53775	Fee-for-Service	1235698184	1235698184	1	1	PENTA, DEEPTHI MD	7/1/2024	207L00000X	NA	Other	026	PHYSICIANS	182028	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
53847	Fee-for-Service	1770871774	1770871774	1	1	PRIETTO, CHRISTIAN M	11/23/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22691 LAMBERT ST	502	LAKE FOREST	CA	92630	1614	30	06059	33.63321041	-117.7137117	Orange County
53853	Fee-for-Service	1386604452	1386604452	1	1	PENTA, PRAMILA MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130736	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
53896	Fee-for-Service	1992033237	1992033237	1	1	PREMMER, KAREEN D MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122554	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53913	Fee-for-Service	1124314919	1124314919	1	1	PRESSER, NAFTALI MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139965	02	General Surgery	0	In state provider	None	10833 LECONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
53930	Fee-for-Service	1225471337	1225471337	1	1	PAGE, ALEXANDER MD	8/16/2019	2085R0204X	NA	Other	026	PHYSICIANS	163429	30	Radiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
53941	Fee-for-Service	1821605031	1821605031	1	1	PATCHETT, KATRINA PT	8/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
53991	Fee-for-Service	1891993267	1891993267	1	1	PAK, SUSAN J MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90686	26	Psychiatry (child)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54012	Fee-for-Service	1295980878	1295980878	1	1	PIFER, ERIC A MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88234	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
54021	Fee-for-Service	1710031588	1710031588	1	18	PROVIDENCE FACEY MEDICAL FOU	5/22/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5525 ETIWANDA AVE	STE 212	TARZANA	CA	91356	6118	19	06037	34.17046451	-118.5308463	Los Angeles County
54027	Fee-for-Service	1790090264	1790090264	1	1	PATCHA, PRASANTH MD	1/17/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	150993	None	None	0	In state provider	None	555 HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
54064	Fee-for-Service	1194923995	1194923995	1	1	PARADISE HEARING & BALANCE	10/19/2018	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	CLINICS INC	5500 CLARK RD	None	PARADISE	CA	95969	5106	04	06007	39.74733498	-121.6076666	Butte County
54071	Fee-for-Service	1184645897	1184645897	1	1	PENA, JAMES PAUL MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75724	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
54075	Fee-for-Service	1043496037	1043496037	1	1	PARLOW, SARAH CRNA	3/13/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
54076	Fee-for-Service	1881741668	1881741668	1	1	PHUNG, KIEN T MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13766	18	Ophthalmology	0	In state provider	None	7407 N CEDAR AVE	SUITE 103	FRESNO	CA	93720	3839	10	06019	36.84303529	-119.7568435	Fresno County
54120	Fee-for-Service	1093969115	1093969115	1	16	PLANNED PARENTHOOD OF LA	10/12/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1200 W COLTON ST	None	LOS ANGELES	CA	90026	5816	19	06037	34.06193384	-118.254702	Los Angeles County
54127	Fee-for-Service	1093155343	1093155343	1	1	PREMIER HOSPICE & HOMECARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21300 VICTORY BLVD	SUITE 640A	WOODLAND HILLS	CA	91367	2521	19	06037	34.18833948	-118.595925	Los Angeles County
54145	Fee-for-Service	1437612538	1437612538	1	1	PHILLIPS, RONALD E CNP	1/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
54172	Fee-for-Service	1912728767	1912728767	1	1	PIEDMONT INTERVENTIONAL PSYC	12/16/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	HIATRY PC	675 N 1ST ST	STE 100A	SAN JOSE	CA	95112	5137	43	06085	37.34856453	-121.899953	Santa Clara County
54182	Fee-for-Service	1992033237	1992033237	1	1	PREMMER, KAREEN D MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122554	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
54194	Fee-for-Service	1922560556	1922560556	1	1	POLONI, CHRISTINA M DO	8/12/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	23086	02	General Surgery	0	In state provider	None	1100 SAN BERNARDINO RD	1100	UPLAND	CA	91786	4923	36	06071	34.10129201	-117.636283	San Bernardino County
54204	Fee-for-Service	1912218165	1912218165	1	1	PARK, ANDREW MD	3/9/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	174427	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
54224	Fee-for-Service	1013019678	1013019678	1	1	PERL, MATTHEW J MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58726	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
54250	Fee-for-Service	1750533394	1750533394	1	1	PAK, UNSON LCSW	8/9/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
54281	Fee-for-Service	1891993267	1891993267	1	1	PAK, SUSAN J MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90686	36	Psychiatry	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54286	Fee-for-Service	1952513962	1952513962	1	1	PEAK, JEFFREY MD INC	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78221	05	Anesthesiology	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
54337	Fee-for-Service	1568459436	1568459436	1	1	POCONO MEDICAL CENTER	1/6/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	206 E BROWN ST	None	E STROUDSBURG	PA	18301	3006	00	None	40.99227709	-75.17447295	Monroe County
54367	Fee-for-Service	1548307549	1548307549	1	1	PATEL, ANU C PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
54416	Fee-for-Service	1093155343	1093155343	1	1	PREMIER HOSPICE & HOMECARE	1/14/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21300 VICTORY BLVD	SUITE 640A	WOODLAND HILLS	CA	91367	2521	19	06037	34.18833948	-118.595925	Los Angeles County
54492	Fee-for-Service	1194739375	1194739375	1	1	PARK, JOHN S MD	12/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95402	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
54499	Fee-for-Service	1003421025	1003421025	1	1	PURE COMFORT HOSPICE CARE	9/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5658 SEPULVEDA BLVD	STE 213	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
54531	Fee-for-Service	1215411459	1215411459	1	2	PULEO, RHONDA J LMFT	9/21/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106070	-	NOT APPLICABLE	0	In state provider	None	1352 COLUSA HWY	SUITE C	YUBA CITY	CA	95993	9147	51	06101	39.14177255	-121.635963	Sutter County
54536	Fee-for-Service	1326668500	1326668500	1	1	PANG, CATHERINE MD	11/17/2023	207R00000X	NA	Other	026	PHYSICIANS	191062	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
54560	Fee-for-Service	1861568347	1861568347	1	1	PETERS, WILLIAM A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43148	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
54571	Fee-for-Service	1568757243	1568757243	1	1	PODOLSKY, MICHAEL J MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130146	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
54573	Fee-for-Service	1306098652	1306098652	1	1	PEDIATRIC SUBSPECIALTY	12/22/2009	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FACULTY INC	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
54585	Fee-for-Service	1841369022	1841369022	1	1	PARREN SCOTT MCNEELY	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
54595	Fee-for-Service	1629227962	1629227962	1	1	PACIFIC HEMATOLOGY	3/23/2009	207RH0003X	NA	Oncology	026	PHYSICIANS	72545	78	Neoplastic Diseases/Oncology	0	In state provider	& ONCOLOGY INSTITUTE	612 W DUARTE RD	STE 804	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
54601	Fee-for-Service	1013007756	1013007756	1	1	PETER J CORNELL, MD INC	6/30/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	450 N BEDFORD DR	STE 101	BEVERLY HILLS	CA	90210	4305	19	06037	34.06885525	-118.4059408	Los Angeles County
54625	Fee-for-Service	1568459436	1568459436	1	1	POCONO MEDICAL CENTER	1/6/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	206 E BROWN ST	None	E STROUDSBURG	PA	18301	3006	00	None	40.99227709	-75.17447295	Monroe County
54645	Fee-for-Service	1881765048	1881765048	1	2	PACHECO, SANTOS F MD INC	7/10/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54292	01	General Practice	0	In state provider	None	10719 S INGLEWOOD AVE	None	INGLEWOOD	CA	90304	1793	19	06037	33.938811	-118.3613665	Los Angeles County
54650	Fee-for-Service	1992245047	1992245047	1	1	PROHEALTH PARTNERS A MEDICAL	10/11/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP INC	1382 E FOOTHILL BLVD	None	UPLAND	CA	91786	4014	36	06071	34.10697145	-117.6319655	San Bernardino County
54705	Fee-for-Service	1831163096	1831163096	1	1	PROTELL, ROBERT L MD	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	40985	10	Gastroenterology (M.D. only)	0	In state provider	None	415 E HARDING WAY	STE G	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
54708	Fee-for-Service	1689659195	1689659195	1	1	PATTON, ROBERT H MD	1/2/1995	207R00000X	NA	Other	026	PHYSICIANS	38319	41	Internal Medicine	0	In state provider	None	780 E ROMIE LN	STE C	SALINAS	CA	93901	4223	27	06053	36.65861498	-121.6403327	Monterey County
54749	Fee-for-Service	1609649987	1609649987	1	1	PETTY, JOSHUA NP	2/10/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
54756	Fee-for-Service	1144252040	1144252040	1	1	PETERSEN, GRETI I MD	10/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93553	None	None	0	In state provider	None	2201 MOUNT VERNON AVE	STE 211	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
54765	Fee-for-Service	1063856094	1063856094	1	1	PRIEM, DANIELLE M DO	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14844	40	Pediatrics	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
54773	Fee-for-Service	1508849035	1508849035	1	1	PAIK, CLARA K MD	8/6/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68053	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
54775	Fee-for-Service	1962500157	1962500157	1	1	PORTER, LADONNA R MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65145	08	Family Practice	0	In state provider	None	3911 NORWOOD AVE	None	SACRAMENTO	CA	95838	3361	34	06067	38.638197	-121.4573895	Sacramento County
54787	Fee-for-Service	1003421025	1003421025	1	1	PURE COMFORT HOSPICE CARE	9/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5658 SEPULVEDA BLVD	STE 213	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
54816	Fee-for-Service	1194784371	1194784371	1	1	PORZIG, KLAUS J MD	11/1/1981	207RX0202X	NA	Oncology	026	PHYSICIANS	28344	41	Internal Medicine	0	In state provider	None	678 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1931	43	06085	37.34268625	-121.8767695	Santa Clara County
54817	Fee-for-Service	1871975318	1871975318	1	1	PITTMAN, ERIC S MD	12/22/2022	207P00000X	NA	Other	026	PHYSICIANS	144847	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
54818	Fee-for-Service	1376833038	1376833038	1	1	PALA, KAITLIN D MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
54847	Fee-for-Service	1225115165	1225115165	1	1	PHAM, CHANTAL T MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82142	07	Dermatology	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
54854	Fee-for-Service	1710321500	1710321500	1	1	PATEL, SAPNA M PHD	10/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
54857	Fee-for-Service	1568757243	1568757243	1	1	PODOLSKY, MICHAEL J MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130146	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
54862	Fee-for-Service	1306098652	1306098652	1	1	PEDIATRIC SUBSPECIALTY	12/22/2009	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FACULTY INC	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
54873	Fee-for-Service	1689987521	1689987521	1	2	PRAVIN J KANSAGRA MD INC	10/22/2019	261QM2500X	NA	Other	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1020 S ANAHEIM BLVD	SUITE 215	ANAHEIM	CA	92805	5851	30	06059	33.82002206	-117.9087091	Orange County
54876	Fee-for-Service	1659062685	1659062685	2	1	POWELL, KURITA BENAE	3/24/2025	152W00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
54881	Fee-for-Service	1629227962	1629227962	1	1	PACIFIC HEMATOLOGY	3/23/2009	207RH0003X	NA	Oncology	026	PHYSICIANS	72545	68	Hematology	0	In state provider	& ONCOLOGY INSTITUTE	612 W DUARTE RD	STE 804	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
54901	Fee-for-Service	1275828113	1275828113	2	1	PANIKKATH, RAGESH MD	7/9/2024	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161106	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1304 ELLA ST	STE A	SAN LUIS OBISPO	CA	93401	4165	40	06079	35.27704692	-120.6496857	San Luis Obispo County
54904	Fee-for-Service	1366517393	1366517393	1	1	PRN CONVALESCENT HOSPITAL	12/8/1989	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	7912 TOPLEY LN	None	SUNLAND	CA	91040	3336	19	06037	34.25540878	-118.3050361	Los Angeles County
54988	Fee-for-Service	1083606776	1083606776	1	1	PFEIFER, KELLY S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66577	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	None	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
54998	Fee-for-Service	1568431666	1568431666	1	1	PETRILLO,RAYMOUND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97227	0000	00	None	45.54387841	-122.6696022	Multnomah County
55052	Fee-for-Service	1134292121	1134292121	1	1	PASADENA EYE MEDICAL GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	10 CONGRESS ST	STE 340	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
55064	Fee-for-Service	1558755785	1558755785	1	1	PIETROWSKI, MARGARET A MD	12/30/2018	207P00000X	NA	Other	026	PHYSICIANS	151604	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
55080	Fee-for-Service	1720059744	1720059744	1	1	POWELL, STEPHANIE J MD	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76747	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 112	SAN DIEGO	CA	92123	4226	37	06073	32.798889	-117.150826	San Diego County
55096	Fee-for-Service	1871585067	1871585067	1	1	PERKINELMER GENETICS, INC.	11/30/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	250 INDUSTRY DR	SUITE 400	PITTSBURGH	PA	15275	1017	00	None	40.46753908	-80.20778987	Allegheny County
55105	Fee-for-Service	1477959286	1477959286	1	1	POOL, JULIE LCSW	4/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
55111	Fee-for-Service	1528127156	1528127156	1	1	PATEL, PRAGATI MD INC	4/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	36474	01	General Practice	0	In state provider	None	2612 F STREET	None	BAKERSFIELD	CA	93301	1816	15	06029	35.38333118	-119.0234494	Kern County
55126	Fee-for-Service	1053370239	1053370239	1	1	PARK, JASON H	11/17/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4482 BARRANCA PKWY	STE 195	IRVINE	CA	92604	4706	30	06059	33.68008811	-117.8015383	Orange County
55147	Fee-for-Service	1568757243	1568757243	1	1	PODOLSKY, MICHAEL J MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130146	41	Internal Medicine	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
55160	Fee-for-Service	1205901691	1205901691	1	1	PATEL, NEEL D MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80060	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55184	Fee-for-Service	1366076671	1366076671	1	1	PAYLOR, KIM L LPCC	4/21/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
55207	Fee-for-Service	1700945177	1700945177	1	1	PUSWELLA, AMAL MD	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110328	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
55239	Fee-for-Service	1780827444	1780827444	1	1	PITTS, CHARLENE L	8/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2301 E 28ST ST	STE 309	SIGNAL HILL	CA	90755	2181	19	06037	33.80807423	-118.1639744	Los Angeles County
55250	Fee-for-Service	1952415317	1952415317	1	1	PETER T SILBERSTEIN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CREIGHTON MEDICAL ASSOCI	601 N 30TH ST	None	OMAHA	NE	68103	2159	00	None	41.2654263	-95.95644327	Douglas County
55253	Fee-for-Service	1518128891	1518128891	1	1	PEARSON, MARY M MD	1/18/2023	207R00000X	NA	Other	026	PHYSICIANS	104494	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
55264	Fee-for-Service	1770741068	1770741068	1	1	POON, STEPHEN A MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125092	34	Urology and Urological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
55267	Fee-for-Service	1609275841	1609275841	1	1	PRAGER, BERIL J LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
55268	Fee-for-Service	1689966285	1689966285	1	1	PATEL, RUPA K MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144358	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55294	Fee-for-Service	1427598796	1427598796	1	1	PALMER, LINDSAY K	6/29/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
55336	Fee-for-Service	1023152048	1023152048	1	1	PEASE, MARIA R LMFT	6/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
55348	Fee-for-Service	1053725366	1053725366	1	1	PARSA, NOUR A MD	1/3/2022	207R00000X	NA	Other	026	PHYSICIANS	170413	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
55373	Fee-for-Service	1316985633	1316985633	1	1	POON, HENRY K MD	12/17/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	87335	39	Preventive (M.D. only)	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
55412	Fee-for-Service	1982606299	1982606299	1	1	PREFERRED FAMILY CARE	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PHYSICIANS	5925 TRUXTUN AVE	STE A	BAKERSFIELD	CA	93309	0433	15	06029	35.36335425	-119.070183	Kern County
55413	Fee-for-Service	1023062593	1023062593	1	2	PLANNED PARENTHOOD MAR	4/5/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	211 N STEVENSON ST	None	VISALIA	CA	93291	6023	54	06107	36.331731	-119.3001525	Tulare County
55436	Fee-for-Service	1720274517	1720274517	1	1	PRESBY, DAVID LMFT	10/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
55453	Fee-for-Service	1033366026	1033366026	1	1	PINEDA, MELISSA A MD	11/11/2021	207L00000X	NA	Other	026	PHYSICIANS	116044	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
55471	Fee-for-Service	1437142270	1437142270	1	1	PARSONS, ERIC S MD	7/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136730	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
55482	Fee-for-Service	1871501916	1871501916	1	1	PRIME HEALTHCARE ANAHEIM	9/30/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
55530	Fee-for-Service	1407143845	1407143845	1	1	POLLOCK, JUSTIN E MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122341	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55538	Fee-for-Service	1841378825	1841378825	1	1	PARK, BRUCE MD	8/16/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	64682	07	Dermatology	0	In state provider	None	1966 E CHAPMAN AVE	SUITE G	FULLERTON	CA	92831	4142	30	06059	33.87415051	-117.896427	Orange County
55544	Fee-for-Service	1376582114	1376582114	1	1	PADUA, ERIC M MD	2/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53728	30	Radiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
55558	Fee-for-Service	1932401338	1932401338	1	1	PANDEY, SUCHITRA MD	12/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91155	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
55586	Fee-for-Service	1922452333	1922452333	1	1	PEIXOTO, KARINA O B	6/20/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
55587	Fee-for-Service	1316383102	1316383102	1	1	PLEVEL, TANIA S LMFT	2/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PRACTICE	10090 W DRIVE	None	GRASS VALLEY	CA	95945	8509	29	06057	0	0	None
55596	Fee-for-Service	1962405860	1962405860	1	1	PMK MEDICAL GROUP INC	5/6/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
55602	Fee-for-Service	1063895811	1063895811	1	1	PEROFSKY, KATHERINE L MD	1/12/2022	2080P0203X	NA	Other	026	PHYSICIANS	155639	None	None	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
55624	Fee-for-Service	1548583651	1548583651	1	1	PENINSULA ENDOSCOPY CENTER	12/27/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	50 SOUTH SAN MATEO DR	SUITE 400	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
55640	Fee-for-Service	1023065646	1023065646	1	1	PAIN MANAGEMENT CONSULTANTS	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	47938	None	None	0	In state provider	A PROFESSIONAL MEDICAL C	477 N EL CAMINO REAL	STE B301	ENCINITAS	CA	92024	1331	37	06073	33.05700866	-117.262449	San Diego County
55660	Fee-for-Service	1992349310	1992349310	1	1	POLISSO, MICHAEL J LCSW	1/9/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55708	Fee-for-Service	1609218817	1609218817	1	1	PITTMAN, LAKEASHA LCSW	12/13/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
55713	Fee-for-Service	1235217720	1235217720	1	1	PATEL, PURVI R MD	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82356	41	Internal Medicine	0	In state provider	None	1510 S CENTRAL AVE	STE 500	GLENDALE	CA	91204	2540	19	06037	34.12709764	-118.2577911	Los Angeles County
55719	Fee-for-Service	1497780480	1497780480	1	1	PLANNED PARENTHOOD OF	1/10/1989	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	THE PACIFIC SOUTHWEST	2017 1ST AVE	STE 100	SAN DIEGO	CA	92101	9001	37	06073	32.72646147	-117.1638767	San Diego County
55721	Fee-for-Service	1356645048	1356645048	1	1	PARKS, RICHARD L MD APC	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	47152	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12486 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96785241	-118.0451556	Los Angeles County
55744	Fee-for-Service	1588261788	1588261788	1	1	PACIFIC POINT HCS INC	7/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2081 BUSINESS CENTER DR	STE 128	IRVINE	CA	92612	1115	30	06059	33.67939212	-117.8561729	Orange County
55745	Fee-for-Service	1902153109	1902153109	1	1	PAIN MANAGEMENT SERVICES AND	1/30/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HYSICAL THERAPY	3009 STRATOFORTRESS AVE	B	ATWATER	CA	95301	5170	24	06047	37.36164294	-120.5703841	Merced County
55777	Fee-for-Service	1568874790	1568874790	1	1	PATIL, NEHA R MD	4/3/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
55815	Fee-for-Service	1174790802	1174790802	1	1	PATEL, CHANDRA E DO	2/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10986	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
55820	Fee-for-Service	1932434206	1932434206	1	1	PACIFIC HEART MEDICAL GROUP,	10/15/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	25470 MEDICAL CENTER DR	SUITE 201	MURRIETA	CA	92562	4900	33	06065	33.55723646	-117.1859554	Riverside County
55856	Fee-for-Service	1184654493	1184654493	1	1	PHELAN, KIERAN J MD	3/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149199	40	Pediatrics	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
55877	Fee-for-Service	1356327316	1356327316	1	1	PATEL, HITENDRA MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144440	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55878	Fee-for-Service	1194734434	1194734434	1	1	PICKER, SCOTT D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74508	05	Anesthesiology	0	In state provider	A PROFESSIONAL CORP	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
55903	Fee-for-Service	1154362234	1154362234	1	1	PATEL, JAYESHKUMAR M MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66777	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90089	0287	19	06037	34.05855992	-118.209755	Los Angeles County
55921	Fee-for-Service	1407342298	1407342298	1	1	PHILLIPS, LISA LAC	3/31/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
55934	Fee-for-Service	1235601071	1235601071	1	1	PHAN, MYLINH T	1/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
55947	Fee-for-Service	1043315195	1043315195	1	1	PRESCOTT, CLINTON JR MD	8/31/1980	207N00000X	NA	Dermatology	026	PHYSICIANS	25653	07	Dermatology	0	In state provider	DBA CENTRAL VALLEY DERM.	296 COTTAGE AVE	None	MANTECA	CA	95336	4942	39	06077	37.80097641	-121.1982533	San Joaquin County
55977	Fee-for-Service	1104832070	1104832070	1	1	PHILLIPS, ROY DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CLAIREMONT MED CTR	3670 CLAIREMONT DR	STE 7	SAN DIEGO	CA	92117	5960	37	06073	32.808087	-117.201066	San Diego County
56009	Fee-for-Service	1437258860	1437258860	1	1	PEREGRINE HOSPICE, INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3440 W CARSON ST	STE 301	TORRANCE	CA	90503	5729	19	06037	33.83112114	-118.3464883	Los Angeles County
56011	Fee-for-Service	1700800232	1700800232	1	1	POTTER, DONALD E MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	19181	45	Nephrology (Renal-Kidney)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
56033	Fee-for-Service	1902153109	1902153109	1	1	PAIN MANAGEMENT SERVICES AND	5/25/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HYSICAL THERAPY	3009 STRATOFORTRESS AVE	B	ATWATER	CA	95301	5170	24	06047	37.36164294	-120.5703841	Merced County
56043	Fee-for-Service	1720060015	1720060015	1	1	PAYNE, JENNIE LEE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2551 W 84TH AVE	None	WESTMINSTER	CO	80031	3807	00	None	39.84905501	-105.0182452	Adams County
56063	Fee-for-Service	1568874790	1568874790	1	1	PATIL, NEHA R MD	4/3/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
56072	Fee-for-Service	1477959161	1477959161	1	1	PEREZ-MEDINA, JEREEN B NP	7/11/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
56100	Fee-for-Service	1720136500	1720136500	1	1	PARK, SUK W MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80514	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
56113	Fee-for-Service	1932388303	1932388303	1	1	PEARSON, RYAN D MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129064	01	General Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
56118	Fee-for-Service	1972556967	1972556967	1	1	PLANNED PARENTHOOD	7/1/1994	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	625 HILBY AVE	None	SEASIDE	CA	93955	5720	27	06053	36.60257396	-121.8495595	Monterey County
56133	Fee-for-Service	1760954291	1760954291	1	1	PACIFICA SL HEMET LLC	11/10/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1177 S PALM AVENUE	None	HEMET	CA	92543	7817	33	06065	33.7286379	-116.9803159	Riverside County
56145	Fee-for-Service	1760678692	1760678692	2	2	PENG, BOB MD FACOG	9/12/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108823	None	None	0	In state provider	None	204 BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
56165	Fee-for-Service	1356327316	1356327316	1	1	PATEL, HITENDRA MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144440	68	Hematology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
56195	Fee-for-Service	1346372703	1346372703	1	1	PHAM, MAI T LCSW	8/30/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
56201	Fee-for-Service	1689202129	1689202129	1	1	PISHARODY, SRUTI MD	10/1/2024	208M00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
56243	Fee-for-Service	1518789114	1518789114	1	2	PETROVSKY, AUTUMN ROSE TOLA	2/28/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
56256	Fee-for-Service	1861425381	1861425381	1	1	PILZ, RENATE B MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43356	78	Neoplastic Diseases/Oncology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
56292	Fee-for-Service	1104006006	1104006006	2	2	PACIFIC ENDOSCOPY AND SURGER	7/4/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	Y CENTER, LLC	17815 NEWHOPE ST	None	FOUNTAIN VALLEY	CA	92708	5426	30	06059	33.70540466	-117.9327426	Orange County
56297	Fee-for-Service	1437258860	1437258860	1	1	PEREGRINE HOSPICE, INC	5/8/2024	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3440 W CARSON ST	STE 301	TORRANCE	CA	90503	5729	19	06037	33.83112114	-118.3464883	Los Angeles County
56299	Fee-for-Service	1700800232	1700800232	1	1	POTTER, DONALD E MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	19181	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
56323	Fee-for-Service	1205918422	1205918422	1	1	PAVKOVIC, STEVEN A MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74968	41	Internal Medicine	0	In state provider	None	50 BELLEFONTAINE ST	STE 303	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
56465	Fee-for-Service	1538109517	1538109517	1	1	PRESANT, CARY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18084	68	Hematology	0	In state provider	None	1250 S SUNSET AVE	STE 303	WEST COVINA	CA	91790	3961	19	06037	34.0610671	-117.9463685	Los Angeles County
56492	Fee-for-Service	1730144346	1730144346	1	1	PIRSCH, JOHN D MD	6/27/2017	207R00000X	NA	Other	026	PHYSICIANS	143364	41	Internal Medicine	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
56546	Fee-for-Service	1861425381	1861425381	1	1	PILZ, RENATE B MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43356	68	Hematology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
56601	Fee-for-Service	1912933706	1912933706	1	1	PURSWANI, POORNIMA M MD	7/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78450	None	None	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
56612	Fee-for-Service	1205918422	1205918422	1	1	PAVKOVIC, STEVEN A MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	74968	77	Infectious Disease	0	In state provider	None	50 BELLEFONTAINE ST	STE 303	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
56618	Fee-for-Service	1417441411	1417441411	1	1	PREFERRED CHOICE HOME HEALTH	6/20/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	18645 SHERMAN WAY	SUITE 103	RESEDA	CA	91335	8602	19	06037	34.20120553	-118.54026	Los Angeles County
56622	Fee-for-Service	1912001934	1912001934	1	1	PACIFIC CLINICS	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1020 S ARROYO PARKWAY	SUITE 100	PASADENA	CA	91101	3973	19	06037	34.128351	-118.1471735	Los Angeles County
56626	Fee-for-Service	1821609660	1821609660	1	1	PD HOSPICE INC	8/7/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10324 BALBOA BLVD	STE 200	GRANADA HILLS	CA	91344	7349	19	06037	34.258293	-118.5022935	Los Angeles County
56681	Fee-for-Service	1306864384	1306864384	1	1	PERKINS, DOUGLAS K MD	1/25/2008	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
56710	Fee-for-Service	1891981569	1891981569	1	1	PLANADA ELEMENTARY SD	9/22/2007	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	161 S PLAINSBURG RD	None	PLANADA	CA	95365	0000	24	06047	37.285416	-120.3248785	Merced County
56733	Fee-for-Service	1518973668	1518973668	1	1	PAWEL, BARBARA B MD	5/22/2019	2080P0204X	NA	Other	026	PHYSICIANS	159912	40	Pediatrics	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
56752	Fee-for-Service	1538109517	1538109517	1	1	PRESANT, CARY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18084	01	General Practice	0	In state provider	None	1250 S SUNSET AVE	STE 303	WEST COVINA	CA	91790	3961	19	06037	34.0610671	-117.9463685	Los Angeles County
56773	Fee-for-Service	1487732160	1487732160	1	1	PATTON, DOUGLAS B MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81133	07	Dermatology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
56848	Fee-for-Service	1093969115	1093969115	1	1	PLANNED PARENTHOOD OF LA	10/22/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	400 W 30TH STREET	None	LOS ANGELES	CA	90007	3320	19	06037	34.0239409	-118.2755606	Los Angeles County
56907	Fee-for-Service	1437390010	1437390010	1	1	PAPPAS, VICTORIA M	8/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
56914	Fee-for-Service	1821609660	1821609660	1	1	PD HOSPICE INC	8/7/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10324 BALBOA BLVD	STE 200	GRANADA HILLS	CA	91344	7349	19	06037	34.258293	-118.5022935	Los Angeles County
56917	Fee-for-Service	1447477054	1447477054	1	1	PANG, JASON S MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96959	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
56952	Fee-for-Service	1477564573	1477564573	1	1	PUGH, CARLA MARIE MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	83898	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56971	Fee-for-Service	1194793448	1194793448	1	1	PASTUSZKO, PETER MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103559	33	Thoracic Surgery	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
56980	Fee-for-Service	1558541789	1558541789	1	1	PROCARE HOSPICE,LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5500 MING AVENUE	STE 190	BAKERSFIELD	CA	93309	4623	15	06029	35.33787572	-119.0620525	Kern County
57011	Fee-for-Service	1063000578	1063000578	1	1	POSEY, DINA	6/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 FASHION LN	STE 102	TUSTIN	CA	92780	3319	30	06059	33.7470725	-117.8179335	Orange County
57022	Fee-for-Service	1417039371	1417039371	1	1	PERERA, SUNIL P MD	3/31/1987	207KA0200X	NA	Other	026	PHYSICIANS	30538	None	None	0	In state provider	None	402 SUNRISE AVE	None	ROSEVILLE	CA	95661	4106	31	06061	38.740131	-121.272058	Placer County
57024	Fee-for-Service	1285048868	1285048868	1	1	PATEL, LANCE K MD	7/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155058	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
57042	Fee-for-Service	1538109517	1538109517	1	1	PRESANT, CARY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18084	78	Neoplastic Diseases/Oncology	0	In state provider	None	1250 S SUNSET AVE	STE 303	WEST COVINA	CA	91790	3961	19	06037	34.0610671	-117.9463685	Los Angeles County
57043	Fee-for-Service	1316051501	1316051501	1	1	PRINCE, DIANA M MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63605	01	General Practice	0	In state provider	None	1450 MEDICAL CENTER DR	STE 3	ROHNERT PARK	CA	94928	2933	49	06097	38.34758366	-122.6816633	Sonoma County
57059	Fee-for-Service	1720001498	1720001498	1	1	PATTEN, RANDALL M MD	8/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47765	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
57082	Fee-for-Service	1811332851	1811332851	1	1	PEEVA, SOFIA D MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134738	05	Anesthesiology	0	In state provider	None	5530 BIRDCAGE STREET	SUITE 145	CITRUS HEIGHTS	CA	95610	7690	34	06067	38.667744	-121.273758	Sacramento County
57086	Fee-for-Service	1366521734	1366521734	1	1	PRICE, ANDREW C MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87282	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
57092	Fee-for-Service	1336586684	1336586684	1	1	PADMANABHAN, ARUN MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136125	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
57096	Fee-for-Service	1275675613	1275675613	1	1	PETTY, ERNESTINE R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71691	05	Anesthesiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
57118	Fee-for-Service	1285058727	1285058727	1	1	PISIGAN, DOMINIC L NP	1/15/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
57153	Fee-for-Service	1881034031	1881034031	1	1	PRYCE ECHEVERRY, MARIA LMFT	5/15/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 41ST AVE	SUITE. 238	CAPITOLA	CA	95062	2328	44	06087	36.972108	-121.964831	Santa Cruz County
57154	Fee-for-Service	1306333059	1306333059	1	1	PATEL, RICHA A	7/2/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	SUITE 202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
57170	Fee-for-Service	1124026349	1124026349	1	2	PURVANCE, CLINTON D MD	9/23/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
57182	Fee-for-Service	1255412474	1255412474	1	2	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	INLAND EMPIRE INC	401 E HIGHLAND AVE	STE 552	SAN BERNARDINO	CA	92404	3838	36	06071	34.1358627	-117.2757778	San Bernardino County
57184	Fee-for-Service	1306814371	1306814371	1	1	PARK, KAY LOREN MD	12/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81539	18	Ophthalmology	0	In state provider	None	222 W EULALIA ST	STE 110	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
57189	Fee-for-Service	1598040495	1598040495	1	1	PHAN, KATHY OD	1/24/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 N LA BREA AVE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
57190	Fee-for-Service	1013673169	1013673169	1	1	PAUL, LAUREN E PT	11/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2339 W HAMMER LN	STE K	STOCKTON	CA	95209	2368	39	06077	38.02138826	-121.344545	San Joaquin County
57198	Fee-for-Service	1144649211	1144649211	1	1	PARLETTE, KARLI M DO	10/1/2019	207PP0204X	NA	Other	026	PHYSICIANS	14629	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
57199	Fee-for-Service	1104243211	1104243211	1	1	PANDURANGI, MAYA MD	8/28/2017	390200000X	NA	Other	026	PHYSICIANS	14552	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
57236	Fee-for-Service	1427193408	1427193408	1	1	PACIFIC CLINICS	9/3/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY SPECIALTY SVS	2550 E FOOTHILL BLVD	2ND FLOOR	PASADENA	CA	91107	3406	19	06037	34.14979153	-118.0979955	Los Angeles County
57242	Fee-for-Service	1134304447	1134304447	1	1	PALLIATIVE PARTNERS, INC	4/9/2021	2081H0002X	NA	Physical Medicine and Rehabilitation	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
57254	Fee-for-Service	1538691928	1538691928	1	1	PATEL, SONIKA MD	12/9/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	11	Aviation (M.D. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
57258	Fee-for-Service	1194793448	1194793448	1	1	PASTUSZKO, PETER MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103559	02	General Surgery	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
57269	Fee-for-Service	1558541789	1558541789	1	1	PROCARE HOSPICE,LLC	11/7/2008	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5500 MING AVENUE	STE 190	BAKERSFIELD	CA	93309	4623	15	06029	35.33787572	-119.0620525	Kern County
57281	Fee-for-Service	1386818482	1386818482	1	1	PHAM, LARRY T MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 HOAG DRIVE	ECU	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
57283	Fee-for-Service	1376508200	1376508200	1	1	PAIGE, MARY LMFT	8/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 BEL MARIN KEYS BLVD.	C1	NOVATO	CA	94949	5708	21	06041	38.06937851	-122.5353192	Marin County
57311	Fee-for-Service	1720042732	1720042732	1	1	PHILLIPS, DANIEL B. MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56099	41	Internal Medicine	0	In state provider	None	4 S FOREST RD	STE J	SONORA	CA	95370	4827	55	06109	37.9822178	-120.391143	Tuolumne County
57333	Fee-for-Service	1457473043	1457473043	1	1	PERRY, DAVID C MD	3/10/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	111282	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
57341	Fee-for-Service	1518093467	1518093467	1	1	PAN, PATRICK T MD INC	2/5/2011	193400000X	NA	Other	026	PHYSICIANS	61505	41	Internal Medicine	0	In state provider	None	351 HOSPITAL ROAD	SUITE 411	NEWPORT BEACH	CA	92663	3506	30	06059	33.62579141	-117.9299554	Orange County
57345	Fee-for-Service	1740639301	1740639301	1	1	PEREGRINO, CAROLAIN S NP	2/12/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
57349	Fee-for-Service	1922593599	1922593599	1	1	PEZESHKI, ALEXANDER A	7/17/2022	207P00000X	NA	Other	026	PHYSICIANS	177340	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
57385	Fee-for-Service	1023108925	1023108925	1	1	POPOVA, STELLA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65599	41	Internal Medicine	0	In state provider	None	7531 SANTA MONICA BLVD	STE 100	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
57416	Fee-for-Service	1881768190	1881768190	1	1	PALENCIA, ROMEO MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62913	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
57447	Fee-for-Service	1386064020	1386064020	1	1	PEARSON, RACHEL P MD	9/5/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140013	79	Neurology-Child	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
57463	Fee-for-Service	1255412474	1255412474	1	2	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INLAND EMPIRE INC	401 E HIGHLAND AVE	STE 552	SAN BERNARDINO	CA	92404	3838	36	06071	34.1358627	-117.2757778	San Bernardino County
57479	Fee-for-Service	1457543076	1457543076	1	1	PILOSSYAN, VAGHARSHAK M	7/16/2004	193400000X	NA	Other	026	PHYSICIANS	51303	41	Internal Medicine	0	In state provider	PILOSSYAN MED CENTER INC	13321 VICTORY BLVD	None	VAN NUYS	CA	91401	1832	19	06037	34.18670353	-118.4233635	Los Angeles County
57481	Fee-for-Service	1528248754	1528248754	1	1	PAYNE, TARA A CRNA	3/21/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
57487	Fee-for-Service	1144649211	1144649211	1	1	PARLETTE, KARLI M DO	10/1/2019	207PP0204X	NA	Other	026	PHYSICIANS	14629	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
57494	Fee-for-Service	1912989542	1912989542	1	1	PFLUG, JENNIFER J MD	6/12/2007	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	2800 10TH AVE NORTH	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
57528	Fee-for-Service	1952505125	1952505125	1	1	PARUYRYAN, HRACHYA MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97760	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
57529	Fee-for-Service	1134304447	1134304447	1	1	PALLIATIVE PARTNERS, INC	4/9/2021	2081H0002X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
57582	Fee-for-Service	1265538102	1265538102	1	1	PITTS, MARGARET A MD	8/16/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
57589	Fee-for-Service	1396765954	1396765954	2	1	PIRO, FRANK J MD	5/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56410	24	Plastic Surgery	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
57591	Fee-for-Service	1962673046	1962673046	1	1	PAIK, DANIEL Y MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116295	78	Neoplastic Diseases/Oncology	0	In state provider	None	1455 MONTEGO	SUITE 100	WALNUT CREEK	CA	94598	2952	07	06013	37.91046956	-122.0418669	Contra Costa County
57640	Fee-for-Service	1174678742	1174678742	2	1	PATEE, MERCEDES MD	3/1/2024	207RA0401X	NA	Other	026	PHYSICIANS	98141	None	None	0	In state provider	None	376 HARTNELL AVE	SUITE A	REDDING	CA	96002	1881	45	06089	40.56518339	-122.3683085	Shasta County
57647	Fee-for-Service	1184615494	1184615494	1	1	PRESCOTT, STACY L MD	4/30/1996	207P00000X	NA	Other	026	PHYSICIANS	79689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
57654	Fee-for-Service	1275554867	1275554867	1	1	PRITCHETT, JON R MD	4/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
57664	Fee-for-Service	1831656578	1831656578	1	1	PANJAITAN, LUCYANA M NP	5/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
57741	Fee-for-Service	1093229320	1093229320	1	2	PHAST PHARMACY	3/4/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1121 W COLUMBUS ST	None	BAKERSFIELD	CA	93301	1105	15	06029	35.39808852	-119.015352	Kern County
57767	Fee-for-Service	1457543076	1457543076	1	1	PILOSSYAN, VAGHARSHAK M	7/16/2004	193400000X	NA	Other	026	PHYSICIANS	51303	01	General Practice	0	In state provider	PILOSSYAN MED CENTER INC	13321 VICTORY BLVD	None	VAN NUYS	CA	91401	1832	19	06037	34.18670353	-118.4233635	Los Angeles County
57788	Fee-for-Service	1861677452	1861677452	1	1	PUSHIN, ELENA LCSW	10/29/2012	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	16200 VENTURA BLVD	STE 403	ENCINO	CA	91436	4692	19	06037	34.15659457	-118.485532	Los Angeles County
57812	Fee-for-Service	1932475902	1932475902	1	1	POLLOM, ERQI L MD	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127028	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
57834	Fee-for-Service	1780071894	1780071894	1	1	POON, PAK N LMFT	1/14/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1015 FREMONT AVE	2ND FLOOR	SOUTH PASADENA	CA	91030	3224	19	06037	34.114176	-118.1531575	Los Angeles County
57838	Fee-for-Service	1851385983	1851385983	1	1	PINE DRUG INC	4/17/1989	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15611 BROOKHURST ST	None	WESTMINSTER	CA	92683	7556	30	06059	33.73555334	-117.9547644	Orange County
57840	Fee-for-Service	1538270830	1538270830	1	1	PARAGUYA, LAUREEN V MD	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88227	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
57889	Fee-for-Service	1891948071	1891948071	1	1	PEREIRA, TAMARA S LMFT	1/30/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
57905	Fee-for-Service	1487822326	1487822326	1	1	PEZESHKI, BABAK MD APC	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60224	41	Internal Medicine	0	In state provider	None	520 SUPEROR AVENUE	SUITE 280	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
57950	Fee-for-Service	1528534930	1528534930	1	1	PATTUGALAN, JO CHRISTINE R L	3/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	1335 S EUCLID ST	None	ANAHEIM	CA	92802	2008	30	06059	33.814575	-117.9414565	Orange County
57964	Fee-for-Service	1487188751	1487188751	1	1	PATIL, SAMANTHA P MD	7/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157262	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
57993	Fee-for-Service	1063831170	1063831170	1	1	POPE, NICOLE L MD	10/1/2017	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 CAMPUS STREET	COLEMAN PAVILION A1120	LOMA LINDA	CA	92350	1700	36	06071	34.049547	-117.2656245	San Bernardino County
58036	Fee-for-Service	1588735492	1588735492	1	1	PENMAN, WILLIAM D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31810	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
58051	Fee-for-Service	1811926652	1811926652	1	1	PARNELL, DIANA D MD	11/27/1985	174400000X	NA	Other	026	PHYSICIANS	18571	07	Dermatology	0	In state provider	SUITE 201	599 SIR FRANCIS DRAKE BL	None	GREENBRAE	CA	94904	1712	21	06041	37.95026531	-122.5332546	Marin County
58060	Fee-for-Service	1720263825	1720263825	1	1	PRASHANTH, SHYLAJA MD	10/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100963	None	None	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
58064	Fee-for-Service	1679659197	1679659197	1	1	PHAM, THAO N DO	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7397	01	General Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
58096	Fee-for-Service	1881191682	1881191682	1	1	PANOSIAN, CLAIRE A LCSW	3/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
58102	Fee-for-Service	1932475902	1932475902	1	1	POLLOM, ERQI L MD	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127028	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58114	Fee-for-Service	1366903429	1366903429	1	1	PHAN, SANDY DO	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19629	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
58129	Fee-for-Service	1538270830	1538270830	1	1	PARAGUYA, LAUREEN V MD	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88227	40	Pediatrics	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
58150	Fee-for-Service	1114933652	1114933652	1	1	PENTHEROUDAKIS, EMMANUEL	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75192	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
58169	Fee-for-Service	1144279928	1144279928	1	1	PEREZ, MATTHEW D	6/23/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1391 E MADISON AVE	None	EL CAJON	CA	92021	8568	37	06073	32.80015949	-116.932077	San Diego County
58190	Fee-for-Service	1982892659	1982892659	1	1	PANESAR, PARAMJIT S MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114684	08	Family Practice	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
58194	Fee-for-Service	1487822326	1487822326	1	1	PEZESHKI, BABAK MD APC	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60224	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	520 SUPEROR AVENUE	SUITE 280	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
58219	Fee-for-Service	1477754661	1477754661	1	1	PARKER, SHARMAINE D LMFT	7/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2431 W MARCH LN	STE 200	STOCKTON	CA	95207	8211	39	06077	37.985267	-121.3372349	San Joaquin County
58229	Fee-for-Service	1518994367	1518994367	1	1	PRIEST, MARSHALL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
58251	Fee-for-Service	1588636765	1588636765	1	1	PRENDIVILLE, KEVIN J MD	7/10/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	45074	18	Ophthalmology	0	In state provider	None	24022 CALLE DE LA PLATA	SUITE 350	LAGUNA HILLS	CA	92653	3626	30	06059	33.6104493	-117.7110924	Orange County
58275	Fee-for-Service	1477604643	1477604643	1	1	PEREZ, VERONICA B PHD	12/28/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
58282	Fee-for-Service	1063831170	1063831170	1	1	POPE, NICOLE L MD	10/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138219	40	Pediatrics	0	In state provider	None	11175 CAMPUS STREET	COLEMAN PAVILION A1120	LOMA LINDA	CA	92350	1700	36	06071	34.049547	-117.2656245	San Bernardino County
58301	Fee-for-Service	1568415495	1568415495	1	1	PLANNED PARENTHOOD	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	WOODLAND	520 COTTONWOOD ST	STE 10	WOODLAND	CA	95695	3603	57	06113	38.675016	-121.7933365	Yolo County
58326	Fee-for-Service	1326297466	1326297466	1	1	PROPERSI, TARYN L LCSW	8/22/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1242 PARK ST	SUITE C	ALAMEDA	CA	94501	5500	01	06001	37.76187672	-122.2447503	Alameda County
58352	Fee-for-Service	1174173298	1174173298	1	1	PMS HOME HEALTH CARE, INC	12/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6314 VAN NUYS BLVD	STE 217	VAN NUYS	CA	91401	2625	19	06037	34.18518362	-118.4487146	Los Angeles County
58363	Fee-for-Service	1265951099	1265951099	1	1	PIH HEALTH PHYSICIANS	12/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11411 BROOKSHIRE AVE	SUITE 207	DOWNEY	CA	90241	5004	19	06037	33.93667091	-118.1309273	Los Angeles County
58388	Fee-for-Service	1750602736	1750602736	1	1	PATEL, RUPAL M MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123360	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
58423	Fee-for-Service	1326127846	1326127846	1	1	PHAM, LAUREN OPT	8/10/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	61 SERRA WAY	STE 128	MILPITAS	CA	95035	8519	43	06085	37.42799329	-121.907974	Santa Clara County
58452	Fee-for-Service	1598284382	1598284382	1	1	PAULSON, RYAN PT	3/20/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
58465	Fee-for-Service	1548479132	1548479132	1	1	PAK, SUNNYO LMFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40070	-	NOT APPLICABLE	0	In state provider	None	3288 EL CAJON BLVD	SUITE 3,6,10,11,12,13	SAN DIEGO	CA	92104	1430	37	06073	32.75537145	-117.1228095	San Diego County
58487	Fee-for-Service	1528353323	1528353323	1	1	PETERSEN, RACHEL L	8/11/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43814074	-120.6259249	Lassen County
58496	Fee-for-Service	1740450378	1740450378	1	1	PEDIATRIC SLEEP, ADOPTION AN	4/15/2022	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	DEVELOPMENT CLINIC INC	2880 ATLANTIC AVE	STE 255	LONG BEACH	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles County
58504	Fee-for-Service	1407811219	1407811219	1	1	PRUITT,JEFFEREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
58511	Fee-for-Service	1689691644	1689691644	1	1	PANGILINAN, GILBERT A	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 W COLE ROAD	STE B	CALEXICO	CA	92231	9700	13	06025	32.6939187	-115.5012423	Imperial County
58527	Fee-for-Service	1114373636	1114373636	1	1	PRATHAP, VISHNU MD	1/7/2022	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	172407	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
58552	Fee-for-Service	1255006268	1255006268	1	1	PALMA, GAVIN	1/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2335 VISTA WAY	None	OCEANSIDE	CA	92054	5663	37	06073	33.18316476	-117.3365251	San Diego County
58553	Fee-for-Service	1710031588	1710031588	1	4	PROVIDENCE FACEY MEDICAL FOU	12/31/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
58622	Fee-for-Service	1023182128	1023182128	1	1	PRICE, MARK O OD	6/5/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PRICE & PRICE ODS	812 W OAK AVE	None	VISALIA	CA	93291	6034	54	06107	36.332154	-119.3006205	Tulare County
58636	Fee-for-Service	1073519443	1073519443	1	4	PIONEERS MEMORIAL HEALTH	4/22/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	751 WEST LEGION ROAD	SUITE 302	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
58653	Fee-for-Service	1265951099	1265951099	1	1	PIH HEALTH PHYSICIANS	12/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11411 BROOKSHIRE AVE	SUITE 207	DOWNEY	CA	90241	5004	19	06037	33.93667091	-118.1309273	Los Angeles County
58662	Fee-for-Service	1093894966	1093894966	1	1	PECK, JUDITH E MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53494	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
58676	Fee-for-Service	1952788549	1952788549	1	1	PETRIE, BRIAN A MD DO	10/24/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145604	08	Family Practice	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
58690	Fee-for-Service	1295239028	1295239028	1	1	PURE CARE HOME HEALTH INC	3/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 305E	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
58717	Fee-for-Service	1679505127	1679505127	1	1	PARADISE MIDWIFERY	8/28/1994	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	SERVICE	771 BUSCHMANN RD	STE H	PARADISE	CA	95969	5848	04	06007	39.7485737	-121.6213589	Butte County
58734	Fee-for-Service	1467742783	1467742783	1	1	PHADKE, ANURADHA J MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122095	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58742	Fee-for-Service	1942688528	1942688528	1	1	PROGRESSIVE HOME HEALTH AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE, INC	1619 H ST	SUITE A	MODESTO	CA	95354	1209	50	06099	37.64345951	-120.9915765	Stanislaus County
58747	Fee-for-Service	1306104534	1306104534	1	1	PETERSON, MATTHEW M MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141623	05	Anesthesiology	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
58759	Fee-for-Service	1700050994	1700050994	1	1	POWERS, JAMIE W	4/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91780	None	None	0	In state provider	None	10833 LE CONTE AVE	MDCC B2-375	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
58778	Fee-for-Service	1275945446	1275945446	1	1	PERESS, LILIA MD	3/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168066	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
58782	Fee-for-Service	1265187793	1265187793	1	1	PHAMILY HOME SENIOR CARE LLC	3/17/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16652 HUGGINS AVE	None	YORBA LINDA	CA	92886	2013	30	06059	33.89366449	-117.843741	Orange County
58786	Fee-for-Service	1740450378	1740450378	1	1	PEDIATRIC SLEEP, ADOPTION AN	11/12/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DEVELOPMENT CLINIC INC	2880 ATLANTIC AVE	STE 255	LONG BEACH	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles County
58791	Fee-for-Service	1285055210	1285055210	1	1	PARMA, JENNIFER J DO MD	9/5/2017	390200000X	NA	Other	026	PHYSICIANS	13834	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
58841	Fee-for-Service	1710031588	1710031588	1	4	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
58848	Fee-for-Service	1699827774	1699827774	1	1	PROFESS PODIATRY GROUP	1/1/1979	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	#129	1240 S WESTLAKE BLVD	None	WESTLAKE VILLAGE	CA	91361	1929	56	06111	34.14966879	-118.8378084	Ventura County
58923	Fee-for-Service	1235498510	1235498510	1	1	PERRY, TIFFANY E MD	9/14/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160645	15	Obstetrics (D.O. only)	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
58924	Fee-for-Service	1629093927	1629093927	1	1	PARKER, BARBARA MD	9/30/1984	207RH0003X	NA	Oncology	026	PHYSICIANS	49044	68	Hematology	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
58939	Fee-for-Service	1689275430	1689275430	1	1	PRO CHOICE HOSPICE INC	2/2/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 302	TARZANA	CA	91356	7140	19	06037	34.17264197	-118.5613482	Los Angeles County
58940	Fee-for-Service	1265951099	1265951099	1	1	PIH HEALTH PHYSICIANS	7/31/2023	207Q00000X	NA	Adult Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11411 BROOKSHIRE AVE	SUITE 207	DOWNEY	CA	90241	5004	19	06037	33.93667091	-118.1309273	Los Angeles County
58943	Fee-for-Service	1518931112	1518931112	1	1	PATEL, NILESH N DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	9454	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
58944	Fee-for-Service	1205880242	1205880242	1	1	PAIN ASSOC OF MERCED	3/18/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1390 E YOSEMITE AVE	STE C	MERCED	CA	95340	8221	24	06047	37.33211251	-120.452175	Merced County
58950	Fee-for-Service	1902903180	1902903180	1	1	PRIMARY PEDIATRIC MEDICAL	12/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	20126 STANTON AVE	STE 200	CASTRO VALLEY	CA	94546	5270	01	06001	37.69722866	-122.090936	Alameda County
58953	Fee-for-Service	1184366544	1184366544	1	1	PAN, JUNE MD	1/9/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188963	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
58968	Fee-for-Service	1578826053	1578826053	1	1	PALLIATIVE CARE DOCTORS	11/20/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	19	06037	34.05159882	-118.4385447	Los Angeles County
58991	Fee-for-Service	1104882729	1104882729	1	1	PRENNER, BRUCE M MD	9/21/1994	207K00000X	NA	Other	026	PHYSICIANS	21931	43	Pediatric Allergy	0	In state provider	None	6386 ALVARADO CT	STE 210	SAN DIEGO	CA	92120	4907	37	06073	32.77666838	-117.0614255	San Diego County
59032	Fee-for-Service	1942688528	1942688528	1	1	PROGRESSIVE HOME HEALTH AND	2/9/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE, INC	1619 H ST	SUITE A	MODESTO	CA	95354	1209	50	06099	37.64345951	-120.9915765	Stanislaus County
59044	Fee-for-Service	1598994121	1598994121	1	1	PATEL, NEEMA M	7/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121410	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
59049	Fee-for-Service	1669543427	1669543427	1	1	PRANSKY, SETH M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54722	04	Otology, Laryngology, Rhinology	0	In state provider	None	3030 BERGER AVE	STE 402	SAN DIEGO	CA	92123	4228	37	06073	32.79859767	-117.1508677	San Diego County
59052	Fee-for-Service	1902096969	1902096969	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC HOSPITALIST	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
59057	Fee-for-Service	1275251175	1275251175	1	1	POYOTTE, ANTHONETTE C NP	9/28/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59064	Fee-for-Service	1619344488	1619344488	1	1	POTTER CARE LLC	5/8/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2041 POTTER AVE	None	SIMI VALLEY	CA	93065	2442	56	06111	34.273764	-118.7608565	Ventura County
59080	Fee-for-Service	1457025256	1457025256	1	2	PARHELION HEALTHCARE INC	6/6/2024	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CARE PLEASANTON	5311 HOPYARD RD	None	PLEASANTON	CA	94588	3307	01	06001	37.69896849	-121.9046448	Alameda County
59091	Fee-for-Service	1699482687	1699482687	1	1	PETRUS CORP.	1/9/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	21350 LASSEN ST	UNIT# A6	CHATSWORTH	CA	91311	4254	19	06037	34.24995852	-118.596807	Los Angeles County
59114	Fee-for-Service	1699915009	1699915009	1	1	PHUNG, ANTHONY V MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98741	05	Anesthesiology	0	In state provider	None	332 S JUNIPER	#108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
59130	Fee-for-Service	1710031588	1710031588	1	4	PROVIDENCE FACEY MEDICAL FOU	12/31/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
59161	Fee-for-Service	1679198204	1679198204	1	1	PRASAD, SHEENA LCSW	1/5/2024	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
59173	Fee-for-Service	1225336456	1225336456	1	1	PETUNIA HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3275 VILLA LANE	None	NAPA	CA	94558	3016	28	06055	38.32223637	-122.2927198	Napa County
59187	Fee-for-Service	1003493024	1003493024	1	1	PRATT, ALEXIA L NP	8/22/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
59207	Fee-for-Service	1073829685	1073829685	1	1	PANTAZOPOULOS, CHRISTINA DO	3/11/2020	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	11260	20	Orthopedic Surgery	0	In state provider	None	4354 LATHAM ST	100	RIVERSIDE	CA	92501	1777	33	06065	34.00210305	-117.3744075	Riverside County
59211	Fee-for-Service	1235498510	1235498510	1	1	PERRY, TIFFANY E MD	9/14/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160645	09	Gynecology (D.O. only)	0	In state provider	None	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	07	06013	37.88212237	-122.1854034	Contra Costa County
59212	Fee-for-Service	1114421047	1114421047	1	1	PATEL, PRIYAL Y MD	9/10/2021	208M00000X	NA	Other	026	PHYSICIANS	173548	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
59225	Fee-for-Service	1689275430	1689275430	1	1	PRO CHOICE HOSPICE INC	2/2/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 302	TARZANA	CA	91356	7140	19	06037	34.17264197	-118.5613482	Los Angeles County
59247	Fee-for-Service	1346705175	1346705175	1	1	PARAGON PHARMACY SERVICES IN	2/27/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 E WASHINGTON AVE	SUITE C	ESCONDIDO	CA	92025	2226	37	06073	33.13209541	-117.0696618	San Diego County
59264	Fee-for-Service	1811211428	1811211428	1	1	POLISETTY, SUDHEER K MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 EAST LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
59267	Fee-for-Service	1396720371	1396720371	1	2	PACIFIC PEDIATRIC CARDIO	3/4/2009	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	CARDIOLOGY MED GR INC	1700 CESAR E CHAVEZ AVE	STE 1300	LOS ANGELES	CA	90033	2467	19	06037	34.05101259	-118.217259	Los Angeles County
59277	Fee-for-Service	1104882729	1104882729	1	1	PRENNER, BRUCE M MD	9/21/1994	207K00000X	NA	Other	026	PHYSICIANS	21931	03	Allergy	0	In state provider	None	6386 ALVARADO CT	STE 210	SAN DIEGO	CA	92120	4907	37	06073	32.77666838	-117.0614255	San Diego County
59292	Fee-for-Service	1366059602	1366059602	1	1	PRIORITY HOSPICE CARE SERVIC	10/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	15720 VENTURA BLVD	SUITE 234	ENCINO	CA	91436	2911	19	06037	34.15524484	-118.4756687	Los Angeles County
59303	Fee-for-Service	1487985404	1487985404	1	1	PULMEDICA INC	1/1/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1145 WHISKEYTOWN COURT	SUITE A	REDDING	CA	96001	0227	45	06089	40.58504488	-122.4126269	Shasta County
59306	Fee-for-Service	1861653560	1861653560	1	1	PTAK, ELIAS J DO	12/3/2010	204D00000X	NA	Other	026	PHYSICIANS	9728	08	Family Practice	0	In state provider	None	795 E SECOND ST	STE 5	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
59337	Fee-for-Service	1730321423	1730321423	1	1	PRASERTSIT, SARA S MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121344	18	Ophthalmology	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
59369	Fee-for-Service	1457025256	1457025256	1	2	PARHELION HEALTHCARE INC	10/6/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CARE PLEASANTON	5311 HOPYARD RD	None	PLEASANTON	CA	94588	3307	01	06001	37.69896849	-121.9046448	Alameda County
59385	Fee-for-Service	1073900809	1073900809	1	1	PENZINER, SAMUEL M MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	155325	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
59403	Fee-for-Service	1912363151	1912363151	1	1	POPIEMLARP, JENNY	1/19/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST ST	STE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
59416	Fee-for-Service	1710031588	1710031588	1	4	PROVIDENCE FACEY MEDICAL FOU	12/31/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
59428	Fee-for-Service	1780915066	1780915066	1	1	PEYVAN, SHADYE Z CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2304 HUNTINGTON DR	STE 252	SAN MARINO	CA	91108	2645	19	06037	34.12220718	-118.1047096	Los Angeles County
59434	Fee-for-Service	1215244546	1215244546	1	1	PANICKER, TOBIN J MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121381	None	None	0	In state provider	None	555 S SEVENTH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
59466	Fee-for-Service	1922237916	1922237916	1	1	PARKS, ROSHANDA R	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73304	40	Pediatrics	0	In state provider	None	190 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3658	36	06071	34.1360043	-117.2826788	San Bernardino County
59485	Fee-for-Service	1962424135	1962424135	1	1	PEREZ, FREDY OD APC	6/14/2009	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1509 W SUNSET BLVD	None	LOS ANGELES	CA	90026	3319	19	06037	34.07596752	-118.2554684	Los Angeles County
59522	Fee-for-Service	1659508075	1659508075	1	1	PRAMANIK, SUNEET MD	10/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110671	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
59580	Fee-for-Service	1427081652	1427081652	1	1	PLANNED PARENTHOOD OF	6/16/1981	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	THE PACIFIC SOUTHWEST	4575 COLLEGE AVE	None	SAN DIEGO	CA	92115	4011	37	06073	32.76023438	-117.0667611	San Diego County
59582	Fee-for-Service	1366059602	1366059602	1	1	PRIORITY HOSPICE CARE SERVIC	10/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	15720 VENTURA BLVD	SUITE 234	ENCINO	CA	91436	2911	19	06037	34.15524484	-118.4756687	Los Angeles County
59652	Fee-for-Service	1164957486	1164957486	1	1	PROGRESSIVE URGENT CARE INC	9/6/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	22101 REDWOOD ROAD	SUITE B	CASTRO VALLEY	CA	94546	7107	01	06001	37.68666803	-122.0735922	Alameda County
59653	Fee-for-Service	1447505581	1447505581	1	1	P H PATEL MD INC	9/27/2012	207R00000X	NA	Other	026	PHYSICIANS	101004	41	Internal Medicine	0	In state provider	None	2400 E 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
59672	Fee-for-Service	1083326375	1083326375	1	1	PHOMMATHETH, MISTY B CNM	9/13/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
59676	Fee-for-Service	1104814086	1104814086	1	1	PEDIATRIC & ADOLESCENT	5/19/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	COMPH CARE MED GROUP INC	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
59706	Fee-for-Service	1295159366	1295159366	1	1	PREMIER HEALTHCARE SERVICES	2/15/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	12401 HESPERIA RD	SUITE 8	VICTORVILLE	CA	92395	9744	36	06071	34.4771995	-117.2911483	San Bernardino County
59709	Fee-for-Service	1144233487	1144233487	1	3	PERINATAL ASSOCIATES OF	11/2/2010	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50409	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTRAL CALIFORNIA MED	2210 E ILLINOIS AVE	SUITE 308	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
59757	Fee-for-Service	1922237916	1922237916	1	1	PARKS, ROSHANDA R	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73304	41	Internal Medicine	0	In state provider	None	190 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3658	36	06071	34.1360043	-117.2826788	San Bernardino County
59769	Fee-for-Service	1992725139	1992725139	1	1	PURCELL, DORIS S MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72785	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
59773	Fee-for-Service	1487765376	1487765376	1	1	PATEL, SHIRISH B MD	3/12/2013	207R00000X	NA	Other	026	PHYSICIANS	40789	None	None	0	In state provider	None	5720 BELLFLOWER BLVD	None	LAKEWOOD	CA	90713	1422	19	06037	33.859638	-118.1250115	Los Angeles County
59774	Fee-for-Service	1700374634	1700374634	1	1	PARK, MIN JUNG DO	9/3/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	19091	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
59792	Fee-for-Service	1588985832	1588985832	1	1	PREMIER PHYSICAL THERAPY INC	3/12/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26700 TOWNE CENTER DRIVE	SUITE 110	FOOTHILL RANCH	CA	92610	2844	30	06059	33.67455886	-117.6639195	Orange County
59804	Fee-for-Service	1649529264	1649529264	1	1	PACHECO, CASSANDRA R MSW LCS	4/20/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	W	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
59808	Fee-for-Service	1013403443	1013403443	1	1	PARIS, MOLLY A LMFT	4/25/2023	106S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
59812	Fee-for-Service	1497838916	1497838916	1	1	PORTO, MANUEL MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30744	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	361 HOSPITAL RD	STE 224	NEWPORT BEACH	CA	92663	3523	30	06059	33.62579141	-117.9299554	Orange County
59814	Fee-for-Service	1417120387	1417120387	1	1	PHILLIPS, JASON M MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129806	34	Urology and Urological Surgery	0	In state provider	None	3609 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.18154968	-117.3096017	San Diego County
59818	Fee-for-Service	1932481686	1932481686	1	1	PEEK, KRISTEN E NP	11/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
59849	Fee-for-Service	1528226016	1528226016	1	1	PATEL, MIHIR H MD	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146858	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
59875	Fee-for-Service	1326115288	1326115288	1	1	PUGMIRE, GORDON A MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	34099	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
59878	Fee-for-Service	1518300565	1518300565	1	1	POLIGNANO, MICHAEL J MD	12/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132818	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
59906	Fee-for-Service	1053933192	1053933192	1	1	PENA, DOLORES	2/4/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181415	08	Family Practice	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
59981	Fee-for-Service	1003855826	1003855826	1	1	PAGANO, JAMES V MD	6/30/1983	207P00000X	NA	Other	026	PHYSICIANS	39919	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14860 ROSCOE BLVD	STE 211	PANORAMA CITY	CA	91402	4694	19	06037	34.2214515	-118.4573205	Los Angeles County
60025	Fee-for-Service	1023503133	1023503133	1	1	PELLETIER, ALLYSON LMFT	1/9/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	500 CAPITOL MALL	SUITE 2350	SACRAMENTO	CA	95814	4737	34	06067	38.578059	-121.501422	Sacramento County
60049	Fee-for-Service	1619413663	1619413663	1	1	PATEL, NIDHI MD	7/15/2021	207PP0204X	NA	Other	026	PHYSICIANS	155059	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
60096	Fee-for-Service	1295894673	1295894673	1	1	PISANI, ALBERT L MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	67056	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5555 RESERVOIR DR	STE 314	SAN DIEGO	CA	92120	5150	37	06073	32.77628471	-117.0563688	San Diego County
60117	Fee-for-Service	1750566915	1750566915	1	1	POSTLETHWAITE, ALEJANDRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88938	26	Psychiatry (child)	0	In state provider	None	12395 EL CAMINO REAL	STE 105	SAN DIEGO	CA	92130	0000	37	06073	32.94324259	-117.2396525	San Diego County
60190	Fee-for-Service	1093814113	1093814113	2	2	PC MEDICAL CLINIC INC	8/23/2021	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1601 W AVENUE J	SUITE 101, SUITE 102	LANCASTER	CA	93534	2824	19	06037	34.68946047	-118.158849	Los Angeles County
60220	Fee-for-Service	1992772529	1992772529	1	1	PAXSON, JESSICA E MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139250	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
60249	Fee-for-Service	1932203478	1932203478	2	1	PENVOSE-YI, JAN R MD	4/16/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	132992	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
60276	Fee-for-Service	1912013780	1912013780	2	1	PHAN, DUNG M MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42236	01	General Practice	0	In state provider	None	1693 FLANIGAN DR	STE 100	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
60277	Fee-for-Service	1174798474	1174798474	1	1	PHAM, THUY M MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109821	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60281	Fee-for-Service	1548229883	1548229883	1	1	PARK, SUNG J MD INC	7/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62508	01	General Practice	0	In state provider	None	6283 CLARK RD	STE 5	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
60285	Fee-for-Service	1588004337	1588004337	1	1	PERITAM SINGH, SHARANJIT	9/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120110	41	Internal Medicine	0	In state provider	KAUR MD	1818 N ORANGE GROVE AVE	STE 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
60296	Fee-for-Service	1467542324	1467542324	1	1	PHILLIP D SWANSON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	None	SEATTLE	WA	98195	0001	00	None	47.65080692	-122.3081828	King County
60332	Fee-for-Service	1043252786	1043252786	1	1	PELLE, MICHELLE T MD	12/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88009	07	Dermatology	0	In state provider	MED DERM ASSOCIATES INC	4065 3RD AVE	STE 102	SAN DIEGO	CA	92103	2184	37	06073	32.75123948	-117.1627318	San Diego County
60342	Fee-for-Service	1922598036	1922598036	1	1	PHOEBE PACKER	10/13/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
60350	Fee-for-Service	1265461701	1265461701	1	1	PAUL ROGER BORGHESANI, M.D.-	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	None	SEATTLE	WA	98195	0001	00	None	47.65080692	-122.3081828	King County
60357	Fee-for-Service	1770970816	1770970816	1	1	PATEL, NISHA MD	8/2/2018	207R00000X	NA	Other	026	PHYSICIANS	145412	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
60372	Fee-for-Service	1952434607	1952434607	1	1	PFEFFER, MICHAEL A MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93075	None	None	0	In state provider	None	200 MED PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
60383	Fee-for-Service	1295894673	1295894673	1	1	PISANI, ALBERT L MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	67056	78	Neoplastic Diseases/Oncology	0	In state provider	None	5555 RESERVOIR DR	STE 314	SAN DIEGO	CA	92120	5150	37	06073	32.77628471	-117.0563688	San Diego County
60399	Fee-for-Service	1083780274	1083780274	1	1	PHAM, HUY D MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89262	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
60408	Fee-for-Service	1750566915	1750566915	1	1	POSTLETHWAITE, ALEJANDRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88938	36	Psychiatry	0	In state provider	None	12395 EL CAMINO REAL	STE 105	SAN DIEGO	CA	92130	0000	37	06073	32.94324259	-117.2396525	San Diego County
60429	Fee-for-Service	1861582124	1861582124	1	1	PATRICK TIBBLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	353 FAIRMONT BLVD	None	RAPID CITY	SD	57701	0000	00	None	44.05854729	-103.2246985	Pennington County
60450	Fee-for-Service	1669561890	1669561890	1	5	PLANNED PARENTHOOD LA	3/14/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1301 W 182ND ST	None	GARDENA	CA	90248	3322	19	06037	33.86826	-118.296855	Los Angeles County
60454	Fee-for-Service	1790814119	1790814119	1	1	PHILLIPS, KATHERINE R MFT	7/12/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49435	-	NOT APPLICABLE	0	In state provider	None	5950 CEDROS AVE	None	VAN NUYS	CA	91411	3115	19	06037	34.17909915	-118.4530807	Los Angeles County
60457	Fee-for-Service	1134335128	1134335128	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	12900 AVALON BLVD	None	LOS ANGELES	CA	90061	2734	19	06037	33.91521644	-118.2652318	Los Angeles County
60468	Fee-for-Service	1144233487	1144233487	1	2	PERINATAL ASSOCIATES OF	11/19/2010	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50409	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTRAL CALIFORNIA MED	2273 E BEECHWOOD AVE	None	FRESNO	CA	93720	0329	10	06019	36.83832447	-119.742471	Fresno County
60480	Fee-for-Service	1093814113	1093814113	2	2	PC MEDICAL CLINIC INC	8/23/2021	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1601 W AVENUE J	SUITE 101, SUITE 102	LANCASTER	CA	93534	2824	19	06037	34.68946047	-118.158849	Los Angeles County
60483	Fee-for-Service	1821083163	1821083163	1	1	PROFESSIONAL ORTHOPEDIC	7/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	SYSTEMS OF SACRAMENTO	5049 COLLEGE OAK DR	STE F	SACRAMENTO	CA	95841	4630	34	06067	38.658672	-121.35177	Sacramento County
60569	Fee-for-Service	1548229883	1548229883	1	1	PARK, SUNG J MD INC	7/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62508	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6283 CLARK RD	STE 5	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
60580	Fee-for-Service	1437352630	1437352630	1	1	PHAN, DUKE A MD	12/3/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	51193	13	Neurology (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 302	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
60601	Fee-for-Service	1831632736	1831632736	1	1	PREMIER RX PHARMACY INC	3/26/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21150 HAWTHORNE BLVD	STE 106	TORRANCE	CA	90503	4602	19	06037	33.83888697	-118.3536109	Los Angeles County
60607	Fee-for-Service	1205550456	1205550456	1	1	PIERSON, LENA	5/14/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
60630	Fee-for-Service	1457558611	1457558611	1	1	PEREZ, VICTOR H MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75114	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
60646	Fee-for-Service	1043852528	1043852528	1	1	PHOENIX PHYSICAL THERAPY AND	5/9/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	WELLNESS INC	9555 FOOTHILL BLVD	SUITE A	RANCHO CUCAMONGA	CA	91730	3576	36	06071	34.10650351	-117.596583	San Bernardino County
60654	Fee-for-Service	1780606053	1780606053	1	1	PHAM, THOHA M MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93009	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
60671	Fee-for-Service	1669963534	1669963534	1	1	PATEL, RESHMA Y OD	2/21/2023	152W00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
60684	Fee-for-Service	1083780274	1083780274	1	1	PHAM, HUY D MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89262	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
60720	Fee-for-Service	1386934875	1386934875	1	2	PEDIATRIC & FAMILY MEDICAL	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1921 MAPLE AVE	None	LOS ANGELES	CA	90011	1036	19	06037	34.02874349	-118.2621279	Los Angeles County
60729	Fee-for-Service	1396720371	1396720371	1	4	PACIFIC PEDIATRIC CARDIO	3/4/2009	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	CARDIOLOGY MED GR INC	2001 SANTA MONICA BLVD	STE 483W	SANTA MONICA	CA	90404	2180	19	06037	34.02891163	-118.4797466	Los Angeles County
60740	Fee-for-Service	1912061805	1912061805	1	1	PRITZLAFF, SCOTT G MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130974	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
60743	Fee-for-Service	1134335128	1134335128	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	12900 AVALON BLVD	None	LOS ANGELES	CA	90061	2734	19	06037	33.91521644	-118.2652318	Los Angeles County
60767	Fee-for-Service	1093889982	1093889982	1	1	PREVISICH, STEVEN H OD	1/1/1997	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2174 E LINCOLN AVE	None	ANAHEIM	CA	92806	4104	30	06059	33.83959212	-117.8870458	Orange County
60798	Fee-for-Service	1144420902	1144420902	1	1	PORZIG, ANNE M MD	10/19/2010	207R00000X	NA	Other	026	PHYSICIANS	99582	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
60801	Fee-for-Service	1215109731	1215109731	1	1	PIROOZZI, MICHAEL MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE + C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.779063	-111.8805548	Salt Lake County
60819	Fee-for-Service	1790213494	1790213494	1	1	PANG, HEIDI DO	7/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17268	08	Family Practice	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
60864	Fee-for-Service	1225109119	1225109119	1	1	PAMPATI, VIJAYAMALINI DO	12/31/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	9474	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
60867	Fee-for-Service	1821195371	1821195371	1	1	PER HANS GESTELAND MD	5/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
60888	Fee-for-Service	1922186410	1922186410	1	1	PATEL, ASMITA J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55849	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
60919	Fee-for-Service	1427119536	1427119536	1	1	PRASAD, RAJENDRA MD	2/25/2022	207R00000X	NA	Other	026	PHYSICIANS	68598	None	None	0	In state provider	None	8711 VENICE BLVD	None	LOS ANGELES	CA	90034	3216	19	06037	34.03259874	-118.3827656	Los Angeles County
60938	Fee-for-Service	1851554588	1851554588	1	1	PILGRIM, CYNTHIA A	12/14/2018	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	139058	-	NOT APPLICABLE	0	In state provider	None	291 SMITH RANCH RD.	None	SAN RAFAEL	CA	94903	2093	21	06041	38.02243532	-122.5239302	Marin County
60941	Fee-for-Service	1023492980	1023492980	1	1	PALMA, MELINDA J MD	4/26/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	146803	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
60972	Fee-for-Service	1881765048	1881765048	1	1	PACHECO, SANTOS F MD INC	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54292	08	Family Practice	0	In state provider	SANTOS MEDICAL GROUP	15159 PRAIRIE AVE	None	LAWNDALE	CA	90260	2210	19	06037	33.893586	-118.343877	Los Angeles County
60996	Fee-for-Service	1588249940	1588249940	1	1	PLANNED PARENTHOOD OF THE	1/11/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1780 E FLORIDA AVE	None	HEMET	CA	92544	4679	33	06065	33.74770382	-116.9532553	Riverside County
61003	Fee-for-Service	1104007673	1104007673	1	1	PAUL, BRIANNA M PHD	12/13/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61009	Fee-for-Service	1386934875	1386934875	1	2	PEDIATRIC & FAMILY MEDICAL	12/4/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1921 MAPLE AVE	None	LOS ANGELES	CA	90011	1036	19	06037	34.02874349	-118.2621279	Los Angeles County
61033	Fee-for-Service	1134335128	1134335128	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	12900 AVALON BLVD	None	LOS ANGELES	CA	90061	2734	19	06037	33.91521644	-118.2652318	Los Angeles County
61049	Fee-for-Service	1871654160	1871654160	1	1	PASTOR, MA TERESA MD	8/7/1989	261QP2300X	NA	Other	026	PHYSICIANS	46377	01	General Practice	0	In state provider	None	1703 TERMINO AVE	STE 206	LONG BEACH	CA	90804	2128	19	06037	33.7883073	-118.1459488	Los Angeles County
61056	Fee-for-Service	1295112613	1295112613	1	1	PAREDES-PLAZA, LESLIE NP	1/14/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1000 SAN GABRIEL BLVD	STE 200	ROSEMEAD	CA	91770	4351	19	06037	34.0411915	-118.0823868	Los Angeles County
61060	Fee-for-Service	1851527063	1851527063	1	1	PARSA, MOHAMAD A MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117319	None	None	0	In state provider	None	248 MAIN ST	#110	HALF MOON BAY	CA	94019	7120	41	06081	37.46716774	-122.4296039	San Mateo County
61068	Fee-for-Service	1467461053	1467461053	1	1	PLEMENTOSH, NICKY MD	12/11/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89229	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
61086	Fee-for-Service	1144420902	1144420902	1	1	PORZIG, ANNE M MD	10/19/2010	207R00000X	NA	Other	026	PHYSICIANS	99582	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61092	Fee-for-Service	1831647833	1831647833	1	1	PUSCHENDORF, VANESSA CNP	6/4/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
61099	Fee-for-Service	1306224332	1306224332	1	2	POST-ACUTE PHYSICIANS OF CAL	6/9/2020	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	IFORNIA PC	35470 WHITEWOOD RD	None	MURRIETA	CA	92563	2415	33	06065	33.60671588	-117.1628131	Riverside County
61142	Fee-for-Service	1851682959	1851682959	1	1	PADREZ, RYAN C MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125284	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
61144	Fee-for-Service	1831191105	1831191105	1	1	PATEL, RAJENDRA A MD	7/31/1989	207R00000X	NA	Other	026	PHYSICIANS	48098	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
61146	Fee-for-Service	1184807943	1184807943	1	1	PEREZ, ALEJANDRA PSYD	1/29/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
61184	Fee-for-Service	1558756122	1558756122	1	1	PEREZ, EVERLYN MD	10/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158632	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
61199	Fee-for-Service	1144546748	1144546748	1	1	PENNER, DAVID L MD	1/9/2023	208600000X	NA	General Surgery	026	PHYSICIANS	136296	None	None	0	In state provider	None	2656 EDITH AVE	None	REDDING	CA	96001	3030	45	06089	40.57073094	-122.3974088	Shasta County
61225	Fee-for-Service	1013974815	1013974815	1	1	PODOLSKY, SUSAN R MD	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62868	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2209 COFFEE RD	STE A	MODESTO	CA	95355	2360	50	06099	37.674603	-120.975788	Stanislaus County
61231	Fee-for-Service	1205808375	1205808375	2	1	PAJARO VALLEY HEALTH CARE DI	5/2/2024	193400000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AL	75 NIELSON STREET	B1430	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
61260	Fee-for-Service	1881765048	1881765048	1	1	PACHECO, SANTOS F MD INC	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54292	01	General Practice	0	In state provider	SANTOS MEDICAL GROUP	15159 PRAIRIE AVE	None	LAWNDALE	CA	90260	2210	19	06037	33.893586	-118.343877	Los Angeles County
61314	Fee-for-Service	1609432434	1609432434	1	1	PURTELL, SEAN E MD	7/14/2022	208M00000X	NA	Other	026	PHYSICIANS	177295	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
61357	Fee-for-Service	1568571925	1568571925	1	1	PAYLESS DRUG STORE 5943	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1650 DECOTO RD	None	UNION CITY	CA	94587	3544	01	06001	37.58976511	-122.0206509	Alameda County
61367	Fee-for-Service	1235369067	1235369067	1	1	PARRY, LISA A MD	5/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131297	02	General Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
61386	Fee-for-Service	1437282316	1437282316	1	2	PROHEALTH PARTNERS, A MEDICA	7/31/2019	213ES0103X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	L GROUP, INC.	901 E SAN ANTONIO DR	None	LONG BEACH	CA	90807	2211	19	06037	33.83829601	-118.1824972	Los Angeles County
61400	Fee-for-Service	1295831865	1295831865	1	1	PENG, WEI MD	11/15/2007	207R00000X	NA	Other	026	PHYSICIANS	97700	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
61403	Fee-for-Service	1942959200	1942959200	1	1	PEDDADA, SAMHITHA	3/13/2025	207R00000X	NA	Other	026	PHYSICIANS	189631	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
61423	Fee-for-Service	1083780423	1083780423	1	1	PYUN CHO, JOYCE HAK MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68083	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
61430	Fee-for-Service	1093902454	1093902454	1	1	PARKER, ELAINE W MD	8/20/2009	207R00000X	NA	Other	026	PHYSICIANS	101466	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
61443	Fee-for-Service	1720304447	1720304447	1	1	PURI, SANJEEV N MD	12/21/2020	2086S0122X	NA	General Surgery	026	PHYSICIANS	116772	None	None	0	In state provider	None	50 BELLEFONTAINE ST	SUITE 304	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
61454	Fee-for-Service	1710336094	1710336094	1	1	POUYA AFSHAR MD INC	4/28/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	37	06073	32.77510996	-117.1277427	San Diego County
61457	Fee-for-Service	1720500796	1720500796	1	1	PAJARO VALLEY PREVENTION AND	10/23/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	STUDENT ASSISTANCE INC	411 E LAKE AVE	None	WATSONVILLE	CA	95076	4424	44	06087	36.91720138	-121.7507888	Santa Cruz County
61462	Fee-for-Service	1033286869	1033286869	1	1	PARK, JASON Y MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68858	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
61473	Fee-for-Service	1639674336	1639674336	1	1	PETERS, MATTHEW MD	6/14/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164289	36	Psychiatry	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
61533	Fee-for-Service	1780910612	1780910612	1	1	PLATT, FELICIA G LCSW	10/27/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
61547	Fee-for-Service	1619167699	1619167699	1	1	PHAN, RICK N MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100834	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
61551	Fee-for-Service	1881765048	1881765048	1	1	PACHECO, SANTOS F MD INC	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54292	22	Pathology (M.D. only)	0	In state provider	SANTOS MEDICAL GROUP	15159 PRAIRIE AVE	None	LAWNDALE	CA	90260	2210	19	06037	33.893586	-118.343877	Los Angeles County
61575	Fee-for-Service	1760687933	1760687933	1	1	PASHTOONWAR, MARIAN	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
61580	Fee-for-Service	1770778037	1770778037	1	1	PONCE, FAVIOLA LCSW	11/21/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
61592	Fee-for-Service	1538172754	1538172754	2	1	PATEL, RAJU B MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51280	41	Internal Medicine	0	In state provider	None	2615 H STREET	None	BAKERSFIELD	CA	93301	2819	15	06029	35.38335768	-119.0211743	Kern County
61635	Fee-for-Service	1184641664	1184641664	1	1	PLANNED PARENTHOOD	1/19/1988	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	5400 RALSTON ST	None	VENTURA	CA	93003	6002	56	06111	34.25974984	-119.2179337	Ventura County
61648	Fee-for-Service	1871767749	1871767749	1	1	PRIME PHARMACY SERVICES INC	4/29/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
61653	Fee-for-Service	1427396530	1427396530	1	1	PILLAI,SAJIN	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3424 KOSSUTH AVENUE	None	BRONX	NY	10467	2410	00	None	40.880385	-73.8815355	Bronx County
61662	Fee-for-Service	1487838843	1487838843	1	1	PENALOSA, RODERICK D LMFT	4/4/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
61690	Fee-for-Service	1932376274	1932376274	1	2	PERRY, RAYMOND C W MD	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107565	-	NOT APPLICABLE	0	In state provider	None	5850 S MAIN ST	RM 1078, 2010, 2017	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
61696	Fee-for-Service	1467845198	1467845198	1	1	PATEL, NIDHI H DO	1/18/2024	207R00000X	NA	Other	026	PHYSICIANS	16617	None	None	0	In state provider	None	1211 W. LA PALMA AVE.	SUITE 404	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
61740	Fee-for-Service	1710336094	1710336094	1	1	POUYA AFSHAR MD INC	4/28/2021	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	37	06073	32.77510996	-117.1277427	San Diego County
61741	Fee-for-Service	1346530441	1346530441	1	1	PARK, ABRAHAM J MD	7/12/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	159365	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
61770	Fee-for-Service	1548357189	1548357189	2	1	PHARMACY ALTERNATIVES CALIFO	12/16/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3743 ELECTRO WAY	UNIT B	REDDING	CA	96002	9393	45	06089	40.53002932	-122.299314	Shasta County
61786	Fee-for-Service	1023134335	1023134335	1	1	PEEPLES, TRACY F LCSW	4/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3316-3320 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1537	19	06037	34.02438077	-118.1399976	Los Angeles County
61794	Fee-for-Service	1710031588	1710031588	1	8	PROVIDENCE FACEY MEDICAL FOU	6/14/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
61803	Fee-for-Service	1245735208	1245735208	1	1	PIENKOS, SHAUN MD	6/4/2024	207RC0200X	NA	Other	026	PHYSICIANS	165909	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61807	Fee-for-Service	1376510313	1376510313	1	1	PETERSON, MILES E	4/13/2005	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8283 GROVE AVE	STE 104	RANCHO CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
61808	Fee-for-Service	1043574262	1043574262	1	1	PATEL, KRUTI MD	1/12/2021	208M00000X	NA	Other	026	PHYSICIANS	170176	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
61829	Fee-for-Service	1821165721	1821165721	1	1	PAN, ELAINE Y MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60678	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
61831	Fee-for-Service	1619167699	1619167699	1	1	PHAN, RICK N MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100834	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
61861	Fee-for-Service	1194986919	1194986919	2	1	PATEL, PALLAVKUMAR MD	11/13/2023	208M00000X	NA	Other	026	PHYSICIANS	115502	None	None	0	In state provider	None	1900 SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
61889	Fee-for-Service	1215020441	1215020441	1	1	PATRIOT AMBULANCE SERVICE, I	6/23/2016	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5189 COMMERCE RD	None	FLINT	MI	48507	2945	00	None	42.97137078	-83.77822539	Genesee County
61911	Fee-for-Service	1467911784	1467911784	1	1	PETERSEN, MAUREEN DO	7/14/2023	207P00000X	NA	Other	026	PHYSICIANS	20419	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
61919	Fee-for-Service	1508446089	1508446089	1	1	PORTER BERG, SKYE R NP	12/17/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
61937	Fee-for-Service	1902898695	1902898695	1	1	PROUM, DAVID MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86091	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
61968	Fee-for-Service	1851549836	1851549836	1	1	PHAM, THOMAS D OD	2/17/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
61990	Fee-for-Service	1366638868	1366638868	1	1	PARVEZ MERCHANT	1/22/2008	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	271 WEST ATARA ST	None	MONROVIA	CA	91016	4716	19	06037	34.12568853	-118.0077042	Los Angeles County
61998	Fee-for-Service	1568500411	1568500411	1	1	PHAM, LESLIE MD	3/4/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	117423	None	None	0	In state provider	None	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
62081	Fee-for-Service	1396270989	1396270989	1	1	PARK, CAROLINE MD	1/29/2024	390200000X	NA	Other	026	PHYSICIANS	170021	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
62083	Fee-for-Service	1710031588	1710031588	1	8	PROVIDENCE FACEY MEDICAL FOU	8/14/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
62089	Fee-for-Service	1740371780	1740371780	1	1	POULSEN, MARIE K PHD	7/1/1996	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
62093	Fee-for-Service	1245735208	1245735208	1	1	PIENKOS, SHAUN MD	6/4/2024	207RC0200X	NA	Other	026	PHYSICIANS	165909	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62094	Fee-for-Service	1740435486	1740435486	1	1	POON, AMY W MD	1/12/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	37293	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62095	Fee-for-Service	1083369151	1083369151	1	1	PATEL, NISHA NP	5/19/2022	207RR0500X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10861 CHERRY ST	104	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
62107	Fee-for-Service	1346250594	1346250594	1	1	PROVIDENCE HEALTH AND SERVIC	7/13/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES WASHINGTON	413 LILLY RD NE	None	OLYMPIA	WA	98506	5166	00	None	47.052801	-122.847462	Thurston County
62112	Fee-for-Service	1033142237	1033142237	1	1	PARK, BURN MD INC	4/6/2012	261QM2500X	NA	Other	026	PHYSICIANS	32222	08	Family Practice	0	In state provider	None	19085 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2953	19	06037	33.98742081	-117.8873248	Los Angeles County
62135	Fee-for-Service	1972949196	1972949196	1	1	POWELL, CARMIN M MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134107	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
62140	Fee-for-Service	1154403921	1154403921	1	1	PARRIS, DAVID C MD	3/25/2020	207R00000X	NA	Other	026	PHYSICIANS	35708	41	Internal Medicine	0	In state provider	None	12660 RIVERSIDE DRIVE	SUITE 310-320	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
62142	Fee-for-Service	1326017831	1326017831	1	1	PERLEY, JONATHAN E MD	9/14/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76527	34	Urology and Urological Surgery	0	In state provider	None	3650 SOUTH ST	STE 408	LAKEWOOD	CA	90712	1510	19	06037	33.86019847	-118.149255	Los Angeles County
62201	Fee-for-Service	1326471624	1326471624	1	1	PAN, PATRICK J MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134359	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
62204	Fee-for-Service	1740352566	1740352566	1	1	PENA, ANDRES MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86087	25	Physical Medicine and Rehabilitation	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
62226	Fee-for-Service	1902898695	1902898695	1	1	PROUM, DAVID MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86091	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
62257	Fee-for-Service	1205862752	1205862752	1	2	PACIFIC ARTHRITIS CARE	7/1/2017	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	5230 PACIFIC CONCOURSE	STE 100	LOS ANGELES	CA	90045	6200	19	06037	33.92774198	-118.3727493	Los Angeles County
62272	Fee-for-Service	1447603006	1447603006	1	1	PATEL, NEAL B MD	8/9/2019	207L00000X	NA	Other	026	PHYSICIANS	152115	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
62295	Fee-for-Service	1629500608	1629500608	1	1	PATEL, PUNIT M DO	8/31/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18911	None	None	0	In state provider	None	1595 SOQUEL DR	STE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
62305	Fee-for-Service	1508922717	1508922717	1	1	PETERSEN, GAIL OD	11/13/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
62314	Fee-for-Service	1518479229	1518479229	1	1	PEREZ-THAYER, VERONICA LMFT	8/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	874 57TH ST	None	SACRAMENTO	CA	95819	3327	34	06067	38.565855	-121.433607	Sacramento County
62365	Fee-for-Service	1649880147	1649880147	1	1	PEDIATRIC OFFICE ANESTHESIA	12/26/2022	207LP3000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALISTS	315 S HWY 101	STE 112	SOLANA BEACH	CA	92075	1875	37	06073	32.98850539	-117.2709861	San Diego County
62371	Fee-for-Service	1710031588	1710031588	1	8	PROVIDENCE FACEY MEDICAL FOU	8/14/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
62391	Fee-for-Service	1750735353	1750735353	1	1	PECHINKO, BRITTANY A CRNA	8/19/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
62394	Fee-for-Service	1346250594	1346250594	1	1	PROVIDENCE HEALTH AND SERVIC	7/13/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES WASHINGTON	413 LILLY RD NE	None	OLYMPIA	WA	98506	5166	00	None	47.052801	-122.847462	Thurston County
62423	Fee-for-Service	1013534981	1013534981	1	1	PEARL HOME HEALTH CARE, INC	12/21/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18711 SHERMAN WAY	UNIT 102B	RESEDA	CA	91335	4086	19	06037	34.20120092	-118.5408066	Los Angeles County
62444	Fee-for-Service	1912976408	1912976408	1	1	PLANNED PRNTHD/ORANGE &	7/23/1998	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN BERNARDINO COUNTY	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	30	06059	33.77685748	-117.8357804	Orange County
62486	Fee-for-Service	1568723450	1568723450	1	1	POURANG, DEENA MD	2/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126576	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
62502	Fee-for-Service	1922194174	1922194174	1	1	PRESTWICH, BRIAN D MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64321	08	Family Practice	0	In state provider	None	1414 S GRAND AVE	FL 2	LOS ANGELES	CA	90015	3067	19	06037	34.03661142	-118.2657227	Los Angeles County
62571	Fee-for-Service	1053391466	1053391466	1	1	POLLARD,RICHARD B MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	28984	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
62582	Fee-for-Service	1891127049	1891127049	1	1	PARKINSON'S ASSOCIATION OF	8/24/2015	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SAN DIEGO	8555 AERO DRIVE	SUITE 308	SAN DIEGO	CA	92123	1745	37	06073	32.80957998	-117.143477	San Diego County
62594	Fee-for-Service	1609472992	1609472992	1	1	PROGRESSIVE PALLIATIVE CARE	6/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1821 W VERDUGO AVE	SUITE 102	BURBANK	CA	91506	2149	19	06037	34.16726728	-118.3250728	Los Angeles County
62602	Fee-for-Service	1154962967	1154962967	1	1	PILLBOX, INC.	10/31/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3941 J ST.	130	SACRAMENTO	CA	95819	3628	34	06067	38.570652	-121.4535465	Sacramento County
62609	Fee-for-Service	1194330563	1194330563	1	1	PLATINUM HEALTH CARE	9/11/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	8001 LAUREL CANYON BLVD	SUITE 103	NORTH HOLLYWOOD	CA	91605	1456	19	06037	34.216164	-118.396559	Los Angeles County
62634	Fee-for-Service	1477921666	1477921666	1	1	PA HEALTHCARE PHARMACEUTICAL	6/3/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7183 NAVAJO ROAD	SUITE A	SAN DIEGO	CA	92119	1650	37	06073	32.80433685	-117.0405513	San Diego County
62654	Fee-for-Service	1386302099	1386302099	1	1	PAPPALARDO, ASHLEY NP	8/4/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	STE 2021	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
62660	Fee-for-Service	1538236518	1538236518	1	1	PROTHERO, MICHAEL W LMFT	12/15/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 COLUSA AVE	STE A	YUBA CITY	CA	95991	4148	51	06101	39.14074601	-121.6172196	Sutter County
62668	Fee-for-Service	1710031588	1710031588	1	8	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	19	06037	34.4588501	-118.5343405	Los Angeles County
62689	Fee-for-Service	1144502998	1144502998	1	1	PATEL, TRUSHNABEN R MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118128	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
62713	Fee-for-Service	1487831947	1487831947	1	1	PACIFIC CLINICS	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	735 S SOTO STREET	None	LOS ANGELES	CA	90023	1336	19	06037	34.03484914	-118.215437	Los Angeles County
62732	Fee-for-Service	1457376790	1457376790	1	1	PIERSON, JOSEPH E MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53815	01	General Practice	0	In state provider	None	4230 DON TAPIA PL	None	LOS ANGELES	CA	90008	4236	19	06037	34.00642418	-118.3489345	Los Angeles County
62781	Fee-for-Service	1184720005	1184720005	1	1	PARK REGENCY CARE, LLC	10/1/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PARK REGENCY CARE CTR	1770 W LA HABRA BLVD	None	LA HABRA	CA	90631	5130	30	06059	33.93182248	-117.966078	Orange County
62805	Fee-for-Service	1053757609	1053757609	1	1	PONTINE INCORPORATED	6/19/2013	261QM2500X	NA	Other	026	PHYSICIANS	116785	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
62811	Fee-for-Service	1013974815	1013974815	1	2	PODOLSKY, SUSAN R MD	8/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62868	15	Obstetrics (D.O. only)	0	In state provider	None	1441 FLORIDA	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
62814	Fee-for-Service	1215411459	1215411459	1	1	PULEO, RHONDA J LMFT	8/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1130 CONROY LN	SUITE 150	ROSEVILLE	CA	95661	4154	31	06061	38.73792807	-121.2748427	Placer County
62827	Fee-for-Service	1609385954	1609385954	1	1	PATTERSON, NIKKIA DOULA	5/15/2023	101YA0400X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
62840	Fee-for-Service	1699832790	1699832790	1	1	PERNET, KAREN E LCSW	8/9/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3725 COOLIDGE AVE	None	OAKLAND	CA	94602	3308	01	06001	37.80013571	-122.2071366	Alameda County
62846	Fee-for-Service	1356685218	1356685218	1	2	PACIFIC NEUROPSYCHIATRIC SPE	4/10/2020	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CIALISTS INC.	18682 BEACH BLVD	SUITE 120	HUNTINGTON BEACH	CA	92648	2048	30	06059	33.69152695	-117.9887007	Orange County
62859	Fee-for-Service	1053391466	1053391466	1	1	POLLARD,RICHARD B MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	28984	77	Infectious Disease	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
62867	Fee-for-Service	1740251727	1740251727	1	1	PETTERSEN, GABRIEL R MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89460	None	None	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
62883	Fee-for-Service	1609472992	1609472992	1	1	PROGRESSIVE PALLIATIVE CARE	6/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1821 W VERDUGO AVE	SUITE 102	BURBANK	CA	91506	2149	19	06037	34.16726728	-118.3250728	Los Angeles County
62907	Fee-for-Service	1720409790	1720409790	1	1	PATEL, CHHAVI A MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127375	41	Internal Medicine	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
62922	Fee-for-Service	1679984736	1679984736	1	1	PADGETT, MAX MD	5/21/2019	390200000X	NA	Other	026	PHYSICIANS	141495	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
62931	Fee-for-Service	1508569567	1508569567	1	1	PIPPIN, TAMARA CNP	9/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
62969	Fee-for-Service	1679057210	1679057210	1	1	PLACENTIA LINDA EMERGENCY PH	11/1/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	YSICIANS, PC	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
62988	Fee-for-Service	1710031588	1710031588	1	19	PROVIDENCE FACEY MEDICAL FOU	3/3/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
63049	Fee-for-Service	1740486414	1740486414	1	1	PAN, LILLIAN Y DO	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10736	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2517	48	06095	38.13070051	-122.237307	Solano County
63107	Fee-for-Service	1659947398	1659947398	1	1	PRIMAMED HEALTH SERVICES INC	8/8/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	171 N ALTADENA DRIVE	ST 250	PASADENA	CA	91107	7352	19	06037	34.14902931	-118.0986299	Los Angeles County
63149	Fee-for-Service	1568638872	1568638872	1	1	PRICE, DAVIDA M LMFT	3/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERVICES	127 E LEXINGTON AVE	None	EL CAJON	CA	92020	4511	37	06073	32.79269801	-116.9617323	San Diego County
63176	Fee-for-Service	1205907243	1205907243	1	1	PANGILINAN, REY T MD	6/14/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	81538	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
63186	Fee-for-Service	1700232519	1700232519	1	1	PRASAD, KASHMITA L LMFT	11/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28550 COLERIDGE AVE	None	HAYWARD	CA	94544	5822	01	06001	37.63001935	-122.0652491	Alameda County
63189	Fee-for-Service	1023209327	1023209327	1	1	PAEK, SUNG H MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101637	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63198	Fee-for-Service	1720409790	1720409790	1	1	PATEL, CHHAVI A MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127375	01	General Practice	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
63206	Fee-for-Service	1750305439	1750305439	1	1	PUMPHREY, EDWARD A MD	1/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	24667	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
63235	Fee-for-Service	1992817613	1992817613	1	1	PATEL, NEIL MD	8/16/2021	207R00000X	NA	Other	026	PHYSICIANS	96232	None	None	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
63274	Fee-for-Service	1710031588	1710031588	1	19	PROVIDENCE FACEY MEDICAL FOU	3/3/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
63322	Fee-for-Service	1881148096	1881148096	1	1	PRIORITY URGENT CARE	3/17/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4821 PANAMA LN	STE A-C	BAKERSFIELD	CA	93313	3480	15	06029	35.29587848	-119.056005	Kern County
63331	Fee-for-Service	1215974423	1215974423	1	1	PULLELA, RAMADEVI MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75548	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
63381	Fee-for-Service	1164957486	1164957486	1	3	PROGRESSIVE URGENT CARE INC	2/15/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
63387	Fee-for-Service	1366429045	1366429045	1	1	PAGE, CHRISTOPHER D DPM	10/12/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	470 PLUMAS BLVD	STE 200	YUBA CITY	CA	95991	5007	51	06101	39.13270038	-121.6141985	Sutter County
63414	Fee-for-Service	1336126408	1336126408	1	1	PERGREM, CHRISTOPHER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
63427	Fee-for-Service	1669550364	1669550364	1	1	PIERRE, MARIA S MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87145	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
63476	Fee-for-Service	1205966405	1205966405	1	1	PARKS, LOUISA A PHD	5/27/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	45 CASTRO ST	STE 220	SAN FRANCISCO	CA	94114	1027	38	06075	37.76829732	-122.4357056	San Francisco County
63491	Fee-for-Service	1649219759	1649219759	1	1	PAUL C Y YOUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY OF UTAH	50 N MEDICAL DR	None	SALT LAKE CITY	UT	84132	3021	00	None	40.77197161	-111.8352608	Salt Lake County
63493	Fee-for-Service	1750305439	1750305439	1	1	PUMPHREY, EDWARD A MD	1/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	24667	01	General Practice	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
63499	Fee-for-Service	1205916780	1205916780	1	1	PANTANGCO, EUGENE R MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74436	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
63504	Fee-for-Service	1770096323	1770096323	1	1	PEREZ, JESSICA LPCC	10/19/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16000 APPLE VALLEY RD	C5-11	APPLE VALLEY	CA	92307	7814	36	06071	34.5421391	-117.2732764	San Bernardino County
63514	Fee-for-Service	1770843500	1770843500	1	1	PERSIANINOVA, MARIA A DO	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14203	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
63525	Fee-for-Service	1962783951	1962783951	1	1	PACIFICA NEUROPSYCHOLOGY	1/7/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CENTER	461 W 6TH ST	STE 211	SAN PEDRO	CA	90731	2677	19	06037	33.73873948	-118.2868695	Los Angeles County
63548	Fee-for-Service	1083915599	1083915599	1	1	PETER, MAGDALENE PHD	2/2/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
63564	Fee-for-Service	1710031588	1710031588	1	19	PROVIDENCE FACEY MEDICAL FOU	3/3/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
63579	Fee-for-Service	1437248473	1437248473	1	1	POMONA UNIFIED SCH DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	800 S GAREY AVE	None	POMONA	CA	91766	3325	19	06037	34.05229671	-117.7498895	Los Angeles County
63619	Fee-for-Service	1215974423	1215974423	1	1	PULLELA, RAMADEVI MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75548	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
63670	Fee-for-Service	1376030817	1376030817	1	1	PHAM, SYLVIE MD	8/18/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	173728	None	None	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5696	37	06073	32.63367609	-117.0769202	San Diego County
63674	Fee-for-Service	1023452760	1023452760	1	1	PIER, KATHERINE S MD	12/9/2019	2084P0802X	NA	Psychiatry	026	PHYSICIANS	146894	36	Psychiatry	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
63733	Fee-for-Service	1184816175	1184816175	1	1	PANDYA, SWATI MD	4/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107563	40	Pediatrics	0	In state provider	None	7225 RAINBOW DRIVE	None	SAN JOSE	CA	95129	4552	43	06085	37.30146258	-122.0315034	Santa Clara County
63746	Fee-for-Service	1568732246	1568732246	1	1	PLEASANTON UNIFIED SCHOOL	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5758 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4083	01	06001	37.68523856	-121.8934051	Alameda County
63763	Fee-for-Service	1871855080	1871855080	1	1	PATRICK, MARIE C DO	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12626	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
63809	Fee-for-Service	1962783951	1962783951	1	1	PACIFICA NEUROPSYCHOLOGY	1/7/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CENTER	461 W 6TH ST	STE 211	SAN PEDRO	CA	90731	2677	19	06037	33.73873948	-118.2868695	Los Angeles County
63810	Fee-for-Service	1912171703	1912171703	1	1	PHAM, MAI T MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136550	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
63853	Fee-for-Service	1710031588	1710031588	1	19	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18133 VENTURA BLVD	204 & 402	TARZANA	CA	91335	0000	19	06037	34.1657808	-118.5283188	Los Angeles County
63863	Fee-for-Service	1831455781	1831455781	1	1	PROLO, LAURA M MD	7/24/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	126464	14	Neurological Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
63900	Fee-for-Service	1306526314	1306526314	1	1	PHAM, DAVID PT	10/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
63909	Fee-for-Service	1558706804	1558706804	1	1	PEREZ, MARIA N M MD	10/7/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5220 CLARK AVE	STE 125	LAKEWOOD	CA	90712	2623	19	06037	33.8527092	-118.1337623	Los Angeles County
64018	Fee-for-Service	1194938860	1194938860	1	1	PADILLA, JENNIFER M MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99681	40	Pediatrics	0	In state provider	None	1920 TIENDA DR	STE 102	LODI	CA	95242	3930	39	06077	38.11678155	-121.2957005	San Joaquin County
64023	Fee-for-Service	1851312862	1851312862	1	1	PACIFIC VALLEY MED GROUP	3/13/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
64031	Fee-for-Service	1568732246	1568732246	1	1	PLEASANTON UNIFIED SCHOOL	11/25/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5758 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4083	01	06001	37.68523856	-121.8934051	Alameda County
64082	Fee-for-Service	1669414744	1669414744	1	1	PARVATANENI, RAM K MD	8/18/2003	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	82739	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	# 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
64113	Fee-for-Service	1841202710	1841202710	1	2	PARKER, PAUL C	9/18/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54747	40	Pediatrics	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
64114	Fee-for-Service	1124320122	1124320122	1	1	POYTRESS, MARGARET H LMFT	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
64118	Fee-for-Service	1669880290	1669880290	1	1	PROFESSIONAL CARE HOSPICE	12/6/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13701 RIVERSIDE DR	#701	SHERMAN OAKS	CA	91423	2449	19	06037	34.15762986	-118.4316325	Los Angeles County
64125	Fee-for-Service	1114587821	1114587821	1	1	PANG, ANDREA NP	7/30/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
64178	Fee-for-Service	1316469034	1316469034	1	1	PRESTIGE RADIOLOGY INC	6/25/2019	261QR0200X	NA	Mammography/MRI Provider	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	1157 HILLTOP DR	SUITE 2	REDDING	CA	96003	3814	45	06089	40.590918	-122.3557515	Shasta County
64213	Fee-for-Service	1992176150	1992176150	1	1	PRATT, KELLY M NP	9/12/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64255	Fee-for-Service	1760474159	1760474159	1	1	PHAM, CATHERINE MD	3/1/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	66719	None	None	0	In state provider	None	900 BUTTE ST	None	REDDING	CA	96001	0827	45	06089	40.58587336	-122.3848508	Shasta County
64280	Fee-for-Service	1295024800	1295024800	1	1	PUCKETT, JAMES L MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
64287	Fee-for-Service	1104106889	1104106889	1	1	PEDROZA-TORNERO, TERESITA L	5/18/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
64290	Fee-for-Service	1477618650	1477618650	1	1	PEREZ, JOSEPHINE M MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51335	08	Family Practice	0	In state provider	None	1041 ROSE AVE	None	SELMA	CA	93662	3240	10	06019	36.56879252	-119.596257	Fresno County
64312	Fee-for-Service	1851312862	1851312862	1	1	PACIFIC VALLEY MED GROUP	8/8/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
64337	Fee-for-Service	1083410823	1083410823	1	1	POOLE, MARINA	2/27/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
64344	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	3/6/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
64346	Fee-for-Service	1659723906	1659723906	1	1	PRODIGY HEALTHCARE INC	9/15/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 S ELM AVENUE	None	FRESNO	CA	93706	6018	10	06019	36.64821336	-119.7908696	Fresno County
64384	Fee-for-Service	1659798791	1659798791	1	1	PETERSON, ASHLEY MD	11/4/2019	207L00000X	NA	Other	026	PHYSICIANS	149267	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
64407	Fee-for-Service	1346822418	1346822418	1	1	PANG, GORDON PT	8/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
64432	Fee-for-Service	1093918872	1093918872	1	1	PHU VAN DANG MD &	4/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PAULINE SUONG THI DANG	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
64485	Fee-for-Service	1396720371	1396720371	1	1	PACIFIC PEDIATRIC CARDIO	3/1/2000	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	-LOGY MED GROUP	50 W BELLEFONTAINE ST	STE 405	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
64508	Fee-for-Service	1467755249	1467755249	2	1	PARKER VALLEY EMERGENCY	8/1/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
64509	Fee-for-Service	1568526309	1568526309	1	1	PRINCE, ALIA L LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
64520	Fee-for-Service	1679983308	1679983308	1	1	PATEL, AKTA A DO	9/12/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	17015	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
64560	Fee-for-Service	1447756671	1447756671	1	1	PALMQUIST, JACOB M MD	8/25/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163475	None	None	0	In state provider	None	5 BON AIR ROAD	STE 105	LARKSPUR	CA	94939	1137	21	06041	37.9438204	-122.5395357	Marin County
64632	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	6/11/2020	No Taxonomy Provided	NA	None	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
64645	Fee-for-Service	1083183404	1083183404	1	1	PARKER, MEA C LPCC	8/1/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
64657	Fee-for-Service	1053518779	1053518779	1	1	PROMISING FUTURES, INC	6/25/1997	320900000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOLLY OAKS	2819 OAK SHADE LN	None	RAMONA	CA	92065	3657	37	06073	32.99873892	-116.8975878	San Diego County
64678	Fee-for-Service	1750533535	1750533535	1	1	PONRARTANA, SORNYA MD	8/12/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102825	40	Pediatrics	0	In state provider	None	3526 W FIRST ST	None	SANTA ANA	CA	92703	3302	30	06059	33.7451367	-117.9165177	Orange County
64693	Fee-for-Service	1679632236	1679632236	1	1	PHILLIP, LISA A MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68250	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
64718	Fee-for-Service	1093918872	1093918872	1	1	PHU VAN DANG MD &	4/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	PAULINE SUONG THI DANG	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
64812	Fee-for-Service	1386939486	1386939486	1	1	PATEL, DIPESH S MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122985	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
64826	Fee-for-Service	1023434677	1023434677	1	1	PLUMMER, TEDDI M LPCC	7/20/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PCC	5079 HWY 140	None	MARIPOSA	CA	95338	0062	22	06043	37.48746975	-119.9681179	Mariposa County
64868	Fee-for-Service	1932119864	1932119864	1	2	PARIKH, VIPUL J MD	8/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
64879	Fee-for-Service	1245305218	1245305218	1	1	PHILLIPS, ROGER B MD	1/1/1991	207L00000X	NA	Other	026	PHYSICIANS	66426	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
64894	Fee-for-Service	1437322377	1437322377	1	5	PRIME HEALTHCARE SRVS	9/25/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
64898	Fee-for-Service	1942765250	1942765250	1	1	POLAT, DILEM MD	7/3/2023	208M00000X	NA	Other	026	PHYSICIANS	175967	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
64919	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	3/6/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
64926	Fee-for-Service	1093809139	1093809139	1	1	PRISMA CARE A MEDICAL	3/31/1988	193400000X	NA	Other	026	PHYSICIANS	43301	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	2648 MAIN ST	STE A	CHULA VISTA	CA	91911	4664	37	06073	32.5948443	-117.0761526	San Diego County
64940	Fee-for-Service	1730740564	1730740564	1	1	PARIKH, ADISH MD	6/25/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64978	Fee-for-Service	1518172535	1518172535	1	1	PATEL, DARSHAN A MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110591	40	Pediatrics	0	In state provider	None	18031 US HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
65006	Fee-for-Service	1093918872	1093918872	1	1	PHU VAN DANG MD &	4/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PAULINE SUONG THI DANG	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
65012	Fee-for-Service	1093851529	1093851529	1	1	PURGASON, CHRISTIAN T DO	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9340	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
65057	Fee-for-Service	1548212681	1548212681	1	1	POURZAND, VAHIDEH P MD	5/20/2008	174400000X	NA	Other	026	PHYSICIANS	80373	08	Family Practice	0	In state provider	None	1141 N BRAND AVE	STE 304	GLENDALE	CA	91202	2579	19	06037	34.162983	-118.2550855	Los Angeles County
65102	Fee-for-Service	1548577745	1548577745	1	1	PEARLMAN, GABRIELLA S MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117725	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
65164	Fee-for-Service	1316772619	1316772619	1	1	PAIK VASCULAR & VEIN CENTER	2/21/2025	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	A PROFESSIONAL CORPORATI	230 S MAIN ST	STE #202	ORANGE	CA	92868	3851	30	06059	33.785154	-117.867318	Orange County
65177	Fee-for-Service	1548696420	1548696420	1	1	PAPAC, JENNIFER MD	4/16/2019	390200000X	NA	Other	026	PHYSICIANS	145337	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
65182	Fee-for-Service	1710537303	1710537303	1	1	PLANNED PARENTHOOD PASADENA	11/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	4070 STERLING WAY	None	BALDWIN PARK	CA	91706	4223	19	06037	34.08540997	-117.9626686	Los Angeles County
65193	Fee-for-Service	1669540043	1669540043	1	1	PLUNKETT, JENNIFER T MD	10/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108841	02	General Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
65199	Fee-for-Service	1982075107	1982075107	1	5	PEDIATRIC AND FAMILY MEDICAL	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6618 VAN NUYS BLVD	None	VAN NUYS	CA	91405	4617	19	06037	34.19123738	-118.4487091	Los Angeles County
65206	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	3/6/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	47	Miscellaneous	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
65209	Fee-for-Service	1427082890	1427082890	1	1	PHAM, THAI-VAN X MD	10/31/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	72892	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
65214	Fee-for-Service	1093809139	1093809139	1	1	PRISMA CARE A MEDICAL	3/31/1988	193400000X	NA	Other	026	PHYSICIANS	43301	41	Internal Medicine	0	In state provider	CORPORATION	2648 MAIN ST	STE A	CHULA VISTA	CA	91911	4664	37	06073	32.5948443	-117.0761526	San Diego County
65244	Fee-for-Service	1659303832	1659303832	1	1	PRIMARY CARE CONSULTANTS	1/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CONSTANTINE E PHIRIPES	255 W BULLARD AVE	STE 124	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
65269	Fee-for-Service	1518172535	1518172535	1	1	PATEL, DARSHAN A MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110591	13	Neurology (M.D. only)	0	In state provider	None	18031 US HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
65278	Fee-for-Service	1023321130	1023321130	1	1	PENINSULA SLEEP LAB	8/31/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	91 WESTBOROUGH BLVD	# 1020	S SAN FRANCISCO	CA	94080	3162	41	06081	37.65423064	-122.4358509	San Mateo County
65343	Fee-for-Service	1548212681	1548212681	1	1	POURZAND, VAHIDEH P MD	5/20/2008	174400000X	NA	Other	026	PHYSICIANS	80373	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1141 N BRAND AVE	STE 304	GLENDALE	CA	91202	2579	19	06037	34.162983	-118.2550855	Los Angeles County
65369	Fee-for-Service	1174630487	1174630487	1	1	PATEL, SHRUTI P MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	82250	41	Internal Medicine	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
65449	Fee-for-Service	1548303589	1548303589	1	1	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	10251 ARTESIA	None	BELLFLOWER	CA	90706	6719	19	06037	33.87290452	-118.1154735	Los Angeles County
65486	Fee-for-Service	1982075107	1982075107	1	5	PEDIATRIC AND FAMILY MEDICAL	4/18/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6618 VAN NUYS BLVD	None	VAN NUYS	CA	91405	4617	19	06037	34.19123738	-118.4487091	Los Angeles County
65494	Fee-for-Service	1336211648	1336211648	1	1	PERAIAH, SUDANAGUNTA MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24549	02	General Surgery	0	In state provider	None	400 W I ST	STE D	LOS BANOS	CA	93635	1408	24	06047	37.06347448	-120.858102	Merced County
65497	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	3/18/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
65503	Fee-for-Service	1114420239	1114420239	1	1	PENG, JIAWEI OT	2/28/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
65549	Fee-for-Service	1528228327	1528228327	1	1	PARTLOW, STEPHEN W PHD	3/31/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
65572	Fee-for-Service	1881856433	1881856433	1	1	PIZZO, HELEN P MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111902	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
65582	Fee-for-Service	1740773035	1740773035	1	1	PETTIBONE, KATHERINE DPM	12/28/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
65584	Fee-for-Service	1962470161	1962470161	1	1	PARKE, ROBERT MD	8/29/1981	207RP1001X	NA	Pulmonology	026	PHYSICIANS	27430	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	STE 608	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
65634	Fee-for-Service	1194219519	1194219519	1	1	PRECISION CARE HOSPICE	10/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1003 E COOLEY DR	STE 201 A	COLTON	CA	92324	3907	36	06071	34.05460945	-117.3107565	San Bernardino County
65709	Fee-for-Service	1346320587	1346320587	1	1	PARE, LAURA S MD	12/17/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70502	14	Neurological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
65739	Fee-for-Service	1326674292	1326674292	1	1	PADDA, AMRITPAL S CNP	8/13/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
65769	Fee-for-Service	1235154618	1235154618	1	1	PRUZINSKY, KATHRYN M MD	7/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
65774	Fee-for-Service	1982075107	1982075107	1	5	PEDIATRIC AND FAMILY MEDICAL	12/9/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6618 VAN NUYS BLVD	None	VAN NUYS	CA	91405	4617	19	06037	34.19123738	-118.4487091	Los Angeles County
65782	Fee-for-Service	1962933267	1962933267	1	1	POWERS, JULIA R MD	9/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165623	08	Family Practice	0	In state provider	None	1301 MISSION STREET	None	SANTA CRUZ	CA	95030	3528	44	06087	36.96817615	-122.0381947	Santa Cruz County
65784	Fee-for-Service	1922112044	1922112044	1	1	PHOENIX CHILDRENS HOSPITAL	1/11/2012	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	2	Out of state provider	GROUP	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
65810	Fee-for-Service	1508815036	1508815036	1	1	PAVLIC, ROMEO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
65850	Fee-for-Service	1407033277	1407033277	1	1	PUEBLO MEDICAL ASSOCIATES, I	2/11/2008	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NC	521 N AZUSA AVE	None	AZUSA	CA	91702	2936	19	06037	34.1306038	-117.9075906	Los Angeles County
65890	Fee-for-Service	1831566546	1831566546	1	1	PEARSON, ANDREW E PSYD	2/1/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2455 BENNETT VALLEY RD	STE B208	SANTA ROSA	CA	95404	5667	49	06097	38.434284	-122.6918565	Sonoma County
65908	Fee-for-Service	1851472302	1851472302	1	1	PANCHAL, MANISHA N MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84337	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
65922	Fee-for-Service	1194219519	1194219519	1	1	PRECISION CARE HOSPICE	10/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1003 E COOLEY DR	STE 201 A	COLTON	CA	92324	3907	36	06071	34.05460945	-117.3107565	San Bernardino County
65936	Fee-for-Service	1831397413	1831397413	1	1	PHAN, STEPHEN H MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109908	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
65990	Fee-for-Service	1891323838	1891323838	1	1	PATEL, RUSHI	8/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176998	36	Psychiatry	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
66064	Fee-for-Service	1063642312	1063642312	2	1	PAPA, RHETT MD DO	3/12/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	11733	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	133 W MAIN ST	None	EL CAJON	CA	92020	3315	37	06073	32.79492453	-116.9627861	San Diego County
66078	Fee-for-Service	1881899391	1881899391	1	1	PRENTICE MITRI & HIJAZIN	10/18/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	NEUROLOGICAL ASSOCIATES	10916 DOWNEY AVE	None	DOWNEY	CA	90241	4982	19	06037	33.94220053	-118.1314672	Los Angeles County
66081	Fee-for-Service	1316089089	1316089089	1	1	PALACIOS, ARTURO LCSW	5/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
66097	Fee-for-Service	1225423148	1225423148	1	1	PEARSE, WILLIAM B MD	9/14/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	173950	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
66098	Fee-for-Service	1447284948	1447284948	1	1	PRASAD, VIBHAY	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	75764	None	None	0	In state provider	None	25775 MCBEAN PKWY	STE 215	SANTA CLARITA	CA	91355	3703	19	06037	34.40042013	-118.5511416	Los Angeles County
66111	Fee-for-Service	1841484789	1841484789	1	1	PRICE, STACY H LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
66148	Fee-for-Service	1376674457	1376674457	1	2	PITTSBURG USD	7/1/2020	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2000 RAILROAD AVE	None	PITTSBURG	CA	94565	3830	07	06013	38.01974062	-121.8884314	Contra Costa County
66161	Fee-for-Service	1154701977	1154701977	1	1	PERVAIZ, SARAH MD	8/27/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	162248	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
66163	Fee-for-Service	1003279449	1003279449	1	1	PALMER, BRANDON MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162579	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
66169	Fee-for-Service	1003164112	1003164112	1	1	PHAM, XUANBINH D MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127436	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
66180	Fee-for-Service	1154583938	1154583938	1	1	PAYAM, AHOORA DO MD	6/28/2021	207R00000X	NA	Other	026	PHYSICIANS	171926	None	None	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
66204	Fee-for-Service	1104485317	1104485317	1	1	PRIME MEDICAL TRANSPORTATION	1/24/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	6470 FOOTHILL BLVD	SUITE J	TUJUNGA	CA	91042	2729	19	06037	34.24452205	-118.2728144	Los Angeles County
66205	Fee-for-Service	1689964686	1689964686	1	1	PAROCUA, LINDA M OT	11/8/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
66245	Fee-for-Service	1801244223	1801244223	1	1	PALOMAR COMMUNITY COLLEGE	7/1/2016	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1140 WEST MISSION RD	None	SAN MARCOS	CA	92069	1415	37	06073	33.151851	-117.178731	San Diego County
66285	Fee-for-Service	1821680430	1821680430	1	1	POULSON, NATALIE LMFT	5/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
66307	Fee-for-Service	1093912974	1093912974	1	1	PANGANIBAN, LORRAINE G	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	444 GLENOAKS	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
66314	Fee-for-Service	1841050416	1841050416	1	1	PHARMACY EXPRESS CARE	10/15/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	936 W AVENUE J4	STE 101A	LANCASTER	CA	93534	4246	19	06037	34.68575448	-118.146933	Los Angeles County
66315	Fee-for-Service	1023196748	1023196748	1	1	PATEL, DHARMENDRAKUMAR V	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90188	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
66329	Fee-for-Service	1427329176	1427329176	1	1	PORTILLO, JASON A MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125714	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
66367	Fee-for-Service	1275548745	1275548745	1	1	PARISH, BROOKE S MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 S AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
66374	Fee-for-Service	1437439445	1437439445	1	1	PEASLEE, JONATHAN M LMFT	11/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1740 PLUM LN	STE B	REDLANDS	CA	92374	0109	36	06071	34.06899169	-117.2145582	San Bernardino County
66383	Fee-for-Service	1669561890	1669561890	1	4	PLANNED PARENTHOOD LA	2/28/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	12124 BULLIS RD	None	LYNWOOD	CA	90262	5106	19	06037	33.91614168	-118.2044211	Los Angeles County
66411	Fee-for-Service	1922210251	1922210251	1	1	PETERSEN, ERIK MD	10/23/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	137589	None	None	0	In state provider	None	17822 BEACH BLVD	SUITE 200	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
66433	Fee-for-Service	1821549981	1821549981	1	1	PRISM FAMILY COUNSELING INC	5/10/2023	305R00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29970 TECHNOLOGY DRIVE	STE 105 B	MURRIETA	CA	92563	5855	33	06065	33.5604702	-117.1370275	Riverside County
66505	Fee-for-Service	1255912515	1255912515	1	1	PASCASIO ENTERPRISES INC	5/4/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9025 GUESS ST	None	ROSEMEAD	CA	91770	1901	19	06037	34.07894711	-118.072169	Los Angeles County
66512	Fee-for-Service	1831687672	1831687672	1	1	POLYXENE GAZETAS KOKINOS MD,	10/24/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	D VEIN INSTI	2255 S BASCOM AVE	SUITE 200	CAMPBELL	CA	95008	7800	43	06085	37.282734	-121.9317765	Santa Clara County
66564	Fee-for-Service	1225693146	1225693146	1	1	PEREZ-CORRAL, CHERLYN A MD	5/23/2023	207R00000X	NA	Other	026	PHYSICIANS	180673	None	None	0	In state provider	MD	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
66588	Fee-for-Service	1073898508	1073898508	1	1	PEARSON-PLUMMER, ELIZABETH	11/2/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD A PROFESSIONAL PSYCH	2827 PALOMINO RIDGE LN	None	SANTA BARBARA	CA	93105	2125	42	06083	34.45404987	-119.7177486	Santa Barbara County
66603	Fee-for-Service	1700270469	1700270469	1	1	PAMULA, RAMESH B MD INC	9/8/2015	174400000X	NA	Other	026	PHYSICIANS	55426	33	Thoracic Surgery	0	In state provider	None	7085 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0353	10	06019	36.83911703	-119.7362963	Fresno County
66624	Fee-for-Service	1629068564	1629068564	3	1	PRIORITY MED SUPPLY INC	11/11/2016	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1504 COLORADO AVE	None	TURLOCK	CA	95380	2711	50	06099	37.50665565	-120.8352628	Stanislaus County
66632	Fee-for-Service	1154816254	1154816254	1	1	PINIZZOTTO, JOSEPH D	7/2/2022	207P00000X	NA	Other	026	PHYSICIANS	19176	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
66680	Fee-for-Service	1801258272	1801258272	1	1	PAULICK, MARK	9/3/2020	207L00000X	NA	Other	026	PHYSICIANS	153727	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93454	4522	42	06083	34.95426953	-120.427596	Santa Barbara County
66724	Fee-for-Service	1407043680	1407043680	1	1	PEACE, SHERRI I MD INC	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72196	None	None	0	In state provider	None	8930 S SEPULVEDA BLVD	STE 104	LOS ANGELES	CA	90045	3606	19	06037	33.955128	-118.3961915	Los Angeles County
66734	Fee-for-Service	1255399515	1255399515	1	1	PEARLMAN, STUART MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	54748	40	Pediatrics	0	In state provider	None	320 DARDANELLI LN	STE 16	LOS GATOS	CA	95032	1419	43	06085	37.262079	-121.9673345	Santa Clara County
66742	Fee-for-Service	1366461782	1366461782	1	1	PRASAD, MADAN MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86600	13	Neurology (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE B220	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
66800	Fee-for-Service	1699137117	1699137117	1	1	PLATA, YAHAIRA MD	10/23/2020	390200000X	NA	Other	026	PHYSICIANS	166876	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
66839	Fee-for-Service	1194032003	1194032003	1	1	PIMENTAL, BRITNI A LMFT	10/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
66848	Fee-for-Service	1861432270	1861432270	1	1	PACAL, ADAM R MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89259	41	Internal Medicine	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
66871	Fee-for-Service	1093785180	1093785180	1	1	POTTER, JON W DO	9/26/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	2	Out of state provider	None	2310 CRAIG RD	None	EAU CLAIRE	WI	54701	6149	00	None	44.794386	-91.51910799	Eau Claire County
66901	Fee-for-Service	1417542473	1417542473	1	1	PRIMARY CHOICE HOME HEALTH	12/7/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	5658 SEPULVEDA BLVD	STE 302	VAN NUYS	CA	91411	2915	19	06037	34.173774	-118.466123	Los Angeles County
66903	Fee-for-Service	1578552402	1578552402	1	1	PEACE HEALTH	7/1/1998	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 9TH ST	None	FLORENCE	OR	97439	7398	00	None	43.97456558	-124.1173551	Lane County
66945	Fee-for-Service	1538217526	1538217526	1	1	PEREZ, RENE C MD	8/24/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	77050	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	LOGAN HEIGHTS FAMILY HLT	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
67011	Fee-for-Service	1497004196	1497004196	1	1	PENA, SANDRA LMFT	4/1/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
67017	Fee-for-Service	1114486339	1114486339	1	1	PIMIENTA, MICHAEL MD	12/18/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
67018	Fee-for-Service	1356772263	1356772263	1	1	PROJECT NINETY, INC	10/10/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	23,29 NORTH GRANT ST	None	SAN MATEO	CA	94401	2903	41	06081	37.57237369	-122.3209725	San Mateo County
67041	Fee-for-Service	1619004926	1619004926	1	1	PRAKASH, SUMA MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98959	45	Nephrology (Renal-Kidney)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
67047	Fee-for-Service	1215991302	1215991302	1	1	PRESS, RAYMOND I MD	10/31/1990	207RR0500X	NA	Other	026	PHYSICIANS	59304	83	Rheumatology	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
67052	Fee-for-Service	1982298394	1982298394	1	1	PRIORITY FAMILY CARE CENTER	4/8/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	APC	2423 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07368953	-118.2161016	Los Angeles County
67054	Fee-for-Service	1598253114	1598253114	1	1	POVLOW, ADRIANA MD	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
67079	Fee-for-Service	1457376790	1457376790	1	2	PIERSON, JOSEPH E MD	4/21/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53815	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DR	417	LOS ANGELES	CA	90008	3614	19	06037	34.00888336	-118.3389334	Los Angeles County
67080	Fee-for-Service	1386934875	1386934875	1	1	PEDIATRIC & FAMILY MEDICAL	7/1/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1400 S GRAND AVE	SUITE 101	LOS ANGELES	CA	90015	3023	19	06037	34.03692236	-118.2655238	Los Angeles County
67096	Fee-for-Service	1013535921	1013535921	1	1	PHUNG, JESSICA PT	1/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
67103	Fee-for-Service	1093760092	1093760092	1	1	PULVERMAN, RALPH S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	4404	08	Family Practice	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
67107	Fee-for-Service	1295986917	1295986917	1	1	PARK, ALEXANDER Y OD	2/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18040 SHERMAN WAY	None	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
67119	Fee-for-Service	1801390869	1801390869	1	1	PHAM, JADY T MD	10/18/2022	207L00000X	NA	Other	026	PHYSICIANS	175572	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
67128	Fee-for-Service	1295843415	1295843415	1	1	PANDYA, BANKIM Y MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95543	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
67157	Fee-for-Service	1629537691	1629537691	1	1	PELAYO, BRENDA E MD	8/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179428	None	None	0	In state provider	None	3833 WORSHAM AVE	STE 301	LONG BEACH	CA	90808	1766	19	06037	33.828552	-118.1462755	Los Angeles County
67159	Fee-for-Service	1447431515	1447431515	1	1	PAYNE, JILLIAN B RN	3/28/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67170	Fee-for-Service	1417299819	1417299819	1	1	PORTLEY, ROBERT M MD	6/12/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	165482	36	Psychiatry	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
67187	Fee-for-Service	1598796336	1598796336	1	1	PHIPPS, ARLENE M LCSW	6/7/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE	STE 101	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
67191	Fee-for-Service	1578552402	1578552402	1	1	PEACE HEALTH	7/1/1998	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 9TH ST	None	FLORENCE	OR	97439	7398	00	None	43.97456558	-124.1173551	Lane County
67248	Fee-for-Service	1467561340	1467561340	1	1	PANG, CHUN NANG	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3401 WHITMAN WAY	None	SAN JOSE	CA	95132	3163	43	06085	37.39618163	-121.8407877	Santa Clara County
67249	Fee-for-Service	1326065954	1326065954	1	1	PINEDA SOTO, JOSE A MD	9/9/2019	2080P0203X	NA	Other	026	PHYSICIANS	164633	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
67302	Fee-for-Service	1831733195	1831733195	1	1	PALM SPRINGS NEUROPSYCHOLOGY	1/10/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	650 E TAHQUITZ CANYON WA	2	PALM SPRINGS	CA	92262	6714	33	06065	33.8232273	-116.5408916	Riverside County
67333	Fee-for-Service	1932490760	1932490760	1	1	PATEL, SHETAL H MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109548	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
67340	Fee-for-Service	1215991302	1215991302	1	1	PRESS, RAYMOND I MD	10/31/1990	207RR0500X	NA	Other	026	PHYSICIANS	59304	41	Internal Medicine	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
67351	Fee-for-Service	1336295401	1336295401	1	1	POLADIAN, DONALD A DC	1/1/1979	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	POLADIAN CHIRO OFFICE	488 W SHAW AVE	None	FRESNO	CA	93704	2511	10	06019	36.80857949	-119.8014255	Fresno County
67374	Fee-for-Service	1386934875	1386934875	1	1	PEDIATRIC & FAMILY MEDICAL	7/1/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1400 S GRAND AVE	SUITE 101	LOS ANGELES	CA	90015	3023	19	06037	34.03692236	-118.2655238	Los Angeles County
67378	Fee-for-Service	1497854269	1497854269	1	1	PULMONARY ASSOCIATES PA	3/18/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	None	1112 E MCDOWELL ROAD	None	PHOENIX	AZ	85006	2611	00	None	33.466041	-112.0577625	Maricopa County
67434	Fee-for-Service	1134166259	1134166259	1	1	PETER J DEWEERD, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CITY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
67478	Fee-for-Service	1245859909	1245859909	1	1	POOLA, NIVEDITA MD MPH	6/24/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
67553	Fee-for-Service	1265118699	1265118699	1	1	PREMIER WOMENS IMAGING	6/19/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	99 LA CIENEGA BLVD	STE 104	BEVERLY HILLS	CA	90211	2286	19	06037	34.06736471	-118.3763201	Los Angeles County
67574	Fee-for-Service	1578505244	1578505244	1	1	PEDIATRIC THERAPY PARTNERS	2/23/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	416 W LAS TUNAS DR	SUITE 201	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
67589	Fee-for-Service	1255412474	1255412474	1	1	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INLAND EMPIRE INC	1998 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
67663	Fee-for-Service	1417397266	1417397266	1	1	PATEL, NIKITA N MD	8/15/2018	207L00000X	NA	Other	026	PHYSICIANS	155681	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
67735	Fee-for-Service	1720396690	1720396690	1	1	PROSTHETIC & ORTHOTIC GROUP	6/5/2017	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES INC	5837A UPLANDER WAY	None	CULVER CITY	CA	90230	6607	19	06037	33.9849033	-118.3862745	Los Angeles County
67738	Fee-for-Service	1932376274	1932376274	1	1	PERRY, RAYMOND C W MD	9/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107565	40	Pediatrics	0	In state provider	None	5850 SOUTH MAIN STREET	ROOM 2235	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
67763	Fee-for-Service	1710031588	1710031588	1	14	PROVIDENCE FACEY MEDICAL FOU	3/12/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2655 1ST ST	SUITE 325	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
67766	Fee-for-Service	1033169198	1033169198	1	1	PETER C DAINES	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 E 1400 N	None	LOGAN	UT	84341	2406	00	None	41.75742385	-111.8209142	Cache County
67773	Fee-for-Service	1164505525	1164505525	1	1	PIPPIN, CHERYL L CNP	11/13/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	None	42.25288307	-121.7896138	Klamath County
67795	Fee-for-Service	1710694161	1710694161	1	1	PROVIDENCE AMBULATORY SERVIC	10/20/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES INC	3975 JACKSON ST	STE 105	RIVERSIDE	CA	92503	3945	33	06065	33.92729721	-117.4413503	Riverside County
67796	Fee-for-Service	1417044868	1417044868	1	1	PETRIK, PAVEL V MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74861	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1331 W AVENUE J	STE 203	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
67803	Fee-for-Service	1316908361	1316908361	1	1	PEHDE, HARRIET LAUREL	12/31/1989	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12801 MEADOWLARK AVE	None	GRANADA HILLS	CA	91344	1210	19	06037	34.30309542	-118.5086992	Los Angeles County
67806	Fee-for-Service	1407315708	1407315708	1	1	PELLICCIONE, ALEX J MD	3/20/2023	208M00000X	NA	Other	026	PHYSICIANS	181379	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
67808	Fee-for-Service	1013495084	1013495084	1	1	PORTUGUES, NATHAN RCP	9/10/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
67840	Fee-for-Service	1578605549	1578605549	1	1	PHILLIPS, MARVA M LMFT	9/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
67852	Fee-for-Service	1679106686	1679106686	1	1	PARKER HEARING INSTITUTE, A	11/1/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	4201 TORRANCE	140	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
67858	Fee-for-Service	1467748244	1467748244	1	1	PATEL, ANISH S MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130387	41	Internal Medicine	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
67870	Fee-for-Service	1588894562	1588894562	1	1	PHAM, NIKKI H MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113355	08	Family Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
67875	Fee-for-Service	1255412474	1255412474	1	1	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	INLAND EMPIRE INC	1998 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
67900	Fee-for-Service	1326180613	1326180613	1	1	PACOFSKY, KENNETH B MD	1/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	32580	30	Radiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
67931	Fee-for-Service	1386299899	1386299899	1	1	PLANNED PARENTHOOD MAR MONTE	11/13/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	2500 CALIFORNIA ST	STE A	MOUNTAIN VIEW	CA	94040	1397	43	06085	37.40337202	-122.1063817	Santa Clara County
67975	Fee-for-Service	1396057105	1396057105	1	1	PUGLIESE, SILVINA B MD	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118309	07	Dermatology	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3844	36	06071	34.12632952	-117.1956652	San Bernardino County
68005	Fee-for-Service	1366119455	1366119455	1	1	PETRARCA, ALEXANDRA PT	1/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
68053	Fee-for-Service	1710031588	1710031588	1	14	PROVIDENCE FACEY MEDICAL FOU	3/12/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2655 1ST ST	SUITE 325	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
68086	Fee-for-Service	1417044868	1417044868	1	1	PETRIK, PAVEL V MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1331 W AVENUE J	STE 203	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
68091	Fee-for-Service	1033267018	1033267018	1	1	PITTS, RICHARD T MD	12/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	3451	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68105	Fee-for-Service	1831216282	1831216282	1	1	PRIESMAN, COREY A MD	8/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90340	36	Psychiatry	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
68142	Fee-for-Service	1679106686	1679106686	1	1	PARKER HEARING INSTITUTE, A	4/16/2021	231H00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	4201 TORRANCE	140	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
68150	Fee-for-Service	1346247855	1346247855	1	1	PEASE, HOWARD F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 RIM RD	STE 300	EL PASO	TX	79902	3669	00	None	31.77007403	-106.4980072	El Paso County
68151	Fee-for-Service	1083060347	1083060347	1	1	PAKALA, KEERTI MD	12/7/2020	207R00000X	NA	Other	026	PHYSICIANS	165983	None	None	0	In state provider	None	TWO MEDICAL PLAZA	STE 180	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
68164	Fee-for-Service	1255412474	1255412474	1	1	PRIMARY CARE MED GRP OF	3/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INLAND EMPIRE INC	1998 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
68202	Fee-for-Service	1043852528	1043852528	1	2	PHOENIX PHYSICAL THERAPY AND	7/12/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	WELLNESS INC	1577 E CHEVY CHASE DR	110	GLENDALE	CA	91206	4172	19	06037	34.15313959	-118.2299467	Los Angeles County
68226	Fee-for-Service	1336302447	1336302447	1	1	PATEL,RIMA	6/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8268 164TH ST	None	JAMAICA	NY	11432	1121	00	None	40.717917	-73.804086	Queens County
68262	Fee-for-Service	1437708526	1437708526	1	1	PLEISA-MUSAEV, ILZE PT	8/13/2021	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
68267	Fee-for-Service	1598993198	1598993198	1	1	PEDIATRIC DENTAL	9/1/2009	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INITIATIVE OF THE NORTH	1380 19TH HOLE DR	None	WINDSOR	CA	95492	7713	49	06097	38.52703536	-122.8043968	Sonoma County
68268	Fee-for-Service	1508097387	1508097387	1	1	PURI, POOJA MD	7/13/2018	2080P0214X	NA	Pulmonology	026	PHYSICIANS	152631	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
68271	Fee-for-Service	1598292302	1598292302	1	1	PELTER, MEGAN N MD	9/3/2024	1835C0206X	NA	None	026	PHYSICIANS	161455	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 6100,6300,7200,7300	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
68274	Fee-for-Service	1043833049	1043833049	1	1	PURPOSEFUL MOBILITY LLC	11/6/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5701 TRUXTUN AVE	220	BAKERSFIELD	CA	93309	0669	15	06029	35.36412529	-119.0677405	Kern County
68278	Fee-for-Service	1992171789	1992171789	1	1	PAING, SU MYAT N MD	4/17/2023	207R00000X	NA	Other	026	PHYSICIANS	153341	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
68313	Fee-for-Service	1275556748	1275556748	1	1	PEVERINI, RICARDO L MD	1/30/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56050	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
68341	Fee-for-Service	1710031588	1710031588	1	14	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2655 1ST ST	SUITE 325	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
68342	Fee-for-Service	1962579961	1962579961	1	1	PIVIK, CHRISTOPHER T MD	1/1/2000	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	65799	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 S SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	6814	19	06037	33.87583364	-118.3958985	Los Angeles County
68362	Fee-for-Service	1619946563	1619946563	1	1	PASTRANO, JOE A MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 EAST MAIN STREET	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
68366	Fee-for-Service	1073640223	1073640223	1	1	PHILLIPS, BROOKE N	7/19/2005	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 W 3RD ST	None	LOS ANGELES	CA	90057	1922	19	06037	34.06308947	-118.2733326	Los Angeles County
68373	Fee-for-Service	1609070994	1609070994	1	1	PATEL, DEVANG J MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91453	40	Pediatrics	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
68381	Fee-for-Service	1033267018	1033267018	1	1	PITTS, RICHARD T MD	12/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	3451	08	Family Practice	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68386	Fee-for-Service	1043446982	1043446982	1	1	PATEL, REEKESH R MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126035	25	Physical Medicine and Rehabilitation	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
68389	Fee-for-Service	1912951799	1912951799	1	1	POLANSKY, ROBIN E MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99219	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
68390	Fee-for-Service	1396069837	1396069837	1	1	PLASENCIA, ALEXIS N MD	11/2/2018	208600000X	NA	General Surgery	026	PHYSICIANS	120574	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
68395	Fee-for-Service	1679630305	1679630305	1	1	PIMENTEL, LINDSAY	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HAND TO SHOULDER REHAB	670 E BULLARD AVE	STE 105	FRESNO	CA	93710	5455	10	06019	36.82312553	-119.774853	Fresno County
68398	Fee-for-Service	1942720263	1942720263	1	1	PONTIER, SHENNA K	10/6/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12031 POUTOUS CT	None	MORENO VALLEY	CA	92557	8147	33	06065	33.945876	-117.2480095	Riverside County
68409	Fee-for-Service	1801941190	1801941190	1	1	PRORIDE CORPORATION	9/14/1995	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	815 COMMERCIAL AVE	None	SAN GABRIEL	CA	91776	1911	19	06037	34.0966941	-118.0902458	Los Angeles County
68431	Fee-for-Service	1396496923	1396496923	1	1	PEIK, AUSTIN J CRNA	9/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
68449	Fee-for-Service	1235508656	1235508656	1	1	PREISS, NICOLE L PHD	11/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
68467	Fee-for-Service	1528246519	1528246519	1	1	PICONE, DEAN E PHD	7/9/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	None	ANTIOCH	CA	94531	8238	07	06013	0	0	None
68497	Fee-for-Service	1528695418	1528695418	1	1	PENN, AMY W MD	2/10/2023	207R00000X	NA	Other	026	PHYSICIANS	179985	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
68509	Fee-for-Service	1477971448	1477971448	1	1	PROMISE ASSISTED LIVING LLC	4/24/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1231 S ALVARADO ST	None	LOS ANGELES	CA	90006	4119	19	06037	34.04795692	-118.2822783	Los Angeles County
68528	Fee-for-Service	1104899319	1104899319	1	1	PETERSBURG HOSPITAL COMPANY	1/25/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	200 MEDICAL PARK BLVD	None	PETERSBURG	VA	23805	9274	00	None	37.182294	-77.359329	Petersburg city
68556	Fee-for-Service	1508097387	1508097387	1	1	PURI, POOJA MD	7/13/2018	2080P0214X	NA	Pulmonology	026	PHYSICIANS	152631	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
68568	Fee-for-Service	1790117331	1790117331	1	1	PHAN, DANA Y OD INC	4/11/2014	302R00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8951 KNOTT AVE	STE K	BUENA PARK	CA	90620	4108	30	06059	33.832791	-118.0110995	Orange County
68576	Fee-for-Service	1215147103	1215147103	1	1	POCHAPPAN, ABHILASH NAIR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1951 N WILMOT RD	STE 4	TUCSON	AZ	85712	8000	00	None	32.246379	-110.859084	Pima County
68580	Fee-for-Service	1073519443	1073519443	1	5	PIONEERS MEMORIAL HEALTH	9/13/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	751 WEST LEGION RD	SUITE 201	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
68581	Fee-for-Service	1124489836	1124489836	1	1	PARK, ANDREW Y LMFT	4/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90876	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
68589	Fee-for-Service	1841426947	1841426947	1	1	POTTALA, SREELATHA MD	9/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117291	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
68593	Fee-for-Service	1629020086	1629020086	1	1	PROVENA HOSPITALS	8/14/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1400 WEST PARK	None	URBANA	IL	61801	2396	00	None	40.11741598	-88.22743343	Champaign County
68594	Fee-for-Service	1568400208	1568400208	1	2	POPULAR MED CLINIC INC	7/14/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	767 W 19TH ST	STE 101	COSTA MESA	CA	92627	3500	30	06059	33.64335649	-117.930528	Orange County
68629	Fee-for-Service	1457403677	1457403677	1	1	PARKAR, JABEEN A MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93695	01	General Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
68651	Fee-for-Service	1083727051	1083727051	1	1	PATEL, RAMESH MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46568	78	Neoplastic Diseases/Oncology	0	In state provider	None	2653 ELM AVE	STE 200	LONG BEACH	CA	90806	1652	19	06037	33.805512	-118.188348	Los Angeles County
68660	Fee-for-Service	1609070994	1609070994	1	1	PATEL, DEVANG J MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91453	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
68667	Fee-for-Service	1033267018	1033267018	1	1	PITTS, RICHARD T MD	12/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	3451	01	General Practice	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68684	Fee-for-Service	1366998882	1366998882	1	1	PIMENTEL, JULIO LCSW	3/20/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
68687	Fee-for-Service	1942720263	1942720263	1	1	PONTIER, SHENNA K	10/6/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12031 POUTOUS CT	None	MORENO VALLEY	CA	92557	8147	33	06065	33.945876	-117.2480095	Riverside County
68723	Fee-for-Service	1811192651	1811192651	1	1	PAEK, WOO MD	3/7/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95866	40	Pediatrics	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
68732	Fee-for-Service	1477602639	1477602639	2	1	PACIFIC DIAGNOSTIC LABS LLC	2/2/2009	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	454 SOUTH PATTERSON AVE	None	SANTA BARBARA	CA	93111	2404	42	06083	34.43265227	-119.8100719	Santa Barbara County
68756	Fee-for-Service	1437281409	1437281409	1	2	PROHEALTH PARTNERS, A MEDICA	4/13/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC.	3661 TORRANCE BLVD	STE 103	TORRANCE	CA	90503	4887	19	06037	33.83762646	-118.351116	Los Angeles County
68801	Fee-for-Service	1639531890	1639531890	1	1	PYIE, AUNG P DO	4/26/2020	207P00000X	NA	Other	026	PHYSICIANS	17195	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
68815	Fee-for-Service	1861855272	1861855272	1	1	PERLOFF, SPENSER H MD	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	12677 ALCOSTA BLVD	STE 220	SAN RAMON	CA	94583	4423	07	06013	37.77574358	-121.9604905	Contra Costa County
68817	Fee-for-Service	1104899319	1104899319	1	1	PETERSBURG HOSPITAL COMPANY	1/25/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	200 MEDICAL PARK BLVD	None	PETERSBURG	VA	23805	9274	00	None	37.182294	-77.359329	Petersburg city
68822	Fee-for-Service	1194814277	1194814277	1	1	PROPST, TOBE M MD	12/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	82123	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
68834	Fee-for-Service	1548303589	1548303589	1	6	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	16510 BLOOMFIELD AVE	None	CERRITOS	CA	90703	2115	19	06037	33.88108335	-118.0639087	Los Angeles County
68860	Fee-for-Service	1073519443	1073519443	1	6	PIONEERS MEMORIAL HEALTH	4/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE DISTRICT	320 WEST CATTLE CALL DR	None	BRAWLEY	CA	92227	3108	13	06025	32.97077248	-115.546194	Imperial County
68862	Fee-for-Service	1467411660	1467411660	1	1	PHILLIP COLLIER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3601 WEST 13TH MILE ROAD	None	ROYAL OAK	MI	48073	0000	00	None	42.513885	-83.193228	Oakland County
68883	Fee-for-Service	1629020086	1629020086	1	1	PROVENA HOSPITALS	8/14/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1400 WEST PARK	None	URBANA	IL	61801	2396	00	None	40.11741598	-88.22743343	Champaign County
68909	Fee-for-Service	1013159318	1013159318	1	1	PEREA, MARTIN A LMFT	11/22/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	628 N VERMONT AVE STE 10	None	LOS ANGELES	CA	90004	2154	19	06037	34.082658	-118.2916805	Los Angeles County
68928	Fee-for-Service	1942712211	1942712211	1	1	POST, ZENON LCSW	11/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
68939	Fee-for-Service	1083727051	1083727051	1	1	PATEL, RAMESH MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46568	40	Pediatrics	0	In state provider	None	2653 ELM AVE	STE 200	LONG BEACH	CA	90806	1652	19	06037	33.805512	-118.188348	Los Angeles County
68965	Fee-for-Service	1760714919	1760714919	1	1	POWERS, NICHOLAS LMFT	2/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
68966	Fee-for-Service	1346544046	1346544046	1	1	PALOMARES, ROSALIA LMFT	1/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
68989	Fee-for-Service	1700863198	1700863198	1	2	PARK, CHRISTOPHER	1/21/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89672	41	Internal Medicine	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
69001	Fee-for-Service	1174507735	1174507735	1	1	PAKYUREK, MURAT MD	10/8/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53394	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
69024	Fee-for-Service	1548343502	1548343502	1	1	PARADIZ, GUSTAVO	12/27/2007	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	125 N JACKSON AVE	#201	SAN JOSE	CA	95116	1915	43	06085	37.36117713	-121.8462226	Santa Clara County
69047	Fee-for-Service	1467479097	1467479097	1	1	PRESS, STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5145 N CALIFORNIA AVE	None	CHICAGO	IL	60625	3661	00	None	41.975136	-87.6988805	Cook County
69058	Fee-for-Service	1366407603	1366407603	1	2	PARKVIEW HOSPITAL, INC	5/28/2021	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	11109 PARKVIEW PLAZA DR	None	FORT WAYNE	IN	46845	1701	00	None	41.1874757	-85.09943567	Allen County
69105	Fee-for-Service	1861855272	1861855272	1	1	PERLOFF, SPENSER H MD	5/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	12677 ALCOSTA BLVD	STE 220	SAN RAMON	CA	94583	4423	07	06013	37.77574358	-121.9604905	Contra Costa County
69137	Fee-for-Service	1629053509	1629053509	1	1	PRESBYTERIAN HEALTHCARE	4/28/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	2100 MARTIN LUTHER KING	None	CLOVIS	NM	88101	9412	00	None	34.420608	-103.233879	Curry County
69140	Fee-for-Service	1225387152	1225387152	1	1	PATEL, SONALI C MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149835	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
69143	Fee-for-Service	1104913540	1104913540	1	1	PRESBERG, BURTON A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79595	36	Psychiatry	0	In state provider	None	286 SANTA CLARA AVE	None	OAKLAND	CA	94610	2624	01	06001	37.81652567	-122.2496469	Alameda County
69145	Fee-for-Service	1710031588	1710031588	1	17	PROVIDENCE FACEY MEDICAL FOU	5/23/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
69166	Fee-for-Service	1164886040	1164886040	1	1	PEACH TREE HEALTHCARE	7/28/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3810 ROSIN CT	SUITE 100	SACRAMENTO	CA	95834	1656	34	06067	38.637702	-121.474773	Sacramento County
69175	Fee-for-Service	1477111805	1477111805	1	1	PHILIP D SZOLD, MD, INC	10/31/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 205	LA MESA	CA	91942	3187	37	06073	32.78442148	-117.0073814	San Diego County
69178	Fee-for-Service	1306994595	1306994595	1	1	PAGE, NATHAN C MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108131	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
69200	Fee-for-Service	1053632950	1053632950	1	1	PANNIER, AARON G MD	11/13/2017	207P00000X	NA	Other	026	PHYSICIANS	150688	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
69214	Fee-for-Service	1992843379	1992843379	1	1	PARLIER UNIFIED SCHOOL	11/18/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	900 S NEWMARK AVE	None	PARLIER	CA	93648	2034	10	06019	36.61739508	-119.529779	Fresno County
69226	Fee-for-Service	1083727051	1083727051	1	1	PATEL, RAMESH MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46568	68	Hematology	0	In state provider	None	2653 ELM AVE	STE 200	LONG BEACH	CA	90806	1652	19	06037	33.805512	-118.188348	Los Angeles County
69302	Fee-for-Service	1548303589	1548303589	1	3	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
69304	Fee-for-Service	1457451585	1457451585	1	1	PHAM, ERIC H MD INC	8/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78428	02	General Surgery	0	In state provider	None	17542 E 17TH STREET	SUITE 410	TUSTIN	CA	92780	1959	30	06059	33.75966953	-117.8261065	Orange County
69327	Fee-for-Service	1639357775	1639357775	1	1	PATEL, REENA MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106184	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
69329	Fee-for-Service	1073669040	1073669040	1	2	PLANNED PARENTHOOD PASADENA	8/18/2014	251V00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	NA	4070 STERLING WAY	ROOM 102	BALDWIN PARK	CA	91706	4223	19	06037	34.08540997	-117.9626686	Los Angeles County
69350	Fee-for-Service	1366407603	1366407603	1	2	PARKVIEW HOSPITAL, INC	5/28/2021	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	11109 PARKVIEW PLAZA DR	None	FORT WAYNE	IN	46845	1701	00	None	41.1874757	-85.09943567	Allen County
69354	Fee-for-Service	1649519646	1649519646	1	2	PURDOM II, KENNETH R MD INC	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	21180	None	None	0	In state provider	None	1441 W WHITTIER BLVD	None	LA HABRA	CA	90631	3614	30	06059	33.93938168	-117.9616934	Orange County
69380	Fee-for-Service	1134132137	1134132137	1	1	PERKINS, STANLEY W MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46916	05	Anesthesiology	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
69406	Fee-for-Service	1770977696	1770977696	1	1	PADILLA, GUILLERMO MD	7/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146214	08	Family Practice	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
69418	Fee-for-Service	1952456105	1952456105	1	1	PLANNED PARENTHOOD	11/3/2006	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA CENTRAL COAST	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	43	06085	37.3373761	-121.9192532	Santa Clara County
69424	Fee-for-Service	1629053509	1629053509	1	1	PRESBYTERIAN HEALTHCARE	4/28/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	2100 MARTIN LUTHER KING	None	CLOVIS	NM	88101	9412	00	None	34.420608	-103.233879	Curry County
69429	Fee-for-Service	1528146412	1528146412	1	1	PIA, JOHN M	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2900 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
69434	Fee-for-Service	1710031588	1710031588	1	17	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
69455	Fee-for-Service	1164886040	1164886040	1	1	PEACH TREE HEALTHCARE	9/20/2017	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3810 ROSIN CT	SUITE 100	SACRAMENTO	CA	95834	1656	34	06067	38.637702	-121.474773	Sacramento County
69482	Fee-for-Service	1740981760	1740981760	1	1	PETE, NELLY MWAI	6/22/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4075 SPARKLE BERRY	None	SAN BERNARDINO	CA	92407	0601	36	06071	34.19012744	-117.4136428	San Bernardino County
69484	Fee-for-Service	1083965131	1083965131	1	2	PORTNOY, ALEXANDRA LMFT	1/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7445 TOPANGA CANYON BLVD	225	CANOGA PARK	CA	91303	3364	19	06037	34.205886	-118.6059885	Los Angeles County
69495	Fee-for-Service	1295182830	1295182830	1	1	PRO NURSING HOME CARE, INC	10/25/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2201 MOUNT VERNON AVE	STE 110	BAKERSFIELD	CA	93306	3312	15	06029	35.38781796	-118.9673567	Kern County
69519	Fee-for-Service	1538169990	1538169990	1	1	PFEIFFER, RICHARD J MD	12/1/1995	207P00000X	NA	Other	026	PHYSICIANS	36848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
69536	Fee-for-Service	1659459477	1659459477	1	1	PEARSON, JAMES L MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54540	01	General Practice	0	In state provider	None	1020 VENTURA AVE	None	CHOWCHILLA	CA	93610	2368	20	06039	37.12167009	-120.2723602	Madera County
69567	Fee-for-Service	1265788558	1265788558	1	1	PHARMACY 90210 INC	2/28/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9735 WILSHIRE BLVD	# 110	BEVERLY HILLS	CA	90212	2107	19	06037	34.06711051	-118.4074605	Los Angeles County
69590	Fee-for-Service	1548303589	1548303589	1	3	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
69622	Fee-for-Service	1639357775	1639357775	1	1	PATEL, REENA MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
69629	Fee-for-Service	1285742601	1285742601	1	1	PAN, THOMAS OD	10/26/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2110 FOREST AVE	STE B	SAN JOSE	CA	95128	3901	43	06085	37.32701954	-121.9374675	Santa Clara County
69630	Fee-for-Service	1033288105	1033288105	1	1	PYPER, AMANDA LMFT	2/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	604 E OCEAN AVE	G	LOMPOC	CA	93436	6925	42	06083	34.63889848	-120.451275	Santa Barbara County
69650	Fee-for-Service	1114422631	1114422631	1	1	PARK, HAELI MD	1/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163831	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
69651	Fee-for-Service	1548303589	1548303589	1	4	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	10234 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2602	19	06037	33.90197379	-118.1144208	Los Angeles County
69660	Fee-for-Service	1659374262	1659374262	1	1	PETERS, BRADLEY R MD	9/25/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134353	30	Radiology	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
69661	Fee-for-Service	1821449430	1821449430	1	1	PARK, JASON A MD APC	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62812	None	None	0	In state provider	None	1111 EXPOSITION BLVD	SUITE 400A	SACRAMENTO	CA	95815	4336	34	06067	38.598876	-121.4502885	Sacramento County
69671	Fee-for-Service	1518638691	1518638691	1	1	PEACE CHINESE MEDICINE WELLN	11/1/2022	261Q00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ESS CENTER	7275 E SOUTHGATE DR	303	SACRAMENTO	CA	95823	2631	34	06067	38.493576	-121.436559	Sacramento County
69720	Fee-for-Service	1710031588	1710031588	1	17	PROVIDENCE FACEY MEDICAL FOU	5/23/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
69724	Fee-for-Service	1568626620	1568626620	1	1	PARIKH, NISHA	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
69732	Fee-for-Service	1245849645	1245849645	1	1	PEREIRA, SHANNON NP	1/12/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	07	06013	37.88758326	-122.1181419	Contra Costa County
69738	Fee-for-Service	1235191883	1235191883	1	1	PRIETO, ALEJANDRO R MD	5/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53184	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2220 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
69742	Fee-for-Service	1164886040	1164886040	1	1	PEACH TREE HEALTHCARE	7/31/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3810 ROSIN CT	SUITE 100	SACRAMENTO	CA	95834	1656	34	06067	38.637702	-121.474773	Sacramento County
69770	Fee-for-Service	1740981760	1740981760	1	1	PETE, NELLY MWAI	6/22/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4075 SPARKLE BERRY	None	SAN BERNARDINO	CA	92407	0601	36	06071	34.19012744	-117.4136428	San Bernardino County
69785	Fee-for-Service	1700868361	1700868361	1	1	PETERSON, ELIZABETH K MD	6/22/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68921	40	Pediatrics	0	In state provider	None	4641 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6816	09	06017	38.69579093	-120.8237245	El Dorado County
69791	Fee-for-Service	1649539586	1649539586	1	1	PRINCE, CATHERINE T DO	8/9/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	17322	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	198 COHASSET RD	None	CHICO	CA	95926	2202	04	06007	39.75140931	-121.8541188	Butte County
69795	Fee-for-Service	1215900824	1215900824	1	1	PETERSEN, DAVID A MD	12/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
69802	Fee-for-Service	1669836953	1669836953	1	1	PUNATAR, NISHA H MD	9/28/2019	207R00000X	NA	Other	026	PHYSICIANS	151009	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
69809	Fee-for-Service	1346879517	1346879517	1	1	PLAVAJKA, ROBERT LMFT	8/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
69841	Fee-for-Service	1073755161	1073755161	1	1	PINGITORE, ANDREA L MD	8/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94438	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
69855	Fee-for-Service	1568978567	1568978567	1	1	PARKER, SARAH J LMFT	11/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	78150 CALLE TAMPICO	STE 200 I	LA QUINTA	CA	92253	7406	33	06065	33.67817382	-116.30003	Riverside County
69863	Fee-for-Service	1255651378	1255651378	1	1	PARK, LOUIS S M D INC	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79245	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1300 N VERMONT AVE	600	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
69909	Fee-for-Service	1659522779	1659522779	1	1	PIAO, CHUN F CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2655 W OLYMPIC BLVD	SUITE 205	LOS ANGELES	CA	90006	2800	19	06037	34.05243121	-118.289956	Los Angeles County
69913	Fee-for-Service	1699185249	1699185249	1	1	PATEL, KUNJ G MD	6/12/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	173522	None	None	0	In state provider	None	4879	MISSION ST	SAN FRANCISCO	CA	95376	3959	38	06075	0	0	None
69915	Fee-for-Service	1548231038	1548231038	2	1	PHAM, THUY L OD	1/15/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17617 PIONEER BLVD	None	ARTESIA	CA	90701	4008	19	06037	33.87077683	-118.0823775	Los Angeles County
69923	Fee-for-Service	1447364872	1447364872	1	1	PRUITT-MCDERMOTT, PATRICIA A	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45516	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
69963	Fee-for-Service	1366717621	1366717621	1	1	PIDOR, MYKIE L MD	1/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120573	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
70030	Fee-for-Service	1164886040	1164886040	1	1	PEACH TREE HEALTHCARE	7/28/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3810 ROSIN CT	SUITE 100	SACRAMENTO	CA	95834	1656	34	06067	38.637702	-121.474773	Sacramento County
70033	Fee-for-Service	1649282823	1649282823	1	1	PATZAKIS, MICHAEL J MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	26268	20	Orthopedic Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 322	LOS ANGELES	CA	90033	5305	19	06037	34.06287152	-118.2029433	Los Angeles County
70119	Fee-for-Service	1104181734	1104181734	1	1	PANDYA, TAPAN MD	3/5/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	155589	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3851 KATELLA AVE	315	LOS ALAMITOS	CA	90720	3309	30	06059	33.80319053	-118.0657305	Orange County
70137	Fee-for-Service	1982130613	1982130613	1	1	PIN, BUNRY	1/3/2023	208600000X	NA	General Surgery	026	PHYSICIANS	19951	None	None	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504962	-121.3858245	San Benito County
70139	Fee-for-Service	1609352798	1609352798	1	1	PHAN, RICHARD OD	9/18/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	82227 US HIGHWAY 111	SUITE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
70145	Fee-for-Service	1255651378	1255651378	1	1	PARK, LOUIS S M D INC	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79245	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	600	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
70215	Fee-for-Service	1245920669	1245920669	1	1	PAQUINI, PAOLA NP	9/30/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
70232	Fee-for-Service	1447327267	1447327267	1	1	PHAM, MINHCHAU T MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80500	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
70271	Fee-for-Service	1285155374	1285155374	1	1	PEREZ-RODRIGUEZ, OLGA L CNP	1/12/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
70291	Fee-for-Service	1730421264	1730421264	1	1	PATEL, ARPAN D MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147573	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
70354	Fee-for-Service	1801808712	1801808712	1	1	PAKDAMAN, NADINE N MD	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76051	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
70367	Fee-for-Service	1366006645	1366006645	1	1	POLEVOI, CAROL A MFT AND	10/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	WELLNESS COACH APC	16055 VENTURA BLVD	STE 717	ENCINO	CA	91436	4591	19	06037	34.15632563	-118.4832351	Los Angeles County
70373	Fee-for-Service	1427810548	1427810548	1	1	PAINTED BRAIN	3/4/2024	251S00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	777 ALAMEDA ST	2029	LOS ANGELES	CA	90021	1633	19	06037	34.03378827	-118.2387417	Los Angeles County
70374	Fee-for-Service	1467075903	1467075903	1	1	PUSO, ANNE MARIE	6/14/2024	390200000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
70473	Fee-for-Service	1871728527	1871728527	1	1	PEYKAR, SHIRIN LMFT	1/8/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4835 VAN NUYS BLVD	SUITE 200	SHERMAN OAKS	CA	91403	2139	19	06037	34.1587068	-118.4487394	Los Angeles County
70478	Fee-for-Service	1629689716	1629689716	1	1	PRUNEAN, JOSEPH OT	7/21/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
70511	Fee-for-Service	1972614899	1972614899	1	1	PALESTRANT,DAVID MD	7/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75862	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
70512	Fee-for-Service	1083348882	1083348882	1	1	PRESS HEALTH INC	12/28/2022	261QU0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	303 BROADWAY ST STE 103	None	LAGUNA BEACH	CA	92651	1816	30	06059	33.54461007	-117.7835126	Orange County
70529	Fee-for-Service	1891258422	1891258422	1	1	PHAM, PHISON MD	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180117	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
70538	Fee-for-Service	1760091698	1760091698	1	1	PARADISE HOME HEALTH GROUP	5/17/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	120 N VICTORY BLVD	STE 205	BURBANK	CA	91502	0001	19	06037	34.17426705	-118.3168333	Los Angeles County
70548	Fee-for-Service	1912373952	1912373952	1	1	POUGATSCH, DAVID A DPM INC	11/7/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4849 VAN NUYS BLVD	STE 210	SHERMAN OAKS	CA	91403	2010	19	06037	34.159113	-118.4487465	Los Angeles County
70551	Fee-for-Service	1932355278	1932355278	1	1	PERRY, KENNETH J MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
70571	Fee-for-Service	1538673181	1538673181	1	1	PETERSON, THOMAS J NP	9/12/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	554-850 MEDICAL CTR DR	None	BIEBER	CA	96009	0277	18	06035	0	0	None
70587	Fee-for-Service	1275600850	1275600850	1	1	PISER, JOEL A MD	6/30/1987	2088P0231X	NA	Other	026	PHYSICIANS	43674	34	Urology and Urological Surgery	0	In state provider	None	2999 REGENT ST	STE 612	BERKELEY	CA	94705	2121	01	06001	37.85592021	-122.2566436	Alameda County
70596	Fee-for-Service	1942356795	1942356795	1	1	PLAXE, STEVEN C MD	9/30/1988	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64817	None	None	0	In state provider	None	225 DICKINSON ST	# H210	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
70637	Fee-for-Service	1629820378	1629820378	1	1	PILEGGI, STEPHANIE M NP	4/4/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
70641	Fee-for-Service	1063257889	1063257889	1	1	PAPAS, BRET HART PT	2/21/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
70643	Fee-for-Service	1871517953	1871517953	1	1	PLOSAY, JOHN J III MD	1/1/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62782	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
70686	Fee-for-Service	1821121336	1821121336	1	1	PERDUE, CYNTHIA C LCSW	6/29/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 S LAKE AVE	STE 284D	PASADENA	CA	91101	3530	19	06037	34.1397069	-118.1322284	Los Angeles County
70739	Fee-for-Service	1538423165	1538423165	1	1	PILLAPPA, RAGHAVENDRA MD	10/8/2023	207ZP0102X	NA	Other	026	PHYSICIANS	190150	None	None	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
70740	Fee-for-Service	1124554639	1124554639	1	1	PHAM, THOMAS	9/1/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	16896	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
70747	Fee-for-Service	1669056149	1669056149	1	1	PREMIERE HOSPICE AND PALLIAT	7/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE INC	18645 SHERMAN WAY	STE 106	RESEDA	CA	91335	8605	19	06037	34.20120553	-118.54026	Los Angeles County
70764	Fee-for-Service	1760480065	1760480065	2	1	PENDERGRAFT, RAY D DC	12/6/2019	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2512 ARTESIA BLVD	STE 230	REDONDO BEACH	CA	90278	3277	19	06037	33.87276506	-118.365232	Los Angeles County
70799	Fee-for-Service	1972614899	1972614899	1	1	PALESTRANT,DAVID MD	7/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75862	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
70816	Fee-for-Service	1770961997	1770961997	1	1	PRESS, JESSICA D LCSW	9/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
70817	Fee-for-Service	1891258422	1891258422	1	1	PHAM, PHISON MD	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	180117	47	Miscellaneous	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
70881	Fee-for-Service	1811091952	1811091952	1	2	PEDIATRIC MEDICAL GROUP OF S	2/1/2021	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ANTA MARIA, INC.	1430 E MAIN ST	SUITE 201	SANTA MARIA	CA	93454	4809	42	06083	34.9528467	-120.4127301	Santa Barbara County
70895	Fee-for-Service	1346752003	1346752003	1	1	PING ON HOLDINGS LLC	6/20/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7921 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.7593273	-117.99108	Orange County
70907	Fee-for-Service	1043741531	1043741531	1	1	PETERS, PAMELA N MD	9/9/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158390	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
70945	Fee-for-Service	1194752527	1194752527	1	1	PETERS, JOHANNES G MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86875	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
70997	Fee-for-Service	1780609982	1780609982	1	1	PATEL, RAJENDRA U MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
71033	Fee-for-Service	1669056149	1669056149	1	1	PREMIERE HOSPICE AND PALLIAT	7/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE INC	18645 SHERMAN WAY	STE 106	RESEDA	CA	91335	8605	19	06037	34.20120553	-118.54026	Los Angeles County
71039	Fee-for-Service	1750452413	1750452413	1	1	PIAN, MARK S MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	56773	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3030 CHILDRENS WAY	STE 205	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
71048	Fee-for-Service	1801837927	1801837927	1	1	PHUN, KENNETH MD	6/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	48951	36	Psychiatry	0	In state provider	None	2418 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	3648	19	06037	34.0558524	-118.0905163	Los Angeles County
71079	Fee-for-Service	1144312430	1144312430	1	1	PRINCETON BAPTIST MED	1/26/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	701 PRINCETON AVE SW	None	BIRMINGHAM	AL	35211	1303	00	None	33.49906545	-86.84606851	Jefferson County
71086	Fee-for-Service	1972614899	1972614899	1	1	PALESTRANT,DAVID MD	7/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75862	13	Neurology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
71118	Fee-for-Service	1295080588	1295080588	1	1	PULLIN, KEITH L	10/1/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
71128	Fee-for-Service	1942274212	1942274212	1	1	PALAZZOLO, MICHAEL MD	10/1/1983	207R00000X	NA	Other	026	PHYSICIANS	33998	41	Internal Medicine	0	In state provider	None	10339 BALBOA BLVD	STE 200	GRANADA HILLS	CA	91344	7319	19	06037	34.2586457	-118.5023394	Los Angeles County
71133	Fee-for-Service	1992753859	1992753859	1	1	PATEL, PRATUL MD	4/27/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53664	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
71153	Fee-for-Service	1013534593	1013534593	1	1	PHILIP ROSENTHAL MD PC	2/5/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2323 16TH ST	STE 407	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
71163	Fee-for-Service	1265512198	1265512198	1	1	PATEL, SANKET L MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
71194	Fee-for-Service	1700131059	1700131059	1	1	PATEL, DARPAN V DO	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13983	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71264	Fee-for-Service	1053576066	1053576066	1	1	PRAKASH, SHRADDHA MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106189	83	Rheumatology	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
71284	Fee-for-Service	1780609982	1780609982	1	1	PATEL, RAJENDRA U MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61544	41	Internal Medicine	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
71292	Fee-for-Service	1508215781	1508215781	1	1	PARIKH, SATYUM R MD	11/29/2022	208VP0000X	NA	Other	026	PHYSICIANS	177457	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
71301	Fee-for-Service	1588050173	1588050173	1	1	POULOS, THERESA A MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145848	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
71315	Fee-for-Service	1386790145	1386790145	1	1	PRAIRIE MEDICAL GRP INC	5/20/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2825 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
71328	Fee-for-Service	1750452413	1750452413	1	1	PIAN, MARK S MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	56773	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 205	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
71339	Fee-for-Service	1164990677	1164990677	1	1	PASTERNAK, ANNA NP	5/6/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
71354	Fee-for-Service	1124751417	1124751417	1	1	PLUCINIK, STANLEY OD	11/15/2023	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 110B	SAN DIMAS	CA	91773	2541	19	06037	34.10669347	-117.814932	Los Angeles County
71367	Fee-for-Service	1144312430	1144312430	1	1	PRINCETON BAPTIST MED	1/26/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	701 PRINCETON AVE SW	None	BIRMINGHAM	AL	35211	1303	00	None	33.49906545	-86.84606851	Jefferson County
71392	Fee-for-Service	1578269627	1578269627	1	1	PRAUGHT, BONNIE NP	8/4/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
71394	Fee-for-Service	1386929719	1386929719	1	1	PATEL, AMIT J MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130076	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
71403	Fee-for-Service	1871652529	1871652529	1	1	PATEL, AVANISH R MD	12/31/1986	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	61770	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
71408	Fee-for-Service	1588930226	1588930226	1	1	POLESCHUK, NATALIA NP	8/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 SAND CREEK RD	STE 144	BRENTWOOD	CA	94513	7176	07	06013	37.94689155	-121.7370896	Contra Costa County
71418	Fee-for-Service	1548822992	1548822992	1	1	PARIKH, HARDIK PT	1/13/2024	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
71458	Fee-for-Service	1710031588	1710031588	1	22	PROVIDENCE FACEY MEDICAL FOU	9/17/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
71474	Fee-for-Service	1578099735	1578099735	1	1	PATEL, DEVIN MD	7/2/2020	207R00000X	NA	Other	026	PHYSICIANS	160323	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
71496	Fee-for-Service	1598719189	1598719189	1	1	PLANNED PRNTHD MAR MONTE	7/1/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3166 COLLINS DR	None	MERCED	CA	95348	3132	24	06047	37.320318	-120.476542	Merced County
71517	Fee-for-Service	1689610511	1689610511	1	1	PANKRATZ, CHARLES L MD	1/19/2011	207R00000X	NA	Other	026	PHYSICIANS	64556	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
71521	Fee-for-Service	1497261549	1497261549	1	1	PAYLESS 96 INC	4/17/2019	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1200 MERCANTILE STREET	None	OXNARD	CA	93030	7522	56	06111	34.18838486	-119.1695037	Ventura County
71525	Fee-for-Service	1720496235	1720496235	1	1	PHELPS, W. KANE LMFT	8/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	860 VIA DE LA PAZ	SUITE F3	PACIFIC PALISADES	CA	90272	3608	19	06037	34.04665798	-118.5272006	Los Angeles County
71528	Fee-for-Service	1013140268	1013140268	1	1	PARK, MI N PHD	5/5/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8631	19	06037	34.07067	-118.4432445	Los Angeles County
71536	Fee-for-Service	1568908804	1568908804	1	1	PAUL J KIM MD INC	9/2/2017	2085R0001X	NA	Other	026	PHYSICIANS	None	78	Neoplastic Diseases/Oncology	0	In state provider	None	2895 EDINGER AVE	None	TUSTIN	CA	92780	7257	30	06059	33.70859781	-117.8080464	Orange County
71550	Fee-for-Service	1053576066	1053576066	1	1	PRAKASH, SHRADDHA MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106189	41	Internal Medicine	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
71581	Fee-for-Service	1568004901	1568004901	1	1	PATINO, DENISE K LMFT	9/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
71613	Fee-for-Service	1144277526	1144277526	1	1	PALISOC, ALMA M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	101303	41	Internal Medicine	0	In state provider	None	1454 E 2ND STREET	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
71666	Fee-for-Service	1700260288	1700260288	1	1	PAISLEY, MICHAEL MD	9/17/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	147257	02	General Surgery	0	In state provider	None	2621 DE LA VINA ST	STE 204	SANTA BARBARA	CA	93105	3823	42	06083	34.43503648	-119.7247588	Santa Barbara County
71725	Fee-for-Service	1396804969	1396804969	1	1	PINSKY, GREGORY S MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69886	70	Clinic (mixed specialty)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
71742	Fee-for-Service	1710031588	1710031588	1	3	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
71748	Fee-for-Service	1710031588	1710031588	1	22	PROVIDENCE FACEY MEDICAL FOU	12/27/2020	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
71775	Fee-for-Service	1750319356	1750319356	1	1	PIMENTEL, MARK MD	1/1/1999	174400000X	NA	Other	026	PHYSICIANS	60576	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
71790	Fee-for-Service	1649621335	1649621335	1	1	PHAM, XUAN T MD	10/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170010	09	Gynecology (D.O. only)	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
71793	Fee-for-Service	1730399460	1730399460	1	1	PEDRETTI, TIA A LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
71796	Fee-for-Service	1619515293	1619515293	1	1	PANGILINAN, LANIGAIL NP	3/6/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
71802	Fee-for-Service	1639676612	1639676612	1	1	PATEL, NEEMA N MD	9/13/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163476	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
71827	Fee-for-Service	1699129403	1699129403	1	1	PLANNED PARENTHOOD MAR MONTE	7/27/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SOUTH SAN FRANCISCO	435 GRAND AVENUE	None	S SAN FRANCISCO	CA	94080	3635	41	06081	37.65596966	-122.413882	San Mateo County
71866	Fee-for-Service	1134931256	1134931256	1	1	PAZAN INTEGRATIVE FAMILY THE	1/28/2025	261QM0850X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RAPY INC	5290 OVERPASS RD	SUITE 106	SANTA BARBARA	CA	93111	2052	42	06083	34.43960012	-119.8079098	Santa Barbara County
71876	Fee-for-Service	1629069885	1629069885	1	1	PATRICK JAMES MULLEN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2121 W IRONWOOD CENTER D	None	COEUR D ALENE	ID	83814	2639	00	None	47.69612849	-116.7966518	Kootenai County
71888	Fee-for-Service	1144266164	1144266164	1	1	PHYSICIANS IMAGING LP	3/11/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1243 E SPRUCE AVE	# 101	FRESNO	CA	93720	3379	10	06019	36.84198651	-119.7610695	Fresno County
71923	Fee-for-Service	1518991074	1518991074	1	1	PLUNKETT, MARK DAVID MD	3/31/1995	208G00000X	NA	General Surgery	026	PHYSICIANS	80946	33	Thoracic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
71940	Fee-for-Service	1932113313	1932113313	1	1	PAK, YOON SUK MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62072	08	Family Practice	0	In state provider	None	11841 SOUTH ST	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
71993	Fee-for-Service	1154584704	1154584704	1	1	PENG, WARNER MD	3/19/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	167982	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
72030	Fee-for-Service	1710031588	1710031588	1	3	PROVIDENCE FACEY MEDICAL FOU	11/8/2017	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
72036	Fee-for-Service	1710031588	1710031588	1	22	PROVIDENCE FACEY MEDICAL FOU	9/17/2019	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
72064	Fee-for-Service	1750319356	1750319356	1	1	PIMENTEL, MARK MD	1/1/1999	174400000X	NA	Other	026	PHYSICIANS	60576	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
72081	Fee-for-Service	1649621335	1649621335	1	1	PHAM, XUAN T MD	10/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170010	15	Obstetrics (D.O. only)	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
72088	Fee-for-Service	1336379577	1336379577	1	1	POLICEPATIL, SEEMA M MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156773	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
72109	Fee-for-Service	1699159269	1699159269	1	1	PENA, RUBY LCSW	1/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
72115	Fee-for-Service	1083134142	1083134142	1	1	PATEL, SAJAL OD	2/18/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
72170	Fee-for-Service	1205104551	1205104551	1	1	PERSICONE, JENNIFER N LCSW	12/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 W FLORIDA AVE	SUITE C	HEMET	CA	92543	4628	33	06065	33.74755149	-116.98533	Riverside County
72181	Fee-for-Service	1952834467	1952834467	1	1	PATEL, PUJA MD	8/21/2019	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
72183	Fee-for-Service	1598262701	1598262701	1	1	PERCIVAL, KARA MD	9/20/2021	390200000X	NA	Other	026	PHYSICIANS	163487	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
72220	Fee-for-Service	1265450837	1265450837	1	1	POSPISIL, RICK F MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	39717	20	Orthopedic Surgery	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
72234	Fee-for-Service	1629383534	1629383534	1	1	PALACIOS, FERNANDO D MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145668	08	Family Practice	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
72281	Fee-for-Service	1154584704	1154584704	1	1	PENG, WARNER MD	3/19/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	167982	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
72300	Fee-for-Service	1104140813	1104140813	1	1	PATHWAY SOCIETY, INC	5/19/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1659 SCOTT BLVD	STE 9, 220, 270	SANTA CLARA	CA	95051	4137	43	06085	37.35434281	-121.9594982	Santa Clara County
72315	Fee-for-Service	1710031588	1710031588	1	3	PROVIDENCE FACEY MEDICAL FOU	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
72323	Fee-for-Service	1710031588	1710031588	1	22	PROVIDENCE FACEY MEDICAL FOU	9/17/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
72327	Fee-for-Service	1861643728	1861643728	1	1	P&A STEELE, INC	9/17/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1120 W VASSAR AVE	None	VISALIA	CA	93277	4671	54	06107	36.314091	-119.3035635	Tulare County
72374	Fee-for-Service	1609916246	1609916246	1	1	PONTIUS, MICHAEL H OD	9/15/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	715 LINCOLN CTR	None	STOCKTON	CA	95207	2644	39	06077	38.01170936	-121.3236351	San Joaquin County
72415	Fee-for-Service	1659719755	1659719755	1	1	PANDYA, MANISH A MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143586	41	Internal Medicine	0	In state provider	None	150 PIONEER LANE	None	BISHOP	CA	93514	2559	14	06027	37.36193834	-118.4073304	Inyo County
72439	Fee-for-Service	1184480535	1184480535	1	1	PALACIOS, STEVEN	10/31/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2908 WESTMINSTER	None	SEAL BEACH	CA	90740	5305	30	06059	33.7594287	-118.0804604	Orange County
72455	Fee-for-Service	1215092291	1215092291	1	1	PASO ROBLES JOINT UNIFIED	4/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	800 NIBLICK RD	None	PASO ROBLES	CA	93446	4858	40	06079	35.61575355	-120.672279	San Luis Obispo County
72456	Fee-for-Service	1366653354	1366653354	1	1	PONNEZHAN, VIMAL J MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116214	41	Internal Medicine	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
72462	Fee-for-Service	1972667947	1972667947	1	1	PETALUMA ORTHOPAEDIC &	7/1/2003	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS THERAPY	226 WELLER ST	None	PETALUMA	CA	94952	3136	49	06097	38.23544718	-122.6365041	Sonoma County
72478	Fee-for-Service	1720593411	1720593411	1	1	PARDO, MALISSA S LMFT	10/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
72485	Fee-for-Service	1760441844	1760441844	1	2	PERINATAL MEDICAL GROUP INC	7/26/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	9363	10	06019	36.7423511	-119.7834688	Fresno County
72559	Fee-for-Service	1881119113	1881119113	1	1	POON, STACEY S	5/21/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
72580	Fee-for-Service	1568490878	1568490878	1	1	PETRU, ANN M MD	10/25/2006	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40627	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
72589	Fee-for-Service	1851465173	1851465173	1	1	PILTCH, REBECCA G MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83451	03	Allergy	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
72599	Fee-for-Service	1881730976	1881730976	1	1	PAINTER, THOMAS L PHD	10/23/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
72608	Fee-for-Service	1710031588	1710031588	1	3	PROVIDENCE FACEY MEDICAL FOU	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
72618	Fee-for-Service	1609602317	1609602317	1	1	PAVON PALACIOS, LIZETTE LMF	9/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
72634	Fee-for-Service	1285851436	1285851436	1	1	PUNN, RAJESH MD	5/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83149	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
72656	Fee-for-Service	1487780821	1487780821	1	1	PALMER, LESLIE S	8/25/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1101 NEWPORT WAY	None	ROSEVILLE	CA	95661	5314	31	06061	38.72603441	-121.2745958	Placer County
72675	Fee-for-Service	1083854293	1083854293	1	1	PARK, PATRICK T MD INC	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	76980	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	266 S HARVARD BLVD	STE 320	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
72677	Fee-for-Service	1255342929	1255342929	1	1	PETRASCU, ANCA M MD	4/1/1999	207R00000X	NA	Other	026	PHYSICIANS	66037	41	Internal Medicine	0	In state provider	None	4050 S DEMAREE ST	None	VISALIA	CA	93277	9476	54	06107	36.293895	-119.3295825	Tulare County
72694	Fee-for-Service	1194816678	1194816678	1	1	PFLUM, JEANNIE L DO INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7910	09	Gynecology (D.O. only)	0	In state provider	WOMENS HLTH & WELLNESS	1140 SONOMA AVE	STE 2A	SANTA ROSA	CA	95405	4817	49	06097	38.440458	-122.699502	Sonoma County
72750	Fee-for-Service	1194509513	1194509513	1	1	PARIKSHAT ALKA PC	3/1/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2323 16TH ST	SUITE 300	BAKERSFIELD	CA	93301	3420	15	06029	35.37238027	-119.0288508	Kern County
72756	Fee-for-Service	1912055815	1912055815	1	1	PRECIADO, GEORGE T MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
72771	Fee-for-Service	1760441844	1760441844	1	2	PERINATAL MEDICAL GROUP INC	7/26/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	9363	10	06019	36.7423511	-119.7834688	Fresno County
72791	Fee-for-Service	1053433870	1053433870	1	1	PLANNED PARENTHOOD	3/16/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GLDN GATE SAN RAFL LAB	2 H ST	1ST FLR LAB	SAN RAFAEL	CA	94901	1700	21	06041	37.97437033	-122.5385699	Marin County
72810	Fee-for-Service	1457331639	1457331639	1	1	PIAO, XIANHUA MD	1/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159900	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
72839	Fee-for-Service	1871600288	1871600288	1	1	PEKO-RIOS, MARIA R MD	6/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	54934	36	Psychiatry	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
72867	Fee-for-Service	1568490878	1568490878	1	1	PETRU, ANN M MD	10/25/2006	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40627	77	Infectious Disease	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
72895	Fee-for-Service	1710031588	1710031588	1	3	PROVIDENCE FACEY MEDICAL FOU	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
72929	Fee-for-Service	1023524899	1023524899	1	1	POPATIA NATHOO, SHAMIA PT	8/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
72942	Fee-for-Service	1790895092	1790895092	1	1	PACIFIC CLINICS	9/4/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1160 S GRAND AVENUE	None	GLENDORA	CA	91740	5000	19	06037	34.11736533	-117.8725213	Los Angeles County
72944	Fee-for-Service	1982925079	1982925079	1	1	PROKOP, MICHAEL A DO	11/7/2019	207L00000X	NA	Other	026	PHYSICIANS	12248	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
72946	Fee-for-Service	1487780821	1487780821	1	1	PALMER, LESLIE S	6/16/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1101 NEWPORT WAY	None	ROSEVILLE	CA	95661	5314	31	06061	38.72603441	-121.2745958	Placer County
72947	Fee-for-Service	1205112174	1205112174	1	1	PRENDERGAST AND RUMMER PHYSI	3/26/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	TION CENTER	340 DARDANELLI LANE	23	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
72949	Fee-for-Service	1982227757	1982227757	1	1	PUGH, ALICIA	10/25/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
72959	Fee-for-Service	1386263622	1386263622	1	1	PSL HOSPICE CARE INC	8/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 202 U	VAN NUYS	CA	91411	2398	19	06037	34.18570347	-118.450386	Los Angeles County
72969	Fee-for-Service	1255342929	1255342929	1	1	PETRASCU, ANCA M MD	4/1/1999	207R00000X	NA	Other	026	PHYSICIANS	66037	08	Family Practice	0	In state provider	None	4050 S DEMAREE ST	None	VISALIA	CA	93277	9476	54	06107	36.293895	-119.3295825	Tulare County
72980	Fee-for-Service	1245246511	1245246511	1	1	PATEL, NISHA S DPM	2/11/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
72986	Fee-for-Service	1225509698	1225509698	1	1	PACLEB, MARIJUNE S RCP	7/25/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
73009	Fee-for-Service	1437375359	1437375359	1	1	PAGE, KIMBERLY A MD INC	11/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	64229	14	Neurological Surgery	0	In state provider	None	1388 COURT ST	STE H	REDDING	CA	96001	1650	45	06089	40.58444066	-122.3963013	Shasta County
73039	Fee-for-Service	1982791026	1982791026	1	1	PALOMAR MEDICAL GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	11	Aviation (M.D. only)	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
73050	Fee-for-Service	1235762279	1235762279	1	1	PEREZ, ALEJANDRA LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
73077	Fee-for-Service	1982085957	1982085957	1	1	PATTANAYAK, PUSKAR MD	11/6/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163341	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73098	Fee-for-Service	1336190982	1336190982	1	1	PALACIOS, SOFIA MD	5/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77250	08	Family Practice	0	In state provider	None	1701 CESAR CHAVEZ AVE	STE 230	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
73113	Fee-for-Service	1497832513	1497832513	1	1	PETERSON, JEFFREY J. MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 SMITH AVE N	None	SAINT PAUL	MN	55102	2346	00	None	44.94251219	-93.1074995	Ramsey County
73141	Fee-for-Service	1710103387	1710103387	1	1	PIPPIN, RUSSELL D LMFT	1/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	55 SHAW AVE	STE 115	CLOVIS	CA	93612	3819	10	06019	36.80859553	-119.708505	Fresno County
73152	Fee-for-Service	1053367896	1053367896	1	1	PAJA MEDICAL GROUP INC	1/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	OLYMPIC FAMILIA CLNC INC	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	19	06037	34.0565363	-118.2728437	Los Angeles County
73154	Fee-for-Service	1447296116	1447296116	1	1	PATEL, SWATI N MD	6/1/1998	207L00000X	NA	Other	026	PHYSICIANS	81540	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
73161	Fee-for-Service	1366427734	1366427734	1	2	PARADISE FAMILY HEALTH	5/25/2010	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1741 EASTLAKE PARKWAY	SUITE 107	CHULA VISTA	CA	91915	2032	37	06073	32.62008814	-116.9622762	San Diego County
73210	Fee-for-Service	1225140312	1225140312	1	1	PERRIN, RICHARD G MD	12/12/2008	207T00000X	NA	General Surgery	026	PHYSICIANS	87647	14	Neurological Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73211	Fee-for-Service	1982803722	1982803722	1	1	PEARN, MATTHEW L MD	7/13/2010	390200000X	NA	Other	026	PHYSICIANS	104013	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
73248	Fee-for-Service	1386263622	1386263622	1	1	PSL HOSPICE CARE INC	8/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 202 U	VAN NUYS	CA	91411	2398	19	06037	34.18570347	-118.450386	Los Angeles County
73251	Fee-for-Service	1255516951	1255516951	1	1	PARIKH, NIKIE MD	3/4/2021	207R00000X	NA	Other	026	PHYSICIANS	170793	None	None	0	In state provider	None	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
73270	Fee-for-Service	1700107711	1700107711	1	1	PERURI, ASHWINI A MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126039	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
73272	Fee-for-Service	1407839715	1407839715	1	1	PURUGGANAN, CYNTHIA S	5/3/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
73286	Fee-for-Service	1336258961	1336258961	1	1	PEEKS, ROGER A MD	10/31/1995	207R00000X	NA	Other	026	PHYSICIANS	39705	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
73287	Fee-for-Service	1174985121	1174985121	1	1	PANTOJA, JOE L MD	12/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	152945	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
73294	Fee-for-Service	1992031306	1992031306	1	1	PELAYO, GILBERT NP	10/3/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
73295	Fee-for-Service	1932475316	1932475316	1	1	POSTOLOVA, ANNA MD	11/6/2019	207R00000X	NA	Other	026	PHYSICIANS	126882	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
73318	Fee-for-Service	1629724067	1629724067	1	1	PACIFIC CARE SALIDA	7/7/2023	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5404 KIERNAN AVE	None	SALIDA	CA	95368	9130	50	06099	37.71077905	-121.094685	Stanislaus County
73325	Fee-for-Service	1932462975	1932462975	1	1	PATEL, ANUP P MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142794	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73328	Fee-for-Service	1982791026	1982791026	1	1	PALOMAR MEDICAL GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
73362	Fee-for-Service	1346341328	1346341328	1	1	PACIFIC NEPHROLOGY MEDICAL	10/12/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	120 E EMERSON AVENUE	None	MONTEREY PARK	CA	91755	1709	19	06037	34.06610653	-118.1219085	Los Angeles County
73367	Fee-for-Service	1316127947	1316127947	1	1	PUNJABI, ANIL P MD DDS INC	7/7/2010	208200000X	NA	General Surgery	026	PHYSICIANS	85143	24	Plastic Surgery	0	In state provider	None	295 TERRACINA BLVD	None	REDLANDS	CA	92373	4847	36	06071	34.03758767	-117.2051317	San Bernardino County
73373	Fee-for-Service	1205856986	1205856986	1	1	PAN, TIMOTHY MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71894	41	Internal Medicine	0	In state provider	None	200 MED PLAZA SUITE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
73416	Fee-for-Service	1972511079	1972511079	1	1	PARTRIDGE, BRIAN L MD	5/31/1986	207L00000X	NA	Other	026	PHYSICIANS	58673	05	Anesthesiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
73441	Fee-for-Service	1053367896	1053367896	1	1	PAJA MEDICAL GROUP INC	1/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OLYMPIC FAMILIA CLNC INC	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	19	06037	34.0565363	-118.2728437	Los Angeles County
73443	Fee-for-Service	1184351538	1184351538	1	1	PYO FAMILY CLINIC INC	11/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2000 E CHAPMAN AVE	100	FULLERTON	CA	92831	4103	30	06059	33.87415253	-117.895851	Orange County
73455	Fee-for-Service	1033136031	1033136031	1	1	PAUL R BILSTAD MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
73512	Fee-for-Service	1790703403	1790703403	1	1	PILE, ORLANDO H MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	32029	01	General Practice	0	In state provider	None	140 W QUEEN ST	None	INGLEWOOD	CA	90301	1726	19	06037	33.96290267	-118.3570245	Los Angeles County
73554	Fee-for-Service	1083943369	1083943369	1	1	PADILLA, RACHEL A LMFT	1/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
73567	Fee-for-Service	1659319838	1659319838	1	1	PSALTIS,PHILLIP MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	I-70 MEDICAL CENTER	105 HOSPITAL DRIVE	None	SWEET SPRINGS	MO	65351	0000	00	None	38.97864341	-93.41763051	Saline County
73614	Fee-for-Service	1982791026	1982791026	1	1	PALOMAR MEDICAL GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
73649	Fee-for-Service	1417418104	1417418104	1	1	PARK, ANDRES MD	7/11/2023	390200000X	NA	Other	026	PHYSICIANS	182173	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
73754	Fee-for-Service	1699451484	1699451484	1	1	PSAILA, MIRANDA PT	10/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
73771	Fee-for-Service	1639140346	1639140346	1	1	PROFESSIONAL NURSES GROUP	8/11/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	13181 CROSSROADS PKWY N	STE 322	CITY OF INDUSTRY	CA	91746	3461	19	06037	34.02964981	-118.0153647	Los Angeles County
73773	Fee-for-Service	1720137763	1720137763	1	1	PHUN, HUY Q MD	12/24/2019	207L00000X	NA	Other	026	PHYSICIANS	159847	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
73785	Fee-for-Service	1699174953	1699174953	1	1	PAREDES, ANGELICA LCSW	2/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
73813	Fee-for-Service	1558144063	1558144063	1	1	PALSMA, CARRIE CCC-SLP	10/10/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
73818	Fee-for-Service	1861891376	1861891376	1	1	PORCIC, ADEMIRA	11/16/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4205 ARCH DRIVE	20	STUDIO CITY	CA	91604	3420	19	06037	34.14261506	-118.372952	Los Angeles County
73831	Fee-for-Service	1104319565	1104319565	1	1	PRACHACHALERM, TIFFANY DO	9/9/2021	207R00000X	NA	Other	026	PHYSICIANS	18914	None	None	0	In state provider	None	2975 NORTH SYCAMORE DR.	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
73871	Fee-for-Service	1538430509	1538430509	1	1	PAUL M CHOI MD A CALIFORNIA	2/5/2019	193400000X	NA	Other	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	266 S HARVARD BLVD	250	LOS ANGELES	CA	90004	4372	19	06037	34.069221	-118.3041245	Los Angeles County
73877	Fee-for-Service	1316494719	1316494719	1	1	PLATON, CHARLENE G NP	10/4/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
73883	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
73981	Fee-for-Service	1871732180	1871732180	1	1	PRUNEAN, ADRIAN MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105765	05	Anesthesiology	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90270	3113	30	06059	33.80318353	-118.0666665	Orange County
73997	Fee-for-Service	1750771523	1750771523	1	1	PHYSICIANS CHOICE HOSPICE	5/23/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	1535 WEST MERCED AVE	SUITE 200	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
74003	Fee-for-Service	1164886040	1164886040	1	2	PEACH TREE HEALTHCARE	9/25/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	120 INDEPENDENCE CIRCLE	SUITE A	CHICO	CA	95973	4925	04	06007	39.77238185	-121.8739834	Butte County
74018	Fee-for-Service	1396823134	1396823134	1	1	PAN JUDY U MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88606	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
74027	Fee-for-Service	1336670678	1336670678	1	1	PATEL, MUKTI MD	10/19/2021	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	160426	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
74041	Fee-for-Service	1295214054	1295214054	1	1	PHITT SERVICES, INC.	8/19/2021	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6320 CANOGA AVE	STE 1500	WOODLAND HILLS	CA	91367	2517	19	06037	34.1856	-118.597372	Los Angeles County
74062	Fee-for-Service	1396404307	1396404307	1	1	PING, LUCIE NP	7/2/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74108	Fee-for-Service	1861891376	1861891376	1	1	PORCIC, ADEMIRA	11/16/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4205 ARCH DRIVE	20	STUDIO CITY	CA	91604	3420	19	06037	34.14261506	-118.372952	Los Angeles County
74119	Fee-for-Service	1942375506	1942375506	2	1	PAK, SU-YONG MD INC	11/21/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34079	41	Internal Medicine	0	In state provider	None	5451 LA PALMA AVE	STE 14	LA PALMA	CA	90623	1729	30	06059	33.84643146	-118.038843	Orange County
74168	Fee-for-Service	1477132314	1477132314	1	1	PEREZ, ALEJANDRO R MD	9/3/2024	207P00000X	NA	Other	026	PHYSICIANS	183054	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
74171	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
74173	Fee-for-Service	1285251314	1285251314	1	1	PAMPERED HOSPICE CARE INC	8/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14051 BURBANK BLVD	STE 10	SHERMAN OAKS	CA	91401	5083	19	06037	34.17214547	-118.439361	Los Angeles County
74181	Fee-for-Service	1891854469	1891854469	1	1	PARRADO-VILLICANA,	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67124	01	General Practice	0	In state provider	SANDRA M MD	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74199	Fee-for-Service	1184799009	1184799009	1	1	PICKUS, KURT F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22160	07	Dermatology	0	In state provider	SUITE #442	3440 LOMITA BLVD	None	TORRANCE	CA	90505	4801	19	06037	33.81328127	-118.3452927	Los Angeles County
74205	Fee-for-Service	1306888037	1306888037	1	1	PATIENT CARE PHARMACY INC	3/2/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	2318 E PASS ROAD	None	GULFPORT	MS	39507	3805	00	None	30.40067446	-89.003169	Harrison County
74209	Fee-for-Service	1740596261	1740596261	1	1	PARIKH, JIMMY MD	8/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168566	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
74237	Fee-for-Service	1215101167	1215101167	1	1	POTNICK, AARON G MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110406	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
74243	Fee-for-Service	1245860824	1245860824	1	1	PARMER, JAMES D NP	3/10/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
74285	Fee-for-Service	1750771523	1750771523	1	1	PHYSICIANS CHOICE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	1535 WEST MERCED AVE	SUITE 200	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
74291	Fee-for-Service	1164886040	1164886040	1	2	PEACH TREE HEALTHCARE	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	120 INDEPENDENCE CIRCLE	SUITE A	CHICO	CA	95973	4925	04	06007	39.77238185	-121.8739834	Butte County
74300	Fee-for-Service	1902906738	1902906738	1	1	PETERSON, KATHERINE E	10/2/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	STE 100	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
74357	Fee-for-Service	1285974287	1285974287	1	1	PYO, CHRISTINA H MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	124446	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	8823	15	06029	35.35253312	-119.1144456	Kern County
74365	Fee-for-Service	1366033540	1366033540	1	1	PERFECT HOSPICE CARE INC	6/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 216	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
74366	Fee-for-Service	1437191103	1437191103	1	1	PANDYA, BHAVIN R MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52908	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
74369	Fee-for-Service	1255119137	1255119137	1	1	PRISTINE HOME CARE INC	4/12/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9252 PACIFIC AVE	None	ANAHEIM	CA	92804	6371	30	06059	33.80768581	-117.9712141	Orange County
74383	Fee-for-Service	1801329933	1801329933	1	1	PATEL, PERSEUS V MD	7/29/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	159562	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
74392	Fee-for-Service	1245013663	1245013663	1	1	PADILLA GONZALEZ, MONICA PT	9/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
74403	Fee-for-Service	1386702801	1386702801	1	1	PURISCH, ELLEN C LCSW	6/22/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23046 AVENIDA DE LA CARL	STE 600	LAGUNA HILLS	CA	92653	1537	30	06059	33.62729647	-117.7222879	Orange County
74408	Fee-for-Service	1942375506	1942375506	2	1	PAK, SU-YONG MD INC	11/21/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34079	30	Radiology	0	In state provider	None	5451 LA PALMA AVE	STE 14	LA PALMA	CA	90623	1729	30	06059	33.84643146	-118.038843	Orange County
74442	Fee-for-Service	1922252725	1922252725	1	1	PENG, JONATHAN A MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109735	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
74459	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
74460	Fee-for-Service	1285251314	1285251314	1	1	PAMPERED HOSPICE CARE INC	8/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14051 BURBANK BLVD	STE 10	SHERMAN OAKS	CA	91401	5083	19	06037	34.17214547	-118.439361	Los Angeles County
74468	Fee-for-Service	1891854469	1891854469	1	1	PARRADO-VILLICANA,	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67124	40	Pediatrics	0	In state provider	SANDRA M MD	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74503	Fee-for-Service	1891298626	1891298626	1	1	PATEL, KAJAL MD	10/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177950	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
74505	Fee-for-Service	1124412143	1124412143	1	1	PERSAUD, KELSIE M MD	1/21/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155354	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
74524	Fee-for-Service	1215931761	1215931761	1	1	PRAKASH, RAVI MD	8/22/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	24484	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4305 TORRANCE BLVD	STE 405	TORRANCE	CA	90503	4407	19	06037	33.83759546	-118.359342	Los Angeles County
74548	Fee-for-Service	1225233133	1225233133	1	1	PATEL, PRANJALKUMAR H MD	4/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	116600	None	None	0	In state provider	None	1470 BESSIE AVE	None	TRACY	CA	95376	3417	39	06077	37.74474	-121.433013	San Joaquin County
74553	Fee-for-Service	1427223643	1427223643	1	1	PAGE, KATHLEEN A MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108191	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
74557	Fee-for-Service	1295778348	1295778348	1	1	POWELL, HENRY C MD	9/30/1982	207ZP0101X	NA	Other	026	PHYSICIANS	25597	22	Pathology (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H720	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
74631	Fee-for-Service	1447440409	1447440409	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC NEUROLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
74653	Fee-for-Service	1366033540	1366033540	1	1	PERFECT HOSPICE CARE INC	6/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 216	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
74659	Fee-for-Service	1144347964	1144347964	1	1	PORTILLO, KI Y	5/9/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
74685	Fee-for-Service	1134145501	1134145501	1	1	PERL, MARK MD	5/7/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	37301	36	Psychiatry	0	In state provider	None	235 MONTGOMERY STREET	SUITE 830	SAN FRANCISCO	CA	94104	2913	38	06075	37.79145792	-122.4024899	San Francisco County
74694	Fee-for-Service	1952315319	1952315319	1	4	PHUNG, THANH G MD	11/5/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	42348	30	Radiology	0	In state provider	None	15027 SOUTH PRAIRIE AVE	None	LAWNDALE	CA	90260	1838	19	06037	33.89484754	-118.3439085	Los Angeles County
74712	Fee-for-Service	1396006748	1396006748	1	1	PEDIGO, RYAN A MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127362	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
74713	Fee-for-Service	1780118018	1780118018	1	1	POLICH, MICHELLE A MD	11/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169936	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
74744	Fee-for-Service	1750337648	1750337648	1	1	PRADHAN, SABEENA MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137913	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
74746	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
74812	Fee-for-Service	1104006287	1104006287	1	1	PAZ, JAIME LMFT	6/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
74826	Fee-for-Service	1215347232	1215347232	1	1	PETTIGREW, COURTENAY E MD	9/12/2018	207P00000X	NA	Other	026	PHYSICIANS	139842	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
74828	Fee-for-Service	1528565371	1528565371	1	1	PARK, SOO YEUN DO	8/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17740	None	None	0	In state provider	None	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
74831	Fee-for-Service	1578939377	1578939377	1	1	PRICE, KEIALA K NP	4/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
74843	Fee-for-Service	1477695054	1477695054	1	1	PATTERSON, ANDREW JAY MD	10/31/1995	207L00000X	NA	Other	026	PHYSICIANS	83284	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
74845	Fee-for-Service	1679990543	1679990543	1	1	POKAGON DIALYSIS LLC	12/8/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	100 W WASHINGTON BLVD	None	MONTEBELLO	CA	90640	6211	19	06037	33.99211083	-118.1119769	Los Angeles County
74850	Fee-for-Service	1437262219	1437262219	1	1	POPOCA-LOGUE, ANA J NP	10/17/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
74920	Fee-for-Service	1447440409	1447440409	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	79	Neurology-Child	0	In state provider	PEDIATRIC NEUROLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
74956	Fee-for-Service	1952789463	1952789463	1	1	PENG, CYNTHIA R MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75010	Fee-for-Service	1902017916	1902017916	1	1	PEOPLES CARE HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12611 HIDDENCREEK WAY	STE K	CERRITOS	CA	90703	2156	36	06071	33.88499597	-118.0628892	Los Angeles County
75027	Fee-for-Service	1568922953	1568922953	1	1	PAICELY, ADAM PT	5/1/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
75033	Fee-for-Service	1417193541	1417193541	1	1	PARK, JIWEON N CRNA	3/16/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
75034	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
75086	Fee-for-Service	1689609679	1689609679	1	1	PLANNED PARENTHOOD OF THE	12/22/1981	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	2017 1ST AVE	STE 301	SAN DIEGO	CA	92101	2033	37	06073	32.72646147	-117.1638767	San Diego County
75095	Fee-for-Service	1164196820	1164196820	1	1	POBLETE, MICHAEL E OD	6/1/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 PALMDALE RD	STE B-10	ADELANTO	CA	92301	6709	36	06071	34.50671749	-117.4015485	San Bernardino County
75101	Fee-for-Service	1801003694	1801003694	1	1	PE, MARK-RALLY L MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112013	34	Urology and Urological Surgery	0	In state provider	None	4060 FOURTH AVE #310	None	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
75119	Fee-for-Service	1235125030	1235125030	2	1	PHARMILYCARE INC	10/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10366 E GARVEY AVE	STE B	EL MONTE	CA	91733	2188	19	06037	34.0626747	-118.0450253	Los Angeles County
75136	Fee-for-Service	1700372794	1700372794	1	1	PROANO, MARYLOU CRNA	11/14/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
75204	Fee-for-Service	1487097119	1487097119	1	1	POURMORADY, JONATHAN S MD	4/8/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	133753	10	Gastroenterology (M.D. only)	0	In state provider	None	9033 WILSHIRE BLVD	#200	BEVERLY HILLS	CA	90211	1836	19	06037	34.06707946	-118.388943	Los Angeles County
75219	Fee-for-Service	1487904546	1487904546	1	1	PEACEHEALTH	11/5/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
75228	Fee-for-Service	1356410351	1356410351	1	2	PRIME HLTHCARE PARADISE VLY	11/7/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	655 EUCLID AVE	STE 200	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
75238	Fee-for-Service	1790793347	1790793347	1	1	PHELPS, PAUL R MD	7/3/1997	207L00000X	NA	Other	026	PHYSICIANS	57719	None	None	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
75264	Fee-for-Service	1437770823	1437770823	1	1	PEPICH, GARRETT	1/25/2024	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
75274	Fee-for-Service	1932249612	1932249612	1	1	PETER SANTOS	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
75294	Fee-for-Service	1902017916	1902017916	1	1	PEOPLES CARE HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12611 HIDDENCREEK WAY	STE K	CERRITOS	CA	90703	2156	36	06071	33.88499597	-118.0628892	Los Angeles County
75296	Fee-for-Service	1427319524	1427319524	1	1	PRIDAY DIALYSIS LLC	3/12/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	725 RIDDER PARK DR	STE 50	SAN JOSE	CA	95131	2431	43	06085	37.37805949	-121.9024898	Santa Clara County
75311	Fee-for-Service	1215054416	1215054416	1	1	PHAN CAO PHAI, JEAN-PIERRE	6/17/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	97938	30	Radiology	0	In state provider	MD	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94119	1618	38	06075	37.78614008	-122.4556866	San Francisco County
75323	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
75330	Fee-for-Service	1376877951	1376877951	1	1	PERAL-RAMIREZ, MARIBEL LCSW	8/16/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	515 13TH ST	SUITE 207	MODESTO	CA	95354	2437	50	06099	37.63824896	-120.992238	Stanislaus County
75375	Fee-for-Service	1164503538	1164503538	1	1	PUSCA, SORIN V MD	5/24/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	127709	None	None	0	In state provider	None	1430 ESPLANADE	6	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
75388	Fee-for-Service	1043744279	1043744279	1	1	PARK, JUN MD	9/26/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	169512	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
75410	Fee-for-Service	1780194159	1780194159	1	1	PROMED HEALTH PROVIDERS INC	12/20/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1614 VICTORY BLVD	STE 104	GLENDALE	CA	91201	3830	19	06037	34.16011082	-118.298801	Los Angeles County
75429	Fee-for-Service	1942534839	1942534839	1	1	PRENATAL CLINIC-JONATHAN	10/5/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AZIZZADEH MD INC	4226 W BEVERLY BLVD	None	LOS ANGELES	CA	90004	1802	19	06037	34.0762665	-118.3010445	Los Angeles County
75445	Fee-for-Service	1194104703	1194104703	1	1	PATEL, SHYAM P MD	11/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158028	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
75463	Fee-for-Service	1285640979	1285640979	1	2	PRECISION ORTHOTICS & PROSTH	12/18/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ETICS INC	3055 WILSHIRE BLVD	460	LOS ANGELES	CA	90010	1108	19	06037	34.06185807	-118.2880358	Los Angeles County
75473	Fee-for-Service	1821368556	1821368556	1	1	PERPETUAL MOTION PHYSICAL	8/21/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY, INC	28975 OLD TOWN FRONT ST	SUITE 201	TEMECULA	CA	92590	2863	33	06065	33.4851599	-117.1440581	Riverside County
75478	Fee-for-Service	1316909542	1316909542	1	1	PLEWINSKI, RUSSELL M CRNA	8/24/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2635 G ST	None	BAKERSFIELD	CA	93301	2813	15	06029	35.38360448	-119.0223416	Kern County
75486	Fee-for-Service	1538506928	1538506928	1	1	PASTOR, ALICIA M	2/2/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
75497	Fee-for-Service	1194169300	1194169300	1	1	PHAM, MICHELE N MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132803	03	Allergy	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
75507	Fee-for-Service	1487904546	1487904546	1	1	PEACEHEALTH	11/5/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
75546	Fee-for-Service	1740367689	1740367689	1	1	PURDY, KENNETH W	6/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65601	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
75575	Fee-for-Service	1609880947	1609880947	1	4	PREMIER ANESTHESIA	9/6/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	201 NEW STINE RD	STE 130	BAKERSFIELD	CA	93309	2659	15	06029	35.352801	-119.0612865	Kern County
75580	Fee-for-Service	1669561890	1669561890	1	1	PLANNED PARENTHOOD LA	8/26/2004	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2690 PACIFIC AVENUE	SUITE 370	LONG BEACH	CA	90806	2661	19	06037	33.805854	-118.1936805	Los Angeles County
75605	Fee-for-Service	1588712442	1588712442	1	1	PALMER-TOY, DARRYL E MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87190	22	Pathology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
75611	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
75624	Fee-for-Service	1477617546	1477617546	1	1	PRICHARD, JOHN G MD	1/9/1997	207R00000X	NA	Other	026	PHYSICIANS	41730	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
75635	Fee-for-Service	1740413681	1740413681	1	1	PHAM, ELIZABETH T MD	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105690	41	Internal Medicine	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
75638	Fee-for-Service	1417272592	1417272592	1	1	PAN, JENNIFER Y MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125050	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75663	Fee-for-Service	1740750165	1740750165	1	1	PROSPECT SENIOR LIVING INC	7/30/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	142 S PROSPECT ST	None	ORANGE	CA	92869	5945	30	06059	33.787044	-117.8184185	Orange County
75677	Fee-for-Service	1972058394	1972058394	1	1	PEREZ, MONICA	10/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
75681	Fee-for-Service	1194920405	1194920405	1	1	PARADISE OAKS YOUTH SERVICES	6/22/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	7730 ANTELOPE RD	None	CITRUS HEIGHTS	CA	95610	2311	34	06067	38.705148	-121.279914	Sacramento County
75707	Fee-for-Service	1013591221	1013591221	1	1	PARAM WALIA MD NEUROSCIENCES	11/11/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	SERVICES CORPORATION	2151 HARBOR	SUITE 3100	FULLERTON	CA	92835	3820	30	06059	33.89443025	-117.9288328	Orange County
75728	Fee-for-Service	1467899450	1467899450	1	1	PACIFIC HERITAGE MEDICAL GRO	4/18/2024	2084P0805X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UP INC	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
75740	Fee-for-Service	1053538363	1053538363	1	1	PICKERING, COURTNEY W MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99325	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
75746	Fee-for-Service	1245400019	1245400019	1	1	PEREZ, AMANDA L MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
75761	Fee-for-Service	1861075574	1861075574	1	1	PEREZ, SAIGE	9/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
75794	Fee-for-Service	1770543761	1770543761	1	1	PROMISE HOSP OF EAST LOS	7/1/2004	282E00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES LP	433 S SOTO ST	None	LOS ANGELES	CA	90033	4315	19	06037	34.03964132	-118.2124695	Los Angeles County
75812	Fee-for-Service	1073674370	1073674370	1	1	PEREZ-MCCRAW, SANDRA MD	5/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62676	40	Pediatrics	0	In state provider	None	502 EUCLID AVE	STE 202	NATIONAL CITY	CA	91950	2985	37	06073	32.68505421	-117.0832793	San Diego County
75831	Fee-for-Service	1497927362	1497927362	1	1	PINTO, JAMES L MD PC	9/29/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53971	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	320 E BUENA VISTA	None	BARSTOW	CA	92311	2806	36	06071	34.89557815	-117.0235915	San Bernardino County
75848	Fee-for-Service	1548306483	1548306483	1	1	PANDE, HEMANT MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54643	41	Internal Medicine	0	In state provider	None	4940 VAN NUYS BLVD	SUITE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
75893	Fee-for-Service	1518015577	1518015577	1	1	PFEIFFER, WILLIAM H	5/31/1991	204D00000X	NA	Other	026	PHYSICIANS	62005	20	Orthopedic Surgery	0	In state provider	None	1015 GAYLEY AVE	# 1273	LOS ANGELES	CA	90024	3424	19	06037	34.0616224	-118.447693	Los Angeles County
75899	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
75926	Fee-for-Service	1417272592	1417272592	1	1	PAN, JENNIFER Y MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125050	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75928	Fee-for-Service	1750771176	1750771176	1	1	PETERSON, MALGORZATA D MD	6/16/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171973	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75934	Fee-for-Service	1285902494	1285902494	1	1	PORTER, HEATHER S PA	9/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11995	-	NOT APPLICABLE	0	In state provider	None	45335 SIERRA HIGHWAY	None	LANCASTER	CA	93534	1611	19	06037	34.7068568	-118.1383834	Los Angeles County
76010	Fee-for-Service	1386141281	1386141281	1	1	PATEL, SURAJ	2/2/2022	390200000X	NA	Other	026	PHYSICIANS	165323	None	None	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
76014	Fee-for-Service	1467899450	1467899450	1	1	PACIFIC HERITAGE MEDICAL GRO	1/10/2023	2084P0805X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	UP INC	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
76016	Fee-for-Service	1215214044	1215214044	1	1	PEREZ, ALICIA N LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
76018	Fee-for-Service	1780731638	1780731638	1	1	PERRON, PAUL R OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5015 FOOTHILLS BLVD	STE 5B	ROSEVILLE	CA	95747	6509	31	06061	38.76055919	-121.3099788	Placer County
76035	Fee-for-Service	1538250980	1538250980	1	1	PATEL, VIJAY V MD	4/30/1992	207R00000X	NA	Other	026	PHYSICIANS	48976	41	Internal Medicine	0	In state provider	None	301 W HUNTINGTON DR	STE 320	ARCADIA	CA	91007	1500	19	06037	34.13481053	-118.0425638	Los Angeles County
76053	Fee-for-Service	1497739593	1497739593	1	1	PATEL, JAGDISH M MD	2/28/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	32743	None	None	0	In state provider	None	11 W DEL MAR BLVD	None	PASADENA	CA	91105	2505	19	06037	34.14074037	-118.1508578	Los Angeles County
76054	Fee-for-Service	1023470275	1023470275	1	1	PSOINOS, DANIEL DO	10/2/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16574	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
76056	Fee-for-Service	1457798233	1457798233	1	1	POONI, RAJDEEP MD	9/24/2017	390200000X	NA	Other	026	PHYSICIANS	134346	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
76070	Fee-for-Service	1306981527	1306981527	1	1	PAROLY, WARREN S MD	2/1/1983	207RH0003X	NA	Oncology	026	PHYSICIANS	29867	41	Internal Medicine	0	In state provider	None	3925 WARING RD	STE C	OCEANSIDE	CA	92056	4459	37	06073	33.18776771	-117.2893136	San Diego County
76080	Fee-for-Service	1467895474	1467895474	1	1	POURKAVIANI, SHALIZ MD	12/5/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	155765	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
76137	Fee-for-Service	1548306483	1548306483	1	1	PANDE, HEMANT MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54643	10	Gastroenterology (M.D. only)	0	In state provider	None	4940 VAN NUYS BLVD	SUITE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
76139	Fee-for-Service	1235266537	1235266537	1	1	POST, LISA I MD	3/1/1993	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
76174	Fee-for-Service	1962420752	1962420752	1	1	PATEL, SANDHYA T MD	1/19/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	94036	41	Internal Medicine	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
76187	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
76189	Fee-for-Service	1922322726	1922322726	1	1	PUTZ, KATHERINE S MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124788	08	Family Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
76198	Fee-for-Service	1063636868	1063636868	1	1	PERKINS, BRADFORD T MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	93594	08	Family Practice	0	In state provider	None	2400 SAMARITAN DRIVE	#203	SAN JOSE	CA	95124	3910	43	06085	37.25103365	-121.9442147	Santa Clara County
76225	Fee-for-Service	1972966836	1972966836	1	1	PATEL, DEV R MD	12/1/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150579	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
76244	Fee-for-Service	1235299611	1235299611	1	1	POTYK, LISAJEANNE LAC	3/5/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	251 EAST MAIN STREET	None	EL CAJON	CA	92020	3911	37	06073	32.79491953	-116.959374	San Diego County
76284	Fee-for-Service	1962550327	1962550327	1	1	PORTA, ROBERT J LCSW	2/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	40680 HIGHWAY 41	SUITE D	OAKHURST	CA	93644	9657	20	06039	37.33849833	-119.6445197	Madera County
76288	Fee-for-Service	1710975727	1710975727	1	2	PLANNED PARENTHOOD/	4/10/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	801 E KATELLA AVE	None	ANAHEIM	CA	92805	6614	30	06059	33.80344749	-117.8986365	Orange County
76303	Fee-for-Service	1467899450	1467899450	1	1	PACIFIC HERITAGE MEDICAL GRO	1/10/2023	2084P0805X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	UP INC	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
76312	Fee-for-Service	1134535289	1134535289	1	1	POUND, LOREN D LMFT	10/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6400 FOLSOM BLVD	224	SACRAMENTO	CA	95819	4645	34	06067	38.553327	-121.428855	Sacramento County
76318	Fee-for-Service	1912467119	1912467119	1	1	PORTILLO, JOSUE DO	5/9/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
76359	Fee-for-Service	1821302340	1821302340	1	1	P0WERS, NICOLE D CRNA	11/13/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
76369	Fee-for-Service	1548617707	1548617707	1	1	PANESAR, AMREETA K MD	8/12/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158061	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
76372	Fee-for-Service	1093336349	1093336349	1	1	PERSONALIZED MEDICINE CARE D	11/7/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	IAGNOSTICS LLC	20271 GOLDENROD LN	FL 2, 2099	GERMANTOWN	MD	20876	4064	00	None	39.18720878	-77.25114055	Montgomery County
76392	Fee-for-Service	1881762896	1881762896	1	1	PAGENKOPF, ERIC L MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54558	20	Orthopedic Surgery	0	In state provider	None	2210 E ILLINOIS AVE	STE 410	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
76410	Fee-for-Service	1124101084	1124101084	1	1	PEREZ, EVELYN M OD	1/14/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	850 S ATLANTIC BLVD	STE 301	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
76416	Fee-for-Service	1073741799	1073741799	1	1	PAPA, KHRISTINE M MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119533	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
76458	Fee-for-Service	1285193342	1285193342	1	1	PROGUSHEV, SERGEY S MD	4/4/2023	207L00000X	NA	Other	026	PHYSICIANS	181798	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
76463	Fee-for-Service	1962420752	1962420752	1	1	PATEL, SANDHYA T MD	1/19/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	94036	40	Pediatrics	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
76468	Fee-for-Service	1710220439	1710220439	1	3	PACIFIC CENTRAL COAST HEALTH	6/1/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	116 S PALISADE DRIVE	SUITE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
76475	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
76537	Fee-for-Service	1104604859	1104604859	1	1	PHARMACY AND BEYOND INC	11/28/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3415 W MAGNOLIA BLVD	None	BURBANK	CA	91505	2910	19	06037	34.16876982	-118.3444097	Los Angeles County
76565	Fee-for-Service	1558638833	1558638833	1	1	PARUYRYAN, HRACHYA MD INC	4/18/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	97760	01	General Practice	0	In state provider	None	1332 S GLENDALE ST	None	GLENDALE	CA	91205	3349	19	06037	34.12915317	-118.2525649	Los Angeles County
76602	Fee-for-Service	1538129028	1538129028	1	1	PAZEVIC, BRIAN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73431	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
76626	Fee-for-Service	1174548242	1174548242	1	1	PARISH, KATHY L PHD	9/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
76630	Fee-for-Service	1457343717	1457343717	1	1	PEDERSEN, RAYMOND F OD	7/6/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	38069 MARTHA AVE	STE 200	FREMONT	CA	94536	3811	01	06001	37.55978715	-121.991892	Alameda County
76632	Fee-for-Service	1881635076	1881635076	1	1	PETERS, TIMOTHY MD	8/2/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
76635	Fee-for-Service	1821549429	1821549429	1	1	PATEL, ANKITA A DO	9/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14994	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
76728	Fee-for-Service	1619994191	1619994191	1	1	PLANNED PARENTHOOD	11/11/2005	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA CENTRAL COAST	1200 W HILLCREST DR	STE 100	THOUSAND OAKS	CA	91320	2734	56	06111	34.18505362	-118.9068862	Ventura County
76756	Fee-for-Service	1568491660	1568491660	1	1	PASVANKAS, GEORGE W MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94342	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
76762	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
76765	Fee-for-Service	1407887243	1407887243	1	1	PERR, HILARY A	4/2/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74860	40	Pediatrics	0	In state provider	None	2340 CLAY ST	FL 3	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
76768	Fee-for-Service	1316995921	1316995921	1	1	PENALOZA, MARIA D MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63385	01	General Practice	0	In state provider	None	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	19	06037	34.04452444	-118.2114844	Los Angeles County
76778	Fee-for-Service	1699075184	1699075184	1	1	PODESTA, MARCELO A LMFT	7/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7317 EL CAJON BLVD	230	LA MESA	CA	91942	7434	37	06073	32.7687506	-117.0398487	San Diego County
76783	Fee-for-Service	1881778165	1881778165	1	1	PATEL, BHAVESH B DO	12/31/2007	207R00000X	NA	Other	026	PHYSICIANS	8240	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76818	Fee-for-Service	1235399650	1235399650	1	1	PAL, SAIKAT MD	1/18/2019	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
76823	Fee-for-Service	1801466826	1801466826	1	2	PALOMAR HOSPITALIST MEDICAL	7/1/2021	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
76833	Fee-for-Service	1063561389	1063561389	1	1	PRESS, GARY A MD	3/17/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56851	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76885	Fee-for-Service	1598459836	1598459836	1	1	PHAM, JOVIANNE	7/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3700 GOSFORD RD	SUITE G	BAKERSFIELD	CA	93309	7694	15	06029	35.320932	-119.092064	Kern County
76907	Fee-for-Service	1407963275	1407963275	1	1	PACIFIC MEDICAL IMAGING	1/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	& ONCOLOGY CENTER, INC	707 S GARFIELD AVE	FL B1	ALHAMBRA	CA	91801	5859	19	06037	34.088688	-118.123106	Los Angeles County
76914	Fee-for-Service	1073519443	1073519443	1	3	PIONEERS MEMORIAL HEALTH	4/22/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	751 WEST LEGION ROAD	SUITE 305	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
76922	Fee-for-Service	1730319906	1730319906	1	1	PRATT, ALISHA N DO	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11336	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6363	50	06099	37.64720049	-120.982338	Stanislaus County
76979	Fee-for-Service	1720673791	1720673791	1	1	PERFORMANCE HEARING CENTER,	2/14/2025	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	19801 VANOWEN ST	SUITE H	WINNETKA	CA	91306	3962	19	06037	34.19383649	-118.5645375	Los Angeles County
76981	Fee-for-Service	1023669231	1023669231	1	1	PELKYI, TENZIN RN CNM	10/30/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
77017	Fee-for-Service	1366403834	1366403834	1	1	POSEY, DAVID M MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	38971	22	Pathology (M.D. only)	0	In state provider	None	6245 DE LONGPRE AVE	None	HOLLYWOOD	CA	90028	8253	19	06037	34.0962065	-118.325178	Los Angeles County
77023	Fee-for-Service	1821194192	1821194192	1	1	PUNJABI, ANIL MD DDS INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85143	24	Plastic Surgery	0	In state provider	None	365 TERRACINA BLVD	None	REDLANDS	CA	92373	4896	36	06071	34.03693536	-117.204131	San Bernardino County
77051	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	12/20/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
77053	Fee-for-Service	1316995921	1316995921	1	1	PENALOZA, MARIA D MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63385	08	Family Practice	0	In state provider	None	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	19	06037	34.04452444	-118.2114844	Los Angeles County
77060	Fee-for-Service	1376695734	1376695734	1	1	POWELL, ROBERT S MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77251	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
77081	Fee-for-Service	1437343183	1437343183	1	1	PETROVIC, MARKO MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97937	13	Neurology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
77084	Fee-for-Service	1073186813	1073186813	1	1	POR, AMBER S PT	2/24/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
77089	Fee-for-Service	1265966378	1265966378	1	1	PEREZ ROGERS, ALEXIS MD	7/27/2020	207P00000X	NA	Other	026	PHYSICIANS	158414	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
77099	Fee-for-Service	1770673238	1770673238	1	1	PITZER, GEOFFREY B MD	1/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125888	04	Otology, Laryngology, Rhinology	0	In state provider	None	5565 GROSSMONT CENTER DR	SUITE 101	LA MESA	CA	91942	3021	37	06073	32.77978322	-117.0094766	San Diego County
77110	Fee-for-Service	1801466826	1801466826	1	2	PALOMAR HOSPITALIST MEDICAL	7/1/2021	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP, INC	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
77119	Fee-for-Service	1619216827	1619216827	1	1	PODIATRY HOTLINE INC	2/28/2020	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	26302 LA PAZ RD	101	MISSION VIEJO	CA	92691	5313	30	06059	33.60034452	-117.671202	Orange County
77120	Fee-for-Service	1063561389	1063561389	1	1	PRESS, GARY A MD	3/17/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56851	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
77191	Fee-for-Service	1407963275	1407963275	1	1	PACIFIC MEDICAL IMAGING	1/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	& ONCOLOGY CENTER, INC	707 S GARFIELD AVE	FL B1	ALHAMBRA	CA	91801	5859	19	06037	34.088688	-118.123106	Los Angeles County
77213	Fee-for-Service	1013081835	1013081835	1	1	PETROVIC, MARIJA MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127707	36	Psychiatry	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
77220	Fee-for-Service	1194121699	1194121699	1	1	PEGODA-HALLOCK, REBECCA A	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
77244	Fee-for-Service	1114245495	1114245495	1	1	PARKVIEW MEDICAL PLAZA	12/21/2015	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	3975 JACKSON ST	STE 111	RIVERSIDE	CA	92503	3946	33	06065	33.92729721	-117.4413503	Riverside County
77249	Fee-for-Service	1063571669	1063571669	1	1	PAW, SAMUEL S MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50466	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
77291	Fee-for-Service	1457447518	1457447518	1	1	PERRY, NENA L MD	3/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56783	38	Geriatrics	0	In state provider	None	2615 BRESLAUER WAY	None	REDDING	CA	96001	4247	45	06089	40.54957365	-122.3807785	Shasta County
77294	Fee-for-Service	1902874761	1902874761	1	1	PRABHAKAR, VEENA A DO	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7432	01	General Practice	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
77339	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
77340	Fee-for-Service	1588985741	1588985741	1	1	PHILLIPS, GINA N LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
77374	Fee-for-Service	1285793018	1285793018	1	1	PASCH, LAURI A PHD	2/16/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77409	Fee-for-Service	1275848251	1275848251	1	1	POSSIN, KATHERINE L PHD	5/26/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
77430	Fee-for-Service	1407167133	1407167133	1	1	PALATINUS, HELEN N DO	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13925	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
77444	Fee-for-Service	1811973316	1811973316	1	1	PINO, RICHARD M MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	55 FRUIT ST	BLDG 2	BOSTON	MA	02114	2696	00	None	42.363216	-71.0687745	Suffolk County
77452	Fee-for-Service	1093865834	1093865834	1	1	PEEL, KARIE G CSW	4/25/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
77466	Fee-for-Service	1831130863	1831130863	1	1	PETERSON, MARK A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40987	02	General Surgery	0	In state provider	None	1300 S ELISEO DR	STE 202	GREENBRAE	CA	94904	2015	21	06041	37.94447529	-122.53657	Marin County
77498	Fee-for-Service	1407078298	1407078298	1	1	PATEL, BIPIN	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50311	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
77510	Fee-for-Service	1043228190	1043228190	1	1	POLENZ, SCOTT C LMFT	5/11/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1495 W SHAW AVE	None	FRESNO	CA	93711	3608	10	06019	36.80821643	-119.8194768	Fresno County
77513	Fee-for-Service	1295189850	1295189850	1	1	PARK, JI YEON DO	6/1/2020	390200000X	NA	Other	026	PHYSICIANS	16572	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
77573	Fee-for-Service	1558621078	1558621078	1	1	PLOTNIK, ADAM MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
77579	Fee-for-Service	1457447518	1457447518	1	1	PERRY, NENA L MD	3/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56783	41	Internal Medicine	0	In state provider	None	2615 BRESLAUER WAY	None	REDDING	CA	96001	4247	45	06089	40.54957365	-122.3807785	Shasta County
77581	Fee-for-Service	1902874761	1902874761	1	1	PRABHAKAR, VEENA A DO	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7432	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
77591	Fee-for-Service	1891785945	1891785945	1	1	PINDER, GODFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	99 OLD INDIAN RD	None	WEST ORANGE	NJ	07052	2603	00	None	40.78168041	-74.26853514	Essex County
77593	Fee-for-Service	1649275868	1649275868	1	1	PRESBYTERIAN INTERCOM HOSP	6/4/1986	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOME HEALTH	15050 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707774	-118.0098054	Los Angeles County
77602	Fee-for-Service	1669561890	1669561890	1	7	PLANNED PARENTHOOD LA	11/1/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2690 PACIFIC AVE	STE 260	LONG BEACH	CA	90806	2661	19	06037	33.805854	-118.1936805	Los Angeles County
77624	Fee-for-Service	1053499640	1053499640	1	1	PATEL-PATRAWALA, SVASTI	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62814	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
77626	Fee-for-Service	1639252604	1639252604	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
77645	Fee-for-Service	1841425568	1841425568	1	1	PORAYETTE, PRASHANTH MD	7/1/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	186822	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
77650	Fee-for-Service	1457407934	1457407934	1	1	PUTNAM, BRANT A MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84443	02	General Surgery	0	In state provider	None	1000 W CARSON ST	BOX 42	TORRANCE	CA	90509	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
77654	Fee-for-Service	1720320989	1720320989	1	1	PUCHAKAYALA, NANDITA C MD	7/16/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	138716	36	Psychiatry	0	In state provider	None	24432 MUIRLANDS BLVD	SUTIE 131	LAKE FOREST	CA	92630	3939	30	06059	33.62755212	-117.7028876	Orange County
77681	Fee-for-Service	1578313607	1578313607	1	1	PROTESTANT EPISCOPAL CHURCH	8/29/2024	172V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	840 ECHO PARK AVE	None	LOS ANGELES	CA	90026	4209	19	06037	34.07350077	-118.2593565	Los Angeles County
77697	Fee-for-Service	1104096296	1104096296	1	1	PETTY, VALERIE K CRNA	3/21/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
77705	Fee-for-Service	1043522956	1043522956	1	1	PERUMBETI, ANIL MD	1/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113144	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
77708	Fee-for-Service	1598184244	1598184244	1	1	PHAN, DEREK Q MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138554	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
77717	Fee-for-Service	1447603931	1447603931	1	1	PLANT, SCOTT LAC	9/28/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CLINIC	8118 GARVEY AVE	SUITE H	ROSEMEAD	CA	91770	2471	19	06037	34.06262049	-118.0917	Los Angeles County
77733	Fee-for-Service	1306375662	1306375662	1	1	PENNISI, VINCENT B MD	6/9/2023	207R00000X	NA	Other	026	PHYSICIANS	186288	None	None	0	In state provider	None	1503 E MARCH LN	A	STOCKTON	CA	95210	5622	39	06077	38.00228434	-121.2903651	San Joaquin County
77743	Fee-for-Service	1174056345	1174056345	1	1	PATEL, DIMPLE M MD	9/20/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158745	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
77760	Fee-for-Service	1326452855	1326452855	1	1	PATSIAS, ALEXIS	4/18/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	160436	04	Otology, Laryngology, Rhinology	0	In state provider	None	5565 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
77772	Fee-for-Service	1861451676	1861451676	1	1	POWAR, MANINDER K MD	12/31/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51281	01	General Practice	0	In state provider	None	568 N SUNRISE	None	ROSEVILLE	CA	95661	3097	31	06061	38.7576732	-121.2534645	Placer County
77811	Fee-for-Service	1083297790	1083297790	1	1	PATEL, AKASH	1/9/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
77863	Fee-for-Service	1841376928	1841376928	1	1	PHAM, THUHA T MD	7/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61246	40	Pediatrics	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
77948	Fee-for-Service	1265433551	1265433551	2	1	PIH HEALTH DOWNEY HOSPITAL	10/1/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
77966	Fee-for-Service	1659792356	1659792356	1	1	PARK AVENUE PHYSICAL THERAPY	12/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	, INC	2808 PARK AVE	SUITE B	MERCED	CA	95348	3392	24	06047	37.31248834	-120.4716474	Merced County
77990	Fee-for-Service	1912449380	1912449380	2	1	PW PLAZA RX INC	7/15/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7230 MEDICAL CENTER DR	STE 106	WEST HILLS	CA	91307	4003	19	06037	34.20172814	-118.6294322	Los Angeles County
78008	Fee-for-Service	1891837753	1891837753	1	1	PERSHING COUNTY AMBULANCE	8/21/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1155 CORNELL AVENUE	None	LOVELOCK	NV	89419	0000	00	None	40.18160797	-118.4735206	Pershing County
78013	Fee-for-Service	1417579061	1417579061	1	1	PATEL, SNEHABEN NP	11/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
78017	Fee-for-Service	1124054036	1124054036	1	1	PNIEWSKI, STAN W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 ALDER ST	None	SOUTH BEND	WA	98586	0000	00	None	46.66222533	-123.8120798	Pacific County
78030	Fee-for-Service	1063036689	1063036689	1	1	PRIVA PATH LABS, INC	11/1/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	222 E HUNTINGTON DR	STE 100	MONROVIA	CA	91016	8012	19	06037	34.14039228	-117.9972726	Los Angeles County
78041	Fee-for-Service	1831553270	1831553270	1	1	PEASLEE, SAMUEL MD	5/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163109	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
78085	Fee-for-Service	1801851795	1801851795	1	1	PREMIER PATHOLOGY LABORATORI	7/30/2021	291U00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES, INC. A PROFESSIONAL	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
78101	Fee-for-Service	1760637094	1760637094	1	1	POSTELL, MICHAEL L LMFT	5/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	631 TENNESSEE STREET	SUITE 208	VALLEJO	CA	94590	4432	48	06095	38.10992398	-122.2522919	Solano County
78120	Fee-for-Service	1114903762	1114903762	1	1	PAYKAR, ABRAHAM MD INC	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	54392	41	Internal Medicine	0	In state provider	None	1601 W AVENUE J	STE 203	LANCASTER	CA	93534	2824	19	06037	34.68946047	-118.158849	Los Angeles County
78162	Fee-for-Service	1750489951	1750489951	1	1	PATHARE, SAMEER S MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80828	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
78167	Fee-for-Service	1386082774	1386082774	1	1	PATEL, JAY V MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154603	01	General Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
78191	Fee-for-Service	1083032635	1083032635	1	2	PEDERSEN, HEATHER PHD	4/21/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	Y	264 CLOVIS AVENUE	SUITE 104	CLOVIS	CA	93612	1115	10	06019	36.8268544	-119.7007055	Fresno County
78193	Fee-for-Service	1629083274	1629083274	3	1	PHARMCARE, INC	8/17/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3003 W. OLYMPIC BLVD	STE 101	LOS ANGELES	CA	90006	6511	19	06037	34.05266953	-118.300716	Los Angeles County
78207	Fee-for-Service	1336131325	1336131325	1	1	PAZMINO, PATRICIO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NIH CENTER	1701 N MESA ST	# 101	EL PASO	TX	79902	3503	00	None	31.76984189	-106.4968977	El Paso County
78236	Fee-for-Service	1265433551	1265433551	2	1	PIH HEALTH DOWNEY HOSPITAL	10/1/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
78263	Fee-for-Service	1699122341	1699122341	1	1	PARTNERS IN CARE FOUNDATION	12/1/2016	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	732 MOTT ST	#150	SAN FERNANDO	CA	91340	4241	19	06037	34.27661761	-118.4442372	Los Angeles County
78292	Fee-for-Service	1538187877	1538187877	1	1	PRADHAN, KAMAL M MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147295	40	Pediatrics	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
78335	Fee-for-Service	1528479821	1528479821	1	1	PATEL, PINA MD	10/10/2017	390200000X	NA	Other	026	PHYSICIANS	140468	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
78352	Fee-for-Service	1003832304	1003832304	1	1	PRABHA RANGANATHAN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	None	SAINT LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
78422	Fee-for-Service	1336173269	1336173269	1	5	PROVIDENCE HEALTH SYSTEM	7/13/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	181 S BUENA VISTA ST	1ST FLOOR, STE 100	BURBANK	CA	91505	4504	19	06037	34.15958049	-118.328816	Los Angeles County
78423	Fee-for-Service	1871534636	1871534636	1	1	POHOST, GERALD M MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86422	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
78429	Fee-for-Service	1932539038	1932539038	1	1	PALLANTI, STEFANO MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
78456	Fee-for-Service	1326282096	1326282096	1	1	PINLAC SANCHEZ, ANNA R DO	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11546	08	Family Practice	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
78470	Fee-for-Service	1396303756	1396303756	1	1	PALEY, MATTHEW DO	7/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	19906	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
78492	Fee-for-Service	1336131325	1336131325	1	1	PAZMINO, PATRICIO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NIH CENTER	1701 N MESA ST	# 101	EL PASO	TX	79902	3503	00	None	31.76984189	-106.4968977	El Paso County
78516	Fee-for-Service	1952390098	1952390098	3	1	POSNER, LAWRENCE MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	20698	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
78549	Fee-for-Service	1699122341	1699122341	1	1	PARTNERS IN CARE FOUNDATION	7/1/2016	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	732 MOTT ST	#150	SAN FERNANDO	CA	91340	4241	19	06037	34.27661761	-118.4442372	Los Angeles County
78565	Fee-for-Service	1780942037	1780942037	1	1	PHAM, THU N MD	1/27/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	163605	10	Gastroenterology (M.D. only)	0	In state provider	None	2621 S BRISTOL ST	202	SANTA ANA	CA	92704	5718	30	06059	33.711876	-117.885371	Orange County
78622	Fee-for-Service	1740505262	1740505262	1	1	PLANNED PARENTHOOD	7/16/2010	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	280 EL CERRITO PLAZA	None	EL CERRITO	CA	94530	4003	07	06013	37.89881448	-122.2994256	Contra Costa County
78721	Fee-for-Service	1336173269	1336173269	1	4	PROVIDENCE HEALTH SYSTEM	7/13/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	181 S BUENA VISTA ST	2ND FLOOR, ROOM 231, 234	BURBANK	CA	91505	4504	19	06037	34.15958049	-118.328816	Los Angeles County
78723	Fee-for-Service	1427506195	1427506195	1	1	PLATONOVA, SVETLANA PT	3/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
78771	Fee-for-Service	1831702398	1831702398	1	1	PALOMAR HEALTH	6/10/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION	2181 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
78780	Fee-for-Service	1801880323	1801880323	1	1	PRESTON MOBILITY PLUS, INC	1/13/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	309 W ELDORADO PARKWAY	SUITE 110 & 112	LITTLE ELM	TX	75068	5196	00	None	33.15855595	-96.94105395	Denton County
78818	Fee-for-Service	1649850207	1649850207	1	1	PHUNG, PAULINE	7/3/2024	207P00000X	NA	Other	026	PHYSICIANS	22393	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
78825	Fee-for-Service	1750375390	1750375390	1	1	PAUL, MARC H MD	1/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87392	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
78827	Fee-for-Service	1932608841	1932608841	1	1	PARENT CHILD THERAPY CLINIC	10/22/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3585 MAPLE ST	246	VENTURA	CA	93003	3504	56	06111	34.26916737	-119.2456769	Ventura County
78835	Fee-for-Service	1558779694	1558779694	1	1	PACIFICA ROYALE ASSISTED	9/16/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING COMMUNITY INC.	15022 PACIFIC ST	None	MIDWAY CITY	CA	92655	1452	30	06059	33.744366	-117.991462	Orange County
78876	Fee-for-Service	1023234358	1023234358	1	1	PLANCHER, DARYN PSYD	12/10/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
78887	Fee-for-Service	1982297552	1982297552	1	1	PETERS, JERRIANN LMFT	11/18/2023	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
78898	Fee-for-Service	1639243116	1639243116	1	1	PALO ALTO COUNTY HOSPITAL	12/14/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	1	Border provider	None	3201 FIRST ST	None	EMMETSBURG	IA	50536	2516	00	None	43.11921099	-94.69133087	Palo Alto County
78924	Fee-for-Service	1104008473	1104008473	1	1	PAI, ASHOK P MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101822	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
78971	Fee-for-Service	1316972144	1316972144	1	1	PHAM, ANH KIM MD	9/30/1991	207L00000X	NA	Other	026	PHYSICIANS	46683	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
78984	Fee-for-Service	1760638415	1760638415	1	1	POSTMAN KUCHTA, AGATHA PT	4/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
79016	Fee-for-Service	1538203971	1538203971	1	1	PACIFIC WOMEN'S MEDICAL	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51569	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CLINIC	4750 GAGE AVE	None	BELL	CA	90201	1351	19	06037	33.97730517	-118.1807015	Los Angeles County
79017	Fee-for-Service	1710023577	1710023577	1	1	PATLOVANY, MATHEW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 MADISON OAK DR	None	SAN ANTONIO	TX	78258	0000	00	None	29.62127927	-98.49119067	Bexar County
79032	Fee-for-Service	1497252464	1497252464	1	1	PIERCE, JASON A DO	5/25/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
79037	Fee-for-Service	1154420743	1154420743	1	1	PARK, SO YOUNG	10/17/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1141 REDONDO BEACH BLVD	SUITE 300	GARDENA	CA	90247	3586	19	06037	33.89247036	-118.2941482	Los Angeles County
79060	Fee-for-Service	1831702398	1831702398	1	1	PALOMAR HEALTH	6/10/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION	2181 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
79061	Fee-for-Service	1114239068	1114239068	1	1	PHYSICIANS FOR HEALTHY HOSPS	11/30/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1117 E DEVONSHIRE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
79091	Fee-for-Service	1427098797	1427098797	1	1	PAWAR, SURENDRA V MD	10/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36271	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
79095	Fee-for-Service	1881841971	1881841971	1	1	PEREZ, ANGEL J MD	4/25/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	157073	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
79113	Fee-for-Service	1255443982	1255443982	1	1	PHILLIPS, KIM B LMFT	11/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	42525 RANCHO MIRAGE LN	EXECUTIVE SUITE #6	RANCHO MIRAGE	CA	92270	4312	33	06065	33.73905433	-116.4139153	Riverside County
79123	Fee-for-Service	1891963237	1891963237	1	1	PASTOR, CHRISTOPHER S MD	7/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
79186	Fee-for-Service	1639243116	1639243116	1	1	PALO ALTO COUNTY HOSPITAL	12/14/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	1	Border provider	None	3201 FIRST ST	None	EMMETSBURG	IA	50536	2516	00	None	43.11921099	-94.69133087	Palo Alto County
79212	Fee-for-Service	1447649769	1447649769	1	1	PHAM, TAI MD	7/1/2019	207R00000X	NA	Other	026	PHYSICIANS	152821	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
79275	Fee-for-Service	1891312880	1891312880	1	1	PERECMAN, AARON J MD	4/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
79302	Fee-for-Service	1538203971	1538203971	1	1	PACIFIC WOMEN'S MEDICAL	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51569	41	Internal Medicine	0	In state provider	CLINIC	4750 GAGE AVE	None	BELL	CA	90201	1351	19	06037	33.97730517	-118.1807015	Los Angeles County
79349	Fee-for-Service	1023079266	1023079266	1	1	PHILLIPS, JENNIFER M	4/1/2003	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
79350	Fee-for-Service	1114239068	1114239068	1	1	PHYSICIANS FOR HEALTHY HOSPS	11/30/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1117 E DEVONSHIRE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
79356	Fee-for-Service	1447077177	1447077177	1	1	PACIFIC SHORES DERMATOLOGY &	12/1/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SKIN CANCER INSTITUTE	860 OAK PARK BLVD	STE 101	ARROYO GRANDE	CA	93420	1800	40	06079	35.13301284	-120.6056029	San Luis Obispo County
79363	Fee-for-Service	1619918133	1619918133	1	1	PECHA, ROBERT E MD	11/1/1998	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	74570	10	Gastroenterology (M.D. only)	0	In state provider	None	1006 MARSHALL WAY	None	PLACERVILLE	CA	95667	5706	09	06017	38.7261417	-120.7925328	El Dorado County
79389	Fee-for-Service	1710587670	1710587670	1	5	PHYSICIANS OF SOUTHERN CALIF	4/19/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	ORNIA INC	1624 S GRAND AVE	None	GLENDORA	CA	91740	5433	19	06037	34.109424	-117.8724915	Los Angeles County
79402	Fee-for-Service	1568999134	1568999134	1	1	PRIME ESSENTIAL HEALTH INC	2/23/2018	193200000X	NA	Other	026	PHYSICIANS	49614	38	Geriatrics	0	In state provider	None	9381 E STOCKTON BLVD	STE 220	ELK GROVE	CA	95624	5070	34	06067	38.416689	-121.3915185	Sacramento County
79449	Fee-for-Service	1114079514	1114079514	1	1	PARMELY, STEPHANIE M PHD	4/11/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
79450	Fee-for-Service	1558947093	1558947093	1	1	PEREZ, JESSE MD	8/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187731	08	Family Practice	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
79459	Fee-for-Service	1922023233	1922023233	1	1	PREGLER, JOHNATHAN L MD	1/31/1991	207L00000X	NA	Other	026	PHYSICIANS	71896	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
79474	Fee-for-Service	1548228661	1548228661	1	1	PE, JEAN MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	40943	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
79502	Fee-for-Service	1295909331	1295909331	1	1	PARIKH, PALAK MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111205	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
79547	Fee-for-Service	1740248475	1740248475	1	1	PIONEER MED SPPLY SVCS	9/17/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8221 S WESTERN AVE	None	LOS ANGELES	CA	90047	3036	19	06037	33.963957	-118.309038	Los Angeles County
79589	Fee-for-Service	1407808454	1407808454	1	1	PANCHAL, NEERAJ J MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83142	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
79590	Fee-for-Service	1992230965	1992230965	1	1	PAEK, JEAN MD	8/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
79596	Fee-for-Service	1134486921	1134486921	1	1	PATEL, YERAL MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124162	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
79655	Fee-for-Service	1104057397	1104057397	1	1	POPAT, MITESH G MD	3/14/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	107005	-	NOT APPLICABLE	0	In state provider	None	361 3RD ST	SUITE G	SAN RAFAEL	CA	94901	3581	21	06041	37.97011695	-122.5160089	Marin County
79658	Fee-for-Service	1326600289	1326600289	1	1	PAZ, JESSICA ERENE B CNP	11/12/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
79690	Fee-for-Service	1568999134	1568999134	1	1	PRIME ESSENTIAL HEALTH INC	2/23/2018	193200000X	NA	Other	026	PHYSICIANS	49614	01	General Practice	0	In state provider	None	9381 E STOCKTON BLVD	STE 220	ELK GROVE	CA	95624	5070	34	06067	38.416689	-121.3915185	Sacramento County
79701	Fee-for-Service	1902085277	1902085277	1	1	PETIT, STEVEN J MD AMC	7/23/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	29872	10	Gastroenterology (M.D. only)	0	In state provider	None	630 S RAYMOND AVE	#240	PASADENA	CA	91105	3283	19	06037	34.13505223	-118.1487761	Los Angeles County
79738	Fee-for-Service	1568408763	1568408763	1	1	PHAM, NHAT M MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79286	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
79783	Fee-for-Service	1265755060	1265755060	1	1	PATEL, TEJAL B MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115269	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3723	56	06111	34.21700406	-119.1582582	Ventura County
79785	Fee-for-Service	1902169873	1902169873	1	1	PATEL, URVI DO	11/29/2023	207P00000X	NA	Other	026	PHYSICIANS	20203	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
79811	Fee-for-Service	1013022433	1013022433	1	1	POOR, PHILIP W MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53273	09	Gynecology (D.O. only)	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
79853	Fee-for-Service	1346246915	1346246915	1	1	POUNDS, THOMAS R MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	40653	42	Nuclear Medicine	0	In state provider	None	1450 EXPO PKWY	None	SACRAMENTO	CA	95815	4230	34	06067	38.597139	-121.4558685	Sacramento County
79945	Fee-for-Service	1952495566	1952495566	1	1	PERLMAN, NICOLE A LMFT	8/27/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38896	-	NOT APPLICABLE	0	In state provider	None	331 E ADAMS STREET	None	SANTA ANA	CA	92868	3509	30	06059	33.71286994	-117.8638575	Orange County
79987	Fee-for-Service	1912215724	1912215724	1	1	PETERS, JOSHUA M LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51738	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVENUE	1ST FLOOR	SAN LUIS OBISPO	CA	93401	4513	40	06079	35.27488974	-120.6468257	San Luis Obispo County
80068	Fee-for-Service	1063906196	1063906196	1	1	PIERSON, MARLANA LMFT	8/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
80099	Fee-for-Service	1013022433	1013022433	1	1	POOR, PHILIP W MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53273	41	Internal Medicine	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
80118	Fee-for-Service	1922167824	1922167824	1	1	PALMER, CAROLINE B	9/4/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
80157	Fee-for-Service	1538203971	1538203971	1	2	PACIFIC WOMEN'S MEDICAL	3/24/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51569	41	Internal Medicine	0	In state provider	PACIFIC WOMENS MEDICAL	4070 TWEEDY BLVD	STE E	SOUTH GATE	CA	90280	6165	19	06037	33.94358863	-118.2003207	Los Angeles County
80158	Fee-for-Service	1689019127	1689019127	1	1	PHUNG, CELYNE T MD	3/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130094	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
80178	Fee-for-Service	1720216153	1720216153	1	1	PATEL, NISHANT D MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120483	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	B7-240	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
80187	Fee-for-Service	1609135623	1609135623	1	1	PEAIRS, JAMES J MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155296	18	Ophthalmology	0	In state provider	None	835 THIRD AVE	STE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
80198	Fee-for-Service	1760404032	1760404032	2	1	PITTSON, STEVEN M DC	5/29/2014	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	420 W LAS PALMAS	None	PATTERSON	CA	95363	2542	50	06099	37.47051177	-121.1323202	Stanislaus County
80220	Fee-for-Service	1083884514	1083884514	1	1	PATEL, RUPAL M MD	5/7/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96321	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
80242	Fee-for-Service	1841377033	1841377033	1	1	PERLOWSKI, ALICE A MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84678	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
80258	Fee-for-Service	1578546479	1578546479	1	1	PENG, AMY L MD	12/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68677	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
80263	Fee-for-Service	1720093198	1720093198	1	1	POSADAS, EMERITO D MD	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	48980	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
80340	Fee-for-Service	1922333004	1922333004	1	1	PEDERSEN, AMY L OD	2/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27309 MADISON AVE	None	TEMECULA	CA	92590	5685	33	06065	33.52449693	-117.166286	Riverside County
80350	Fee-for-Service	1497251672	1497251672	1	1	PUREWAL, JASKEERIT K MD	9/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174354	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	600	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
80364	Fee-for-Service	1548303589	1548303589	1	5	PIONEER MEDICAL GROUP INC	2/15/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4476 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6359	19	06037	33.94280053	-118.1931037	Los Angeles County
80418	Fee-for-Service	1003874702	1003874702	2	5	PROHEALTH ADVANCED IMAGING M	12/16/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	18388 CLARK STREET	SUITE 115	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
80420	Fee-for-Service	1407933005	1407933005	1	2	PINE, PAMELA PHD	2/13/2012	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9735 WILSHIRE BLVD	STE 212	BEVERLY HILLS	CA	90212	2102	19	06037	34.06711051	-118.4074605	Los Angeles County
80436	Fee-for-Service	1134607120	1134607120	1	2	PULMONIC HEALTH, LLC	4/3/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6721 N WILLOW AVE	102	FRESNO	CA	93710	5950	10	06019	36.8342826	-119.7300252	Fresno County
80442	Fee-for-Service	1538144241	1538144241	1	1	PALENCIA, DON D DO	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12968	08	Family Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6002	19	06037	34.28200485	-118.4030797	Los Angeles County
80446	Fee-for-Service	1538203971	1538203971	1	2	PACIFIC WOMEN'S MEDICAL	3/24/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51569	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PACIFIC WOMENS MEDICAL	4070 TWEEDY BLVD	STE E	SOUTH GATE	CA	90280	6165	19	06037	33.94358863	-118.2003207	Los Angeles County
80496	Fee-for-Service	1811121130	1811121130	1	1	PACIFIC HOSPITALIST	9/9/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES AMC	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
80502	Fee-for-Service	1447631627	1447631627	1	1	PETTY, JESSICA E DO	10/12/2021	207R00000X	NA	Other	026	PHYSICIANS	18831	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
80526	Fee-for-Service	1952415150	1952415150	1	1	PATRICK COSTELLO	7/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2808 S 143RD PLAZA	None	OMAHA	NE	68144	5611	00	None	41.23208951	-96.13560171	Douglas County
80555	Fee-for-Service	1083850903	1083850903	1	1	PADILLA, ELIZABETH M PSYD	10/18/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
80560	Fee-for-Service	1639358047	1639358047	2	1	PGBB LLC	6/14/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	212 W. MAGNOLIA BLVD	None	BURBANK	CA	91502	1724	19	06037	34.17764238	-118.3178365	Los Angeles County
80599	Fee-for-Service	1548314396	1548314396	1	1	PODIATRY GROUP SOUTH	8/1/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	A PROFESSIONAL CORP	425 W BONITA AVE	STE 110	SAN DIMAS	CA	91773	2543	19	06037	34.10669347	-117.814932	Los Angeles County
80656	Fee-for-Service	1891708707	1891708707	1	1	POWER, ROBERT D MD	4/30/1985	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	55392	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
80667	Fee-for-Service	1578058962	1578058962	1	1	POPE, DALLEN	4/25/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
80670	Fee-for-Service	1760047898	1760047898	1	1	PRUDENCE HOME HEALTH CARE	12/9/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14126 SHERMAN WAY	STE 202	VAN NUYS	CA	91405	5631	19	06037	34.20118851	-118.4409765	Los Angeles County
80675	Fee-for-Service	1598077463	1598077463	1	1	PORTER, MEREDITH K PSYD	6/12/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
80685	Fee-for-Service	1295824498	1295824498	1	1	PLANNED PARENTHOOD LOS	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES	21001 SHERMAN WAY	STE 9	CANOGA PARK	CA	91303	3683	19	06037	34.20113553	-118.5912126	Los Angeles County
80687	Fee-for-Service	1245802057	1245802057	1	1	PON, CHRISTOPHER CRNA	7/12/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
80714	Fee-for-Service	1346372208	1346372208	1	1	POOVAKAN, SUSAN D LMFT	7/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
80734	Fee-for-Service	1356474852	1356474852	1	1	PROHEALTH PARTNERS A MED	9/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	411 E 10TH ST	STE 105	LONG BEACH	CA	90813	4445	19	06037	33.77901648	-118.187667	Los Angeles County
80739	Fee-for-Service	1003136813	1003136813	1	1	PATEL, NEMISH S MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112534	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
80756	Fee-for-Service	1790213247	1790213247	1	3	PASADENA CLINICAL GROUP, A P	6/16/2024	103TA0400X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	321 RAMPART ST	STE 210	ORANGE	CA	92868	1860	30	06059	33.7916061	-117.8822879	Orange County
80769	Fee-for-Service	1609874445	1609874445	1	1	PORTNOFF, JON S MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43219	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
80799	Fee-for-Service	1639600083	1639600083	1	1	PHILLIPS, COTI MD	7/18/2022	207L00000X	NA	Other	026	PHYSICIANS	160297	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80820	Fee-for-Service	1952482275	1952482275	1	1	PROVIDENCE NEWBERG HOSP	6/6/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	501 VILLA RD	None	NEWBERG	OR	97132	1832	00	None	45.30355961	-122.9626955	Yamhill County
80833	Fee-for-Service	1184094948	1184094948	1	1	PHAMLE, QUEEN	11/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
80855	Fee-for-Service	1851613939	1851613939	1	1	PILLAI, DR SINDU MD INC	6/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66720	40	Pediatrics	0	In state provider	None	24910 LAS BRISAS RD	STE 114	MURRIETA	CA	92562	4035	33	06065	33.57522424	-117.1828078	Riverside County
80857	Fee-for-Service	1568512366	1568512366	1	1	PATEL, AMITKUMAR V MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89744	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
80880	Fee-for-Service	1548520299	1548520299	1	1	PLUMB, JARED P MD	1/28/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	520 MEDICAL CENTER DR	STE 200	MEDFORD	OR	97504	4314	00	None	42.318801	-122.831728	Jackson County
80894	Fee-for-Service	1346437571	1346437571	2	1	POBEDA SERVICES INC	10/7/2014	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	7235 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2718	19	06037	34.2490924	-118.2896079	Los Angeles County
80899	Fee-for-Service	1447766589	1447766589	1	1	PIZARRO, ELEANOR D NP	5/21/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
80902	Fee-for-Service	1275020307	1275020307	1	1	PETRITES, SHANE D MD	10/15/2021	207P00000X	NA	Other	026	PHYSICIANS	166937	None	None	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
80907	Fee-for-Service	1548438062	1548438062	1	1	PROGRESS HOUSE, INC	2/4/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5494 PONY EXPRESS TRAIL	None	CAMINO	CA	95709	9405	09	06017	38.74967088	-120.6164268	El Dorado County
80909	Fee-for-Service	1598089112	1598089112	1	1	PASCOE, JOSHUA E DO	1/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
80917	Fee-for-Service	1932519360	1932519360	1	1	PATEL, SHIVANI R	1/12/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1002 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	15	06029	35.36711975	-119.1118605	Kern County
80930	Fee-for-Service	1861532392	1861532392	1	1	PATEL, TASNEEM DO	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8581	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
80942	Fee-for-Service	1558314609	1558314609	1	1	PLANNED PARENTHOOD MAR MONTE	9/30/1981	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	5440 THORNWOOD DR	STE G	SAN JOSE	CA	95123	1217	43	06085	37.25346406	-121.8609675	Santa Clara County
80946	Fee-for-Service	1891708707	1891708707	1	1	POWER, ROBERT D MD	4/30/1985	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	55392	01	General Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
80963	Fee-for-Service	1942672126	1942672126	1	1	PENNER, GRETCHEN J LCSW	7/10/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97697	-	NOT APPLICABLE	0	In state provider	None	2049 SKYLINE DR	None	LEMON GROVE	CA	91945	4221	37	06073	32.72729271	-117.0254695	San Diego County
81035	Fee-for-Service	1790213247	1790213247	1	4	PASADENA CLINICAL GROUP, A P	9/15/2023	103TA0400X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7825 FAY AVE	200	LA JOLLA	CA	92037	4252	37	06073	32.84527369	-117.275383	San Diego County
81044	Fee-for-Service	1790213247	1790213247	1	3	PASADENA CLINICAL GROUP, A P	9/9/2022	103TA0400X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	321 RAMPART ST	STE 210	ORANGE	CA	92868	1860	30	06059	33.7916061	-117.8822879	Orange County
81074	Fee-for-Service	1073571295	1073571295	1	1	PETERSON, SAMUEL R MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148028	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
81081	Fee-for-Service	1669451571	1669451571	2	1	PATEL, MAYUR MD	8/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	56296	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA AVE	#506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
81093	Fee-for-Service	1609313402	1609313402	1	1	PEEPLES, SYDNEY B PT	9/26/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9501 FLUSHING QUAIL RD	SUITES 8,9 & 10	BAKERSFIELD	CA	93312	2660	15	06029	35.38617049	-119.10825	Kern County
81111	Fee-for-Service	1952482275	1952482275	1	1	PROVIDENCE NEWBERG HOSP	6/6/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	501 VILLA RD	None	NEWBERG	OR	97132	1832	00	None	45.30355961	-122.9626955	Yamhill County
81179	Fee-for-Service	1598225070	1598225070	1	1	PARK, BRIAN MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	182008	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
81255	Fee-for-Service	1134462039	1134462039	1	1	PARK, SANDY S MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125348	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
81262	Fee-for-Service	1851917405	1851917405	1	2	PROMIS DIAGNOSTICS, INC.	12/9/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1 POST	STE 100	IRVINE	CA	92618	5218	30	06059	33.67803404	-117.7681061	Orange County
81293	Fee-for-Service	1134157746	1134157746	1	1	PADULA, ANA M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	52184	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
81305	Fee-for-Service	1326466285	1326466285	1	1	PANTIG, TRACY A MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146503	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
81307	Fee-for-Service	1316066962	1316066962	1	1	PATCHETT, ERYN E LMFT	5/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
81322	Fee-for-Service	1790213247	1790213247	1	4	PASADENA CLINICAL GROUP, A P	10/14/2022	103TA0400X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7825 FAY AVE	200	LA JOLLA	CA	92037	4252	37	06073	32.84527369	-117.275383	San Diego County
81332	Fee-for-Service	1790213247	1790213247	1	3	PASADENA CLINICAL GROUP, A P	9/9/2022	103TA0400X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	321 RAMPART ST	STE 210	ORANGE	CA	92868	1860	30	06059	33.7916061	-117.8822879	Orange County
81335	Fee-for-Service	1669467148	1669467148	1	2	PINTELON,LYN M OD	4/18/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	7308	-	NOT APPLICABLE	0	In state provider	None	1841 E MAIN STREET	None	BARSTOW	CA	92311	3234	36	06071	34.8901829	-116.9978731	San Bernardino County
81348	Fee-for-Service	1063874121	1063874121	1	1	POPLI, RAKESH MD	10/16/2019	390200000X	NA	Other	026	PHYSICIANS	153598	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
81369	Fee-for-Service	1669451571	1669451571	2	1	PATEL, MAYUR MD	8/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	56296	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	#506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
81385	Fee-for-Service	1497833016	1497833016	1	1	POPE, TODD C MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66157	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
81409	Fee-for-Service	1306077870	1306077870	1	1	PUGH, MATTHEW D DO	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12102	None	None	0	In state provider	None	754 MEDICAL CENTER ST	SUITE 206	CHULA VISTA	CA	91911	6656	37	06073	32.61778462	-117.0228924	San Diego County
81441	Fee-for-Service	1982859427	1982859427	1	1	PAGANO, CHRISTINA R MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106106	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81449	Fee-for-Service	1417965559	1417965559	1	5	PRIME HEALTHCARE	3/31/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
81483	Fee-for-Service	1467444984	1467444984	1	1	PI, JOHN I MD	6/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77118	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	0000	36	06071	34.26577765	-117.1695461	San Bernardino County
81495	Fee-for-Service	1598394140	1598394140	1	1	PHAM, KIM T MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
81501	Fee-for-Service	1922167642	1922167642	1	1	PLAISANCE, JON P CRNA	4/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
81502	Fee-for-Service	1699803197	1699803197	1	1	PHILLIPS, AVA D LMFT	10/25/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	220 S INDIAN HILL BLVD	SUITE E	CLAREMONT	CA	91711	4929	19	06037	34.091658	-117.7192535	Los Angeles County
81522	Fee-for-Service	1083965131	1083965131	1	1	PORTNOY, ALEXANDRA LMFT	2/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
81529	Fee-for-Service	1528419546	1528419546	1	1	PAUL, TIFFANY M LCSW	4/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81530	Fee-for-Service	1053680736	1053680736	1	1	POUROUSHASB, ROZITA MD	4/18/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	133959	40	Pediatrics	0	In state provider	None	17742 BEACH BLVD	STE 360	HUNTINGTON BEACH	CA	92647	6854	30	06059	33.704487	-117.989061	Orange County
81536	Fee-for-Service	1831716695	1831716695	1	1	PIRES, AMANDA DPM	2/1/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
81553	Fee-for-Service	1134168289	1134168289	1	1	PEARLMAN, JEFFREY MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40719	01	General Practice	0	In state provider	None	6700 S CENTINELA AVE	STE 300	CULVER CITY	CA	90230	6347	19	06037	33.98373559	-118.4045944	Los Angeles County
81570	Fee-for-Service	1063611945	1063611945	1	1	PORTER, CHRISTOPHER A IV MD	12/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
81585	Fee-for-Service	1023496692	1023496692	1	1	PLESS, ADRIENNE M CRNA	11/23/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
81586	Fee-for-Service	1295894871	1295894871	1	1	PASHAYAN, SHANE MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77640	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
81610	Fee-for-Service	1790213247	1790213247	1	4	PASADENA CLINICAL GROUP, A P	10/14/2022	103TA0400X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7825 FAY AVE	200	LA JOLLA	CA	92037	4252	37	06073	32.84527369	-117.275383	San Diego County
81613	Fee-for-Service	1003256066	1003256066	1	1	PEARSTON, CHRISTINE PSYD	4/18/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
81616	Fee-for-Service	1528644978	1528644978	1	1	PATEL, PRISHA MD	3/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184966	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
81656	Fee-for-Service	1689896813	1689896813	2	1	PEPPERMINT RIDGE	8/22/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	779 FORD STREET	None	CORONA	CA	92879	2507	33	06065	33.8682903	-117.5578641	Riverside County
81665	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	11/9/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
81719	Fee-for-Service	1336125996	1336125996	1	1	PATEL, AMIT I MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78951	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
81801	Fee-for-Service	1720593502	1720593502	1	1	PRICE, SPENCER E MD	6/27/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153172	None	None	0	In state provider	None	1515 E. OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
81809	Fee-for-Service	1376542340	1376542340	1	1	PRICE, NORMAN M MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	26516	07	Dermatology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94598	5318	07	06013	37.89189148	-122.057999	Contra Costa County
81812	Fee-for-Service	1306507231	1306507231	1	1	PEREZ, LILIA R	3/8/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TION SERVICES	3017 DOUGLAS BLVD	SUITE 300 ROOM 13	ROSEVILLE	CA	95661	3848	31	06061	38.74412077	-121.232331	Placer County
81820	Fee-for-Service	1164573473	1164573473	1	1	POULTNEY, CAREY B OD	9/18/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	429 CENTRAL AVE	None	FILLMORE	CA	93015	1329	56	06111	34.4015601	-118.9139634	Ventura County
81836	Fee-for-Service	1295812147	1295812147	1	1	PARIVAR, FARHAD MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51423	34	Urology and Urological Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
81860	Fee-for-Service	1346642840	1346642840	1	1	PAGE, ASHLEY S	10/18/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	SUITE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
81873	Fee-for-Service	1033220660	1033220660	1	1	PATCHETT, CLAYTON E MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34116	20	Orthopedic Surgery	0	In state provider	None	10 CONGRESS ST	STE 103	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
81897	Fee-for-Service	1275935009	1275935009	1	1	PARK, RACHEL D NP	3/2/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
81901	Fee-for-Service	1023196557	1023196557	1	1	PARRETT, BRIAN M MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108008	24	Plastic Surgery	0	In state provider	None	2340 CLAY ST	2ND FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
81947	Fee-for-Service	1184914046	1184914046	1	1	PARK, BEAU Y MD	1/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185568	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
81952	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	8/11/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
81958	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
81961	Fee-for-Service	1396734547	1396734547	1	1	PATEL, AMIT MD	7/17/2007	207KA0200X	NA	Other	026	PHYSICIANS	40664	41	Internal Medicine	0	In state provider	None	440 N MOUNTAIN AVE	STE 301	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
81963	Fee-for-Service	1609981638	1609981638	2	1	PASADENA CITY PHARMACY INC	6/4/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1684 E WASHINGTON BLVD	None	PASADENA	CA	91104	2757	19	06037	34.16908711	-118.115774	Los Angeles County
81966	Fee-for-Service	1811963457	1811963457	1	1	PARKER, RUSSELL K MD	2/4/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162089	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
82042	Fee-for-Service	1689875601	1689875601	1	1	PROVIDENCE HEALTH SYSTEM	10/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	SOUTHERN CA	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
82056	Fee-for-Service	1194790782	1194790782	1	1	PINEWOOD FIRE DEPARTMENT	1/6/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 EAST PINEWOOD BLVD	None	MUNDS PARK	AZ	86017	0000	00	None	34.940259	-111.640941	Coconino County
82071	Fee-for-Service	1073811717	1073811717	1	1	PACE, LEE R NP	6/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
82074	Fee-for-Service	1376621870	1376621870	1	1	PATEL, MITTAL C MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76093	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
82093	Fee-for-Service	1427414242	1427414242	1	1	PFITZER, VICTORIA A LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
82100	Fee-for-Service	1376542340	1376542340	1	1	PRICE, NORMAN M MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	26516	22	Pathology (M.D. only)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94598	5318	07	06013	37.89189148	-122.057999	Contra Costa County
82102	Fee-for-Service	1295971620	1295971620	1	1	PHAM, ANGELA MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106355	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82134	Fee-for-Service	1801238811	1801238811	1	1	PROULX, BRITNI L LMFT	1/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	820 N MOUNTAIN AVE	105	UPLAND	CA	91786	4111	36	06071	34.10373359	-117.6701283	San Bernardino County
82166	Fee-for-Service	1831185776	1831185776	1	1	PREVEDEL, JOHN A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
82191	Fee-for-Service	1023196557	1023196557	1	1	PARRETT, BRIAN M MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108008	46	Hand Surgery	0	In state provider	None	2340 CLAY ST	2ND FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
82221	Fee-for-Service	1306495965	1306495965	1	1	PARKER, STEPHANIE E CRNA	11/21/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
82238	Fee-for-Service	1316147994	1316147994	1	1	PONTONI, MARCIA A LCSW	8/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
82242	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	3/14/2022	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
82247	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
82252	Fee-for-Service	1689009227	1689009227	1	2	PROGRESSIVE FOOT AND ANKLE	2/15/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INSTITUTE PC	13754 VICTORY BLVD	None	VAN NUYS	CA	91401	2324	19	06037	34.18664348	-118.433286	Los Angeles County
82284	Fee-for-Service	1710925086	1710925086	1	1	PHAM, MICHAEL M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69661	None	None	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
82328	Fee-for-Service	1689875601	1689875601	1	1	PROVIDENCE HEALTH SYSTEM	10/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	SOUTHERN CA	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
82336	Fee-for-Service	1568577658	1568577658	2	1	PINCHES,JOHN L DO	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6917	None	None	0	In state provider	None	12321 CARSON ST	STE 1	HAWAIIAN GARDENS	CA	90716	1818	19	06037	33.83157953	-118.0689075	Los Angeles County
82357	Fee-for-Service	1235427568	1235427568	1	1	PATEL, SAJAN R MD	8/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122595	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82369	Fee-for-Service	1194958959	1194958959	1	1	PATEL, JAY R MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127433	18	Ophthalmology	0	In state provider	None	855 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1938	19	06037	34.1511692	-118.0177106	Los Angeles County
82400	Fee-for-Service	1245716513	1245716513	1	1	PATEL, SANI K LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
82431	Fee-for-Service	1639845936	1639845936	1	1	PERFECT HARMONY HOME HEALTH	8/23/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11484 1/2 BURBANK BLVD	SUITE 12B	NORTH HOLLYWOOD	CA	91601	2227	19	06037	34.1720967	-118.3817109	Los Angeles County
82449	Fee-for-Service	1649960865	1649960865	1	1	PATEL, ANJALI OD	1/22/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
82456	Fee-for-Service	1790213247	1790213247	1	1	PASADENA CLINICAL GROUP, A P	1/16/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	YCHOLOGY CORPORATION	595 E COLORADO BLVD	STE 428	PASADENA	CA	91101	2058	19	06037	34.14588202	-118.1380722	Los Angeles County
82478	Fee-for-Service	1821431925	1821431925	1	1	PATEL, MITUL A MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140021	40	Pediatrics	0	In state provider	None	311 N ABBY ST	None	FRESNO	CA	93701	1906	10	06019	36.74716555	-119.7894243	Fresno County
82494	Fee-for-Service	1003172347	1003172347	1	1	PEDIGO, TIFFANY P MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130852	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
82509	Fee-for-Service	1386026102	1386026102	1	1	PATEL, LATISHA OD	4/27/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	36	06071	33.996744	-117.555534	Riverside County
82512	Fee-for-Service	1124131446	1124131446	1	1	PIRO, LAWRENCE D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52155	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
82531	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	1/10/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
82534	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
82537	Fee-for-Service	1427402155	1427402155	1	1	PILKINGTON, MICHAEL B DPM	5/19/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
82553	Fee-for-Service	1982040515	1982040515	1	1	PEROS, JENILYN P NP	8/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82646	Fee-for-Service	1659503175	1659503175	1	1	PAVENTY, MARILYN T LCSW	11/19/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
82683	Fee-for-Service	1184940280	1184940280	1	1	POULIOT, MICHAEL A MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118424	20	Orthopedic Surgery	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
82691	Fee-for-Service	1144994484	1144994484	1	1	PADILLA, JOHANNA LMFT	4/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
82706	Fee-for-Service	1114322518	1114322518	1	1	PLANNED PARENTHOOD	8/28/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES	8704 SANTA MONICA BLVD	SUITE 300	WEST HOLLYWOOD	CA	90069	4548	19	06037	34.08730543	-118.3801764	Los Angeles County
82725	Fee-for-Service	1811163645	1811163645	1	1	PATEL, GAYATRI MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109855	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
82734	Fee-for-Service	1154451953	1154451953	1	1	PIERSON, NANCY LMFT	10/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
82757	Fee-for-Service	1295728921	1295728921	1	1	PADLA, DENNIS P MD	10/16/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152804	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
82759	Fee-for-Service	1811177439	1811177439	1	1	PERSHING, SUZANN Y MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101067	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
82763	Fee-for-Service	1144493131	1144493131	1	1	PANOUSSI, FERDINAND J DO	7/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10970	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
82788	Fee-for-Service	1558753590	1558753590	1	1	PARKS, ERIN N PHD	4/9/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82789	Fee-for-Service	1164717047	1164717047	1	1	POLLOCK, LEALAH C MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124300	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
82799	Fee-for-Service	1124131446	1124131446	1	1	PIRO, LAWRENCE D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52155	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
82810	Fee-for-Service	1487607222	1487607222	1	1	PLANNED PARENTHOOD	12/18/1998	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MANTECA	965 E YOSEMITE AVE	STE 2	MANTECA	CA	95336	5938	39	06077	37.79749432	-121.2033865	San Joaquin County
82817	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	8/13/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
82819	Fee-for-Service	1477977973	1477977973	1	1	PLANNED PARENTHOOD MAR MONTE	6/5/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	- REDWOOD CITY	2907 EL CAMINO REAL	None	REDWOOD CITY	CA	94061	4003	41	06081	37.46906354	-122.2114417	San Mateo County
82821	Fee-for-Service	1588729966	1588729966	1	1	PACE, WILLIAM A MD	7/23/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
82822	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
82823	Fee-for-Service	1578723508	1578723508	1	1	POULOSE, JACOB	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113557	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
82849	Fee-for-Service	1518082064	1518082064	1	1	PADILLA, ELISA LCSW	4/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
82864	Fee-for-Service	1982853131	1982853131	2	1	PROVIDENT HEALTH CARE INC	8/15/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1238 CATALINA DR	None	MERCED	CA	95348	9515	24	06047	37.33070454	-120.4924365	Merced County
82875	Fee-for-Service	1376579326	1376579326	1	1	PALMER, SUZANNE L MD	2/1/1999	2085B0100X	NA	MRI Provider	026	PHYSICIANS	70112	None	None	0	In state provider	None	1744 ZONAL AVE	None	LOS ANGELES	CA	90033	5318	19	06037	34.0616497	-118.2100877	Los Angeles County
82901	Fee-for-Service	1417965559	1417965559	1	1	PRIME HEALTHCARE	9/30/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LA PALMA LLC	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
82915	Fee-for-Service	1407937105	1407937105	1	1	PENG, LUON	8/20/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	8244	41	Internal Medicine	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
82991	Fee-for-Service	1326003229	1326003229	1	1	PROVOST, GLENN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79498	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
83006	Fee-for-Service	1083938906	1083938906	1	1	PATEL, AMISH A MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126376	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90054	0679	19	06037	34.069509	-118.383743	Los Angeles County
83007	Fee-for-Service	1770216855	1770216855	1	2	PNC MSK, PC	8/23/2024	207XX0004X	NA	Orthopedic Surgery	027	PODIATRISTS	-	None	None	0	In state provider	PODIATRIC SPECIALISTS	3536 MENDOCINO AVE STE	300B	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
83014	Fee-for-Service	1619281201	1619281201	1	1	PARHAM GHARAGOZLOU MD INC	8/1/2019	207RS0012X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3101 CLAYTON RD	None	CONCORD	CA	94519	2732	07	06013	37.97361195	-122.0217913	Contra Costa County
83022	Fee-for-Service	1245505866	1245505866	2	1	PEDIATRIX CARDIOLOGY OF ORAN	5/19/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GE COUNTY, P.C.	1010 WEST LA VETA AVE	STE 575	ORANGE	CA	92868	4300	30	06059	33.78028244	-117.8635552	Orange County
83054	Fee-for-Service	1942868021	1942868021	1	1	PALMS CARE CENTER LLC	5/17/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1010 VENTURA AVE	None	CHOWCHILLA	CA	93610	2368	20	06039	37.12217726	-120.2716992	Madera County
83059	Fee-for-Service	1689006934	1689006934	1	1	POLIAKOFF, MATTHEW J DO	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83064	Fee-for-Service	1306289996	1306289996	1	2	PHI HEALTH, LLC	10/11/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1278 AN COUNTY RD 421	None	PALESTINE	TX	75803	2395	00	None	31.78146948	-95.70117047	Anderson County
83072	Fee-for-Service	1124470059	1124470059	1	1	PULIPATI, DEEPA LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
83097	Fee-for-Service	1992096630	1992096630	1	1	PRIMARY CARE CENTER OF NORTH	9/9/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	COUNTY, APC	13525 MIDLAND ROAD	SUITE F	POWAY	CA	92064	4772	37	06073	32.96071787	-117.0362705	San Diego County
83104	Fee-for-Service	1306971262	1306971262	1	1	PERCY, KRISTINE &	10/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	STEARNS MDS INC	539 S BREA BLVD	FL 1	BREA	CA	92821	5377	30	06059	33.91175971	-117.9029588	Orange County
83107	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	3/20/2023	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
83110	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
83121	Fee-for-Service	1164593877	1164593877	1	1	PANTOJA, ANA B MD	2/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	91066	None	None	0	In state provider	None	815 W WASHINGTON BLVD	None	MONTEBELLO	CA	90640	6123	19	06037	33.99411697	-118.1169341	Los Angeles County
83128	Fee-for-Service	1154834117	1154834117	1	1	PEYTON-GUARDADO, SARAH NP	5/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
83133	Fee-for-Service	1487762274	1487762274	1	1	PAUL R GREGORY, JR MD	5/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	46	Hand Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
83144	Fee-for-Service	1609889054	1609889054	1	1	PADOVANI, GARY J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44340	None	None	0	In state provider	None	817 COFFEE RD	STE C3	MODESTO	CA	95355	4241	50	06099	37.655235	-120.975616	Stanislaus County
83155	Fee-for-Service	1396489084	1396489084	1	1	PLANNED PARENTHOOD LOS	7/13/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	3224 W OLYMPIC BLVD	SUITE 101	LOS ANGELES	CA	90006	2317	19	06037	34.05260149	-118.3069623	Los Angeles County
83163	Fee-for-Service	1568478832	1568478832	1	1	PEARCE, MICHAEL J. MD	10/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	170 N. 1100 E.	None	AMERICAN FORK	UT	84003	0000	00	None	40.38039	-111.769053	Utah County
83204	Fee-for-Service	1407937105	1407937105	1	1	PENG, LUON	8/20/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	8244	45	Nephrology (Renal-Kidney)	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
83206	Fee-for-Service	1598813404	1598813404	1	1	PHAM, THOMAS T.Q. MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	74619	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
83207	Fee-for-Service	1932289030	1932289030	1	1	PARK, MICHAEL K MD	5/13/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	75378	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
83251	Fee-for-Service	1255863502	1255863502	1	1	POUDEL, RHIJU MD	12/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
83257	Fee-for-Service	1215543137	1215543137	1	1	PATEL, JANKI PT	10/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
83322	Fee-for-Service	1356416978	1356416978	1	1	PINA, RACQUEL S MD	10/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86596	08	Family Practice	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
83323	Fee-for-Service	1417102021	1417102021	1	1	PAN, JUDONG MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105980	None	None	0	In state provider	None	2410 SAMARITAN DRIVE	#101	SAN JOSE	CA	95124	3909	43	06085	37.25107654	-121.9451342	Santa Clara County
83348	Fee-for-Service	1245505866	1245505866	2	3	PEDIATRIX CARDIOLOGY OF ORAN	12/20/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	HERN CALIFORNIA	600 CORPORATE DR.	STE 210	LADERA RANCH	CA	92694	2106	30	06059	33.55834891	-117.6292039	Orange County
83357	Fee-for-Service	1447899752	1447899752	1	1	PASADENA ORTHOPEDICS INC	8/26/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	959 WALNUT ST	SUITE 150	PASADENA	CA	91106	5342	19	06037	34.14962102	-118.1305187	Los Angeles County
83393	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	11/9/2021	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
83395	Fee-for-Service	1346324589	1346324589	1	1	PEGE, DIANE J MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81737	41	Internal Medicine	0	In state provider	None	5176 HILL RD EAST	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
83397	Fee-for-Service	1962796268	1962796268	1	1	PLANNED PARENTHOOD	9/26/2012	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHASTA DIABLO INC	1165 S DORA ST	STE A	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
83398	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
83403	Fee-for-Service	1861965055	1861965055	1	2	PACIFIC CENTRAL COAST HEALTH	7/8/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	850 FAIR OAKS AVENUE	STE 310	ARROYO GRANDE	CA	93420	3817	40	06079	35.11274104	-120.588873	San Luis Obispo County
83419	Fee-for-Service	1609257435	1609257435	1	1	POYSOPHON, POYRUNG MD	9/17/2021	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	150875	None	None	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
83421	Fee-for-Service	1487762274	1487762274	1	1	PAUL R GREGORY, JR MD	5/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
83423	Fee-for-Service	1477702793	1477702793	1	1	PEREZ, LETICIA J LCSW	6/30/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
83425	Fee-for-Service	1710936471	1710936471	1	1	PREMIER EMERG PHYS OF CA	8/9/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 W E ST	None	TEHACHAPI	CA	93561	1607	15	06029	35.13009994	-118.4488237	Kern County
83444	Fee-for-Service	1366687147	1366687147	1	1	PEDIATRIC GASTROENTEROLO	1/9/2009	2080P0206X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOC OF SO CAL	1760 TERMINO	SUITE 300	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
83492	Fee-for-Service	1932289030	1932289030	1	1	PARK, MICHAEL K MD	5/13/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	75378	25	Physical Medicine and Rehabilitation	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
83517	Fee-for-Service	1104010966	1104010966	1	1	PETERS, ALLISON PSYD	2/12/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
83533	Fee-for-Service	1174543938	1174543938	1	1	PULIDO, EMMELINE R MD	10/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66523	01	General Practice	0	In state provider	None	10837 LAUREL ST	None	RANCHO CUCAMONGA	CA	91730	7643	36	06071	34.10480629	-117.5685104	San Bernardino County
83565	Fee-for-Service	1558520676	1558520676	1	2	PAYNE, MATTHEW S MD	12/7/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	124622	-	NOT APPLICABLE	0	In state provider	None	200 N LA CUMBRE ROAD	SUITE E	SANTA BARBARA	CA	93110	1585	42	06083	34.44255908	-119.7510269	Santa Barbara County
83570	Fee-for-Service	1376504472	1376504472	1	1	PATEL, SNEHA MD	3/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171090	None	None	0	In state provider	None	1524 MCHENRY AVE	STE 100	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
83606	Fee-for-Service	1598911208	1598911208	1	1	PONTES-BOELTER, JEANINE PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
83627	Fee-for-Service	1154548212	1154548212	1	1	PANAMA-BUENA VISTA USD	7/29/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	15	06029	35.316864	-119.0744405	Kern County
83638	Fee-for-Service	1518933605	1518933605	1	1	PERKOCHA, LUKE A MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54643	22	Pathology (M.D. only)	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
83647	Fee-for-Service	1447899752	1447899752	1	1	PASADENA ORTHOPEDICS INC	8/26/2020	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	959 WALNUT ST	SUITE 150	PASADENA	CA	91106	5342	19	06037	34.14962102	-118.1305187	Los Angeles County
83674	Fee-for-Service	1942295159	1942295159	1	1	POLLANDER, GREGG S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 RANDALLIA DR	None	FORT WAYNE	IN	46805	4638	00	None	41.09614623	-85.11152248	Allen County
83683	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	4/11/2022	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
83686	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
83742	Fee-for-Service	1174150122	1174150122	1	1	PALILEO, BEA MARTINA U MD	5/6/2024	390200000X	NA	Other	026	PHYSICIANS	184472	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
83770	Fee-for-Service	1861636177	1861636177	1	1	PLANNED PARENTHOOD PASADENA	7/13/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	& SAN GABRIEL VALLEY	330 S GARFIELD AVE	SUITE 300	ALHAMBRA	CA	91801	3896	19	06037	34.09137167	-118.1241735	Los Angeles County
83784	Fee-for-Service	1376801852	1376801852	1	1	PADINJATH, SIMILY MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133508	41	Internal Medicine	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
83797	Fee-for-Service	1558612770	1558612770	1	1	PUROHIT, TRETA MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138479	10	Gastroenterology (M.D. only)	0	In state provider	None	1595 SOQUEL DRIVE	SUITE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
83813	Fee-for-Service	1447493150	1447493150	1	1	POURASEF, PARVIN LCSW	12/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2225 BUCHANAN RD	STE C	ANTIOCH	CA	94509	4209	07	06013	37.99862519	-121.8375728	Contra Costa County
83854	Fee-for-Service	1912980012	1912980012	1	1	PROTSMAN, FAITH R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72923	01	General Practice	0	In state provider	None	700 W 6TH ST	STE C	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
83855	Fee-for-Service	1154351088	1154351088	1	1	PANZER, GLENN M MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86525	08	Family Practice	0	In state provider	None	5030 CAMINO DE LA SIESTA	STE 208	SAN DIEGO	CA	92108	3118	37	06073	32.76484572	-117.1602073	San Diego County
83856	Fee-for-Service	1588197545	1588197545	1	1	PECK, ALEXANDER R DO	3/31/2022	207R00000X	NA	Other	026	PHYSICIANS	18318	None	None	0	In state provider	None	5230 PACIFIC CONCOURSE	STE 100	LOS ANGELES	CA	90045	6200	19	06037	33.92774198	-118.3727493	Los Angeles County
83867	Fee-for-Service	1104452259	1104452259	1	1	PERLMAN, RYAN J MD	10/4/2020	207L00000X	NA	Other	026	PHYSICIANS	168189	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83876	Fee-for-Service	1427062918	1427062918	1	1	PHILLIPS, VERNON G MD	2/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43409	08	Family Practice	0	In state provider	None	707 PALM AVE	None	IMPERIAL BEACH	CA	91932	1229	37	06073	32.5838667	-117.1175847	San Diego County
83887	Fee-for-Service	1932221694	1932221694	1	1	PHONSOMBAT, SURAT MD	12/29/2009	208800000X	NA	Other	026	PHYSICIANS	86907	34	Urology and Urological Surgery	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
83909	Fee-for-Service	1588184196	1588184196	1	1	PEGADIOTES, MARANITA Z LCSW	6/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
83912	Fee-for-Service	1346879848	1346879848	1	1	PINE PARK HEALTH, INC	10/18/2022	207QA0505X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
83933	Fee-for-Service	1235191057	1235191057	1	1	PATINO, GABRIEL H MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	44315	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
83943	Fee-for-Service	1780988634	1780988634	2	1	P&T VENTURE INC	12/14/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9433 BOLSA AVE	SUITE B	WESTMINSTER	CA	92683	5964	30	06059	33.74498152	-117.964368	Orange County
83970	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	5/23/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
83975	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
83991	Fee-for-Service	1235423914	1235423914	1	1	PAN, AILEEN L MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133838	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
84058	Fee-for-Service	1437451143	1437451143	1	1	PULHAM, NICOLAS J MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114978	10	Gastroenterology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84069	Fee-for-Service	1750318234	1750318234	1	1	PAZDRAL, WILLIAM E MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	24664	40	Pediatrics	0	In state provider	None	15247 11TH ST	STE 500	VICTORVILLE	CA	92395	3700	36	06071	34.52871157	-117.2924819	San Bernardino County
84101	Fee-for-Service	1477616746	1477616746	1	1	PEREZ, JUDI-ANNE S OD	8/28/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	374 E H ST	STE 1708	CHULA VISTA	CA	91910	7492	37	06073	32.64037799	-117.0489675	San Diego County
84105	Fee-for-Service	1235108713	1235108713	1	1	PLANNED PARENTHOOD/	9/19/1980	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	26137 LA PAZ RD	STE 200	MISSION VIEJO	CA	92691	5321	30	06059	33.60038172	-117.6735855	Orange County
84133	Fee-for-Service	1154351088	1154351088	1	1	PANZER, GLENN M MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86525	38	Geriatrics	0	In state provider	None	5030 CAMINO DE LA SIESTA	STE 208	SAN DIEGO	CA	92108	3118	37	06073	32.76484572	-117.1602073	San Diego County
84138	Fee-for-Service	1861920340	1861920340	1	1	PASCUAL, ENRIQUE A MD	4/12/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171450	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
84154	Fee-for-Service	1003874702	1003874702	2	4	PROHEALTH ADVANCED IMAGING M	12/19/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	5620 WILBUR AVENUE	SUITE 330	TARZANA	CA	91356	1335	19	06037	34.17282089	-118.5446783	Los Angeles County
84202	Fee-for-Service	1346879848	1346879848	1	1	PINE PARK HEALTH, INC	2/22/2023	207QA0505X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
84247	Fee-for-Service	1073683595	1073683595	1	1	PALMER, SARAH LMFT	11/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
84250	Fee-for-Service	1821262247	1821262247	1	1	PAYVANDI, SOHEIL A DO	6/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8936	20	Orthopedic Surgery	0	In state provider	None	2801 K ST	STE 310	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
84258	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	1/7/2022	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
84261	Fee-for-Service	1730420399	1730420399	1	1	PURI, SANJEEV DO	5/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15903	08	Family Practice	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
84262	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
84264	Fee-for-Service	1003048026	1003048026	1	1	PROVENCE, BRETT A DO	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11220	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
84287	Fee-for-Service	1821139601	1821139601	1	1	PINER, BRUCE D MA	12/31/1987	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	16311 VENTURA BLVD	STE 560	ENCINO	CA	91436	4315	19	06037	34.15706864	-118.4885978	Los Angeles County
84324	Fee-for-Service	1396896866	1396896866	1	1	PARADISE HOSPICE INCORPORATE	11/4/2010	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	# 207	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
84331	Fee-for-Service	1922061191	1922061191	1	1	PETTIS, SAMUEL R MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44859	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
84362	Fee-for-Service	1154048395	1154048395	1	1	PRIME ENT SINUS SLEEP & ALLE	2/7/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	RGY INC	1503 E MARCH LN	STE A	STOCKTON	CA	95210	5622	39	06077	38.00228434	-121.2903651	San Joaquin County
84443	Fee-for-Service	1770616401	1770616401	1	1	PROHEALTH PARTNERS, A	6/1/1996	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	5979 ATLANTIC AVE	None	LONG BEACH	CA	90805	3510	19	06037	33.86324935	-118.1850847	Los Angeles County
84492	Fee-for-Service	1346879848	1346879848	1	1	PINE PARK HEALTH, INC	10/18/2022	207QA0505X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
84504	Fee-for-Service	1003566217	1003566217	1	1	PHAM, ALEXANDER PT	8/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10900 WARNER AVE	STE 117	FOUNTAIN VALLEY	CA	92708	7203	30	06059	33.71628153	-117.9388215	Orange County
84511	Fee-for-Service	1467417030	1467417030	1	1	PRIMARY CRITICAL CARE	11/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LIMITED PARTNERSHIP	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
84513	Fee-for-Service	1952441966	1952441966	1	1	PETERS, ROGER D LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51816	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVENUE	1ST FLOOR	SAN LUIS OBISPO	CA	93401	4513	40	06079	35.27488974	-120.6468257	San Luis Obispo County
84534	Fee-for-Service	1831387067	1831387067	1	1	PATTERSON, LENWOOD V LCSW	10/6/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	5861 CHERRY AVE	None	LONG BEACH	CA	90805	4405	19	06037	33.86131627	-118.1686066	Los Angeles County
84547	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	9/24/2021	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
84551	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
84612	Fee-for-Service	1396896866	1396896866	1	1	PARADISE HOSPICE INCORPORATE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	# 207	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
84632	Fee-for-Service	1922251354	1922251354	1	1	PANHWAR, SUMERA MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	105137	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
84697	Fee-for-Service	1437281409	1437281409	1	1	PROHEALTH PARTNERS, A MEDICA	4/9/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	3628 E IMPERIAL HWY	STE 202	LYNWOOD	CA	90262	2600	19	06037	33.93070837	-118.2044557	Los Angeles County
84739	Fee-for-Service	1679701858	1679701858	1	1	PRABAKAR, CHERUBA MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136084	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84777	Fee-for-Service	1346879848	1346879848	1	1	PINE PARK HEALTH, INC	10/18/2022	207QA0505X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
84784	Fee-for-Service	1427095587	1427095587	1	1	PAZ, DUSTIN MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	52ND AND F ST	None	SACRAMENTO	CA	95819	0000	34	06067	38.570607	-121.439502	Sacramento County
84793	Fee-for-Service	1942382692	1942382692	1	1	PRATER, RAYMOND MD	11/24/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
84807	Fee-for-Service	1912111873	1912111873	1	1	PERLROTH, CHI L MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90104	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
84831	Fee-for-Service	1144355694	1144355694	1	1	PATEL, BRIJESH G DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CALIF CHIROPRACTIC CARE	2665 E RIVERSIDE DR	STE E	ONTARIO	CA	91761	9206	36	06071	34.020666	-117.5951385	San Bernardino County
84832	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	3/25/2022	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
84834	Fee-for-Service	1528231081	1528231081	1	1	PAZ Y MAR, HUGO L MD	9/15/2021	207RS0012X	NA	Other	026	PHYSICIANS	162203	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
84837	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
84881	Fee-for-Service	1881691558	1881691558	1	1	PERSONAL SUPPORT MEDICAL	10/12/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	SUPPLIERS,INC	262 GEIGER ROAD	None	PHILADELPHIA	PA	19115	1008	00	None	40.10627765	-75.04449729	Philadelphia County
84923	Fee-for-Service	1922058825	1922058825	1	1	PANGARKAR, SANJOG S MD	10/19/2021	208VP0000X	NA	Other	026	PHYSICIANS	83673	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
84946	Fee-for-Service	1033440011	1033440011	1	1	PASCUAL, PATRICIA M MD	10/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110749	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84947	Fee-for-Service	1235742636	1235742636	1	1	PERRYMAN, MICHAEL B PT	2/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
84969	Fee-for-Service	1023302973	1023302973	1	1	PLAYER, HEATHER A MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141895	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
84970	Fee-for-Service	1720243199	1720243199	1	1	PUENTE PARTNERS LLC	8/1/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3541 PUENTE AVENUE	None	BALDWIN PARK	CA	91706	5534	19	06037	34.0776883	-117.954097	Los Angeles County
84992	Fee-for-Service	1275790040	1275790040	1	1	PERITO, EMILY R MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108998	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
84994	Fee-for-Service	1265987721	1265987721	1	1	PATEL, MEGHA J MD	6/21/2021	207P00000X	NA	Other	026	PHYSICIANS	172471	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
85023	Fee-for-Service	1811205644	1811205644	1	1	PATEL, BHAVITA	7/31/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
85044	Fee-for-Service	1437142007	1437142007	1	1	PANCHARI, CHARLES W MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	25133	22	Pathology (M.D. only)	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
85087	Fee-for-Service	1982136107	1982136107	1	1	PHAM, HAI H MD	2/9/2021	207L00000X	NA	Other	026	PHYSICIANS	159907	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
85098	Fee-for-Service	1538565965	1538565965	1	1	PEARMAN, AMANDA M LPCC	11/7/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
85100	Fee-for-Service	1205364361	1205364361	1	1	PARSONS, MAUREEN A NP	7/25/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85120	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	1/17/2022	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
85127	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
85168	Fee-for-Service	1316793755	1316793755	1	1	PAYNE, CINDY LPCC	2/13/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
85192	Fee-for-Service	1386947836	1386947836	1	1	PRIME HEALTHCARE LA PALMA	12/6/2010	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
85211	Fee-for-Service	1114050218	1114050218	1	1	PROHEALTH PARTNERS A	2/7/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	911 E SAN ANTONIO DR	STE 4	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
85234	Fee-for-Service	1073891016	1073891016	1	2	PONS, ADRIANA E NP	10/23/2020	363A00000X	NA	Physician Assistant	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	840 DELBON AVE	STE A	TURLOCK	CA	95382	2005	50	06099	37.51046091	-120.8383932	Stanislaus County
85243	Fee-for-Service	1447319041	1447319041	1	1	PONCE DE LEON, LENA MD	12/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56030	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
85259	Fee-for-Service	1740456441	1740456441	1	1	PIPER, SARAH M MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121513	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85270	Fee-for-Service	1952327181	1952327181	1	1	PERRY, ARIE MD	2/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53919	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
85279	Fee-for-Service	1275790040	1275790040	1	1	PERITO, EMILY R MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108998	10	Gastroenterology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
85326	Fee-for-Service	1265600068	1265600068	1	1	PARTRIDGE, LIBERTY MD	8/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108903	66	Emergency Medicine (Urgent Care)	0	In state provider	None	508 E HICKORY AVE	None	LOMPOC	CA	93436	7318	42	06083	34.63568383	-120.4522776	Santa Barbara County
85358	Fee-for-Service	1043384720	1043384720	1	1	PINCUS, ANNE M PHD	8/23/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	452 LILY ST	None	SAN FRANCISCO	CA	94102	5521	38	06075	37.77384561	-122.4283326	San Francisco County
85364	Fee-for-Service	1649245176	1649245176	1	1	PELLEGRINI, DAVID P MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88091	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
85385	Fee-for-Service	1871606962	1871606962	1	1	PAKULA, BRADLEY A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	61674	None	None	0	In state provider	None	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
85393	Fee-for-Service	1710915160	1710915160	1	1	PENG, PETER D MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88562	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
85396	Fee-for-Service	1609887967	1609887967	1	1	PEERY, BEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1906 BLAKE AVE	None	GLENWOOD SPGS	CO	81601	4227	00	None	39.5325491	-107.3227821	Garfield County
85398	Fee-for-Service	1649426602	1649426602	1	1	PATEL, CHIRAAG S MD	12/29/2008	208M00000X	NA	Other	026	PHYSICIANS	105840	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	SUITE 480	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
85400	Fee-for-Service	1831148162	1831148162	1	1	PENG, TRACY J MD	6/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77250	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85409	Fee-for-Service	1639600125	1639600125	1	1	PUJARE, DEEPTI U MD	8/19/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	157059	None	None	0	In state provider	None	15720 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3337	43	06085	37.24027269	-121.9767692	Santa Clara County
85411	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	8/30/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
85416	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
85436	Fee-for-Service	1043292402	1043292402	1	1	PLEASURE, DAVID E MD	10/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87568	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
85451	Fee-for-Service	1326661505	1326661505	1	1	PAGLIA, MICHAEL J DO	6/15/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20521	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
85462	Fee-for-Service	1639561657	1639561657	1	2	PULSIFER, LISA M LCSW	9/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7855 RIVERTON AVE	None	SUN VALLEY	CA	91352	4519	19	06037	34.213716	-118.365988	Los Angeles County
85489	Fee-for-Service	1598345563	1598345563	1	1	PULDON, KARENA Y MD	6/24/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85563	Fee-for-Service	1710587670	1710587670	1	3	PHYSICIANS OF SOUTHERN CALIF	4/29/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	ORNIA INC	3235 E COLORADO BLVD	SUITE 102	PASADENA	CA	91107	3838	19	06037	34.14624852	-118.0838475	Los Angeles County
85579	Fee-for-Service	1730112301	1730112301	1	1	PHARMACY CORPORATION OF AMER	12/7/2017	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	AMERICA	6330 E 75TH ST	STE 322	INDIANAPOLIS	IN	46250	2708	00	None	39.893445	-86.0587155	Marion County
85595	Fee-for-Service	1508968413	1508968413	1	1	PEDIATRIC HOSPITALISTS	3/19/2008	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF AMERICA INC	2801 ATLANTIC AVE	3RD FL	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
85599	Fee-for-Service	1164522116	1164522116	1	1	PALOMENO, GLADYS E MD	1/7/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	67651	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
85601	Fee-for-Service	1255725909	1255725909	1	1	PINKSTON, CLAIRE E LMFT	11/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	587 N GARFIELD AVE	3	PASADENA	CA	91101	3742	19	06037	34.15491092	-118.1442031	Los Angeles County
85611	Fee-for-Service	1477972735	1477972735	1	1	PUCHALSKY, BRIDGET A LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
85618	Fee-for-Service	1922625284	1922625284	1	1	PAVLENKO, YULIA A CRNA	12/6/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
85640	Fee-for-Service	1912959438	1912959438	1	1	PARVER, MITCHELL MD INC	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20626	30	Radiology	0	In state provider	None	23560 MADISON ST	STE 101	TORRANCE	CA	90505	4709	19	06037	33.81145007	-118.3479265	Los Angeles County
85646	Fee-for-Service	1326168428	1326168428	1	1	PARISI, THOMAS J DO	2/22/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17226	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
85651	Fee-for-Service	1649245176	1649245176	1	1	PELLEGRINI, DAVID P MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88091	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
85663	Fee-for-Service	1578754040	1578754040	1	1	PIRES, EMANUEL L MD	3/11/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
85696	Fee-for-Service	1639252604	1639252604	1	27	PERMANENTE MEDICAL GROUP INC	6/2/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
85702	Fee-for-Service	1639252604	1639252604	1	9	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
85710	Fee-for-Service	1215001763	1215001763	1	1	PORTERVILLE CONV INC	12/16/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1100 W MORTON AVE	None	PORTERVILLE	CA	93257	1947	54	06107	36.07328432	-119.0423402	Tulare County
85711	Fee-for-Service	1831171685	1831171685	1	1	PULMON AIRE INC	7/1/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	O2 SERVICES	750 ARROW HIGHWAY	None	LA VERNE	CA	91750	3599	19	06037	34.10150413	-117.7924625	Los Angeles County
85726	Fee-for-Service	1225289135	1225289135	1	1	PREMIER EMERGENCY PHYSIC	10/16/2008	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA	555 S 7TH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
85749	Fee-for-Service	1538234190	1538234190	2	1	PEARSON, LAWRENCE F	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	37412	None	None	0	In state provider	None	113 SO VINE ST	A	FALLBROOK	CA	92028	2925	37	06073	33.381639	-117.2503265	San Diego County
85765	Fee-for-Service	1982867669	1982867669	1	1	PARSA, KAMRAN DO	2/23/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	11025	None	None	0	In state provider	None	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	19	06037	34.6457071	-118.155831	Los Angeles County
85777	Fee-for-Service	1972840361	1972840361	1	1	PRIONAS, NICOLAS D MD	9/19/2019	2085R0001X	NA	Other	026	PHYSICIANS	138608	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85817	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
85851	Fee-for-Service	1710587670	1710587670	1	3	PHYSICIANS OF SOUTHERN CALIF	3/15/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ORNIA INC	3235 E COLORADO BLVD	SUITE 102	PASADENA	CA	91107	3838	19	06037	34.14624852	-118.0838475	Los Angeles County
85887	Fee-for-Service	1104081868	1104081868	1	1	PENA, MONICA	12/23/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
85894	Fee-for-Service	1205127230	1205127230	1	1	PERKINS, IFEOMA U MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145940	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85933	Fee-for-Service	1003936063	1003936063	1	1	PDAP OF VENTURA COUNTY INC	4/14/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	196 N ASHWOOD AVENUE	None	VENTURA	CA	93003	1810	56	06111	34.27747951	-119.2397921	Ventura County
85965	Fee-for-Service	1154409928	1154409928	1	1	PHELAN, ANGELICA MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73616	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
85967	Fee-for-Service	1134414881	1134414881	1	1	PARK, MIN S DO	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13511	41	Internal Medicine	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
85983	Fee-for-Service	1295991800	1295991800	1	1	PAN, OLIVIA C MD	1/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150255	40	Pediatrics	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
86000	Fee-for-Service	1952350043	1952350043	1	1	PHYLLIS BORGARDT & ASSOC	5/12/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MOBILITY THERAPY	191 S OAK PARK BLVD	STE 5	GROVER BEACH	CA	93433	2265	40	06079	35.11984574	-120.6092103	San Luis Obispo County
86004	Fee-for-Service	1093791667	1093791667	1	1	PULLENS, RENITA J MD	6/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8326	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
86035	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
86091	Fee-for-Service	1447440417	1447440417	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC CARDIOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
86106	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
86134	Fee-for-Service	1497041438	1497041438	1	1	PETER P. KIM	1/6/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10280 INDIANA AVENUE	None	RIVERSIDE	CA	92503	5357	33	06065	33.90600193	-117.4556267	Riverside County
86168	Fee-for-Service	1093903353	1093903353	1	1	PHAM, TU THAO H	6/23/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88631	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
86287	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	3/22/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
86288	Fee-for-Service	1063624278	1063624278	1	1	PLACER CO HLTH DEPT LAB	1/17/1992	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	11475 C AVE	None	AUBURN	CA	95603	2701	31	06061	38.93833614	-121.1048541	Placer County
86301	Fee-for-Service	1336400357	1336400357	1	1	PAVAWALLA, SHITAL P PHD	5/15/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
86323	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
86336	Fee-for-Service	1750348025	1750348025	1	1	POPLI, GAGANDEEP S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90262	26	Psychiatry (child)	0	In state provider	None	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
86355	Fee-for-Service	1992099444	1992099444	1	1	PHILLIP SCOTT	1/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
86364	Fee-for-Service	1396191904	1396191904	1	1	PADDA, SHERMAN S DO	9/23/2019	208M00000X	NA	Other	026	PHYSICIANS	17074	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
86375	Fee-for-Service	1306934492	1306934492	1	1	PEDIATRIC PARTNERS MEDICAL	7/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	1285 S STATE ST	None	HEMET	CA	92543	7976	33	06065	33.727887	-116.971567	Riverside County
86378	Fee-for-Service	1447440417	1447440417	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	PEDIATRIC CARDIOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
86387	Fee-for-Service	1629539028	1629539028	1	1	PARK, SANG DO	6/20/2023	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
86393	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
86432	Fee-for-Service	1114966132	1114966132	1	1	PROFESSIONAL HEARING	6/13/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES INC	1045 E VALLEY PKWY	None	ESCONDIDO	CA	92025	4618	37	06073	33.12958228	-117.0688943	San Diego County
86450	Fee-for-Service	1528290079	1528290079	1	1	PANT, MEENAKSHI	11/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120569	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
86477	Fee-for-Service	1184191769	1184191769	1	1	PEACE OF MIND WELLNESS & FAM	5/2/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY COUNSELING, INC.	505 NORTH TUSTIN AVENUE	SUITE 265	SANTA ANA	CA	78611	3112	30	06059	33.74962094	-117.8341227	Orange County
86547	Fee-for-Service	1013336999	1013336999	1	1	PALMISANO, MEGAN K MD	9/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155401	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
86564	Fee-for-Service	1699955542	1699955542	1	1	PIERCE, HEATHER C MD	6/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103389	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
86565	Fee-for-Service	1508091539	1508091539	1	1	PICKETT, ERIN H LMFT	4/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
86572	Fee-for-Service	1356704985	1356704985	1	1	PATEL, RAVI A MD	11/23/2019	207R00000X	NA	Other	026	PHYSICIANS	152132	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
86575	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	4/24/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
86577	Fee-for-Service	1669628228	1669628228	1	1	PARK, JAE MAN MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105181	41	Internal Medicine	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
86583	Fee-for-Service	1417118639	1417118639	1	1	PORTIER, DAVID A MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116967	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86608	Fee-for-Service	1093777278	1093777278	1	1	PACIFIC ORAL PATHOLOGY	7/19/1993	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY	2155 WEBSTER ST	STE 408	SAN FRANCISCO	CA	94115	2333	38	06075	37.79029884	-122.4324638	San Francisco County
86609	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
86656	Fee-for-Service	1114643319	1114643319	1	1	POOLPUONG, NEVIN	8/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
86682	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
86687	Fee-for-Service	1871805127	1871805127	1	1	PEAVY, SPRING M NP	12/18/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
86696	Fee-for-Service	1770043978	1770043978	1	1	PATEL, PRIYA D DO	6/15/2022	207R00000X	NA	Other	026	PHYSICIANS	19670	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
86722	Fee-for-Service	1851703441	1851703441	1	1	PURE LIFE HOME HEALTH CARE	7/16/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4605 LANKERSHIM BLVD	SUITE 102	NORTH HOLLYWOOD	CA	91602	1873	19	06037	34.15389329	-118.3679999	Los Angeles County
86760	Fee-for-Service	1801466826	1801466826	1	1	PALOMAR HOSPITALIST MEDICAL	7/1/2021	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP, INC	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
86766	Fee-for-Service	1184191769	1184191769	1	1	PEACE OF MIND WELLNESS & FAM	5/2/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY COUNSELING, INC.	505 NORTH TUSTIN AVENUE	SUITE 265	SANTA ANA	CA	78611	3112	30	06059	33.74962094	-117.8341227	Orange County
86801	Fee-for-Service	1659614980	1659614980	1	1	PATEL, BHAVITA MD	10/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139960	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86808	Fee-for-Service	1912908476	1912908476	1	1	PANGILINAN, FLORENCIO MD	1/1/1983	207R00000X	NA	Other	026	PHYSICIANS	39254	41	Internal Medicine	0	In state provider	None	1916 17TH ST	None	BAKERSFIELD	CA	93301	4202	15	06029	35.37437035	-119.0240458	Kern County
86814	Fee-for-Service	1639733736	1639733736	1	1	PURE SOUL HOSPICE INC	10/23/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10700 BURBANK BLVD	UNIT 5	NORTH HOLLYWOOD	CA	91601	2513	19	06037	34.17211552	-118.363959	Los Angeles County
86832	Fee-for-Service	1912583378	1912583378	1	1	PLUVINAGE, JOHN V MD	5/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86838	Fee-for-Service	1871517821	1871517821	1	1	PITROLO,DAVID A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	736 N BATTLEFIELD BLVD	None	CHESAPEAKE	VA	23320	4941	00	None	36.74619744	-76.24489616	Chesapeake city
86841	Fee-for-Service	1659884484	1659884484	1	1	PANTOJA, REFUGIO LMFT	12/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
86851	Fee-for-Service	1770773087	1770773087	1	1	PEMPE, SILKE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W THOMAS RD	STE 950	PHOENIX	AZ	85013	4232	00	None	33.481485	-112.080816	Maricopa County
86858	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	5/20/2019	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
86872	Fee-for-Service	1710145404	1710145404	1	1	PRACHI DHARIA, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
86899	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	8/14/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
86908	Fee-for-Service	1407293913	1407293913	1	1	PARK, SUNG-MIN MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135313	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
86929	Fee-for-Service	1285871137	1285871137	1	2	PINTO, NATASHA J MD	11/25/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106356	-	NOT APPLICABLE	0	In state provider	None	10850 MACARTHUR BLVD	SUITE 200	OAKLAND	CA	94605	5266	01	06001	37.7414325	-122.1498379	Alameda County
86968	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
87005	Fee-for-Service	1568516797	1568516797	1	1	PARKER, JOYCE PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17241 VAN BUREN BLVD	None	RIVERSIDE	CA	92504	5942	33	06065	33.88229953	-117.362205	Riverside County
87006	Fee-for-Service	1245756212	1245756212	1	1	PRIME LAB INC	3/1/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	31344 VIA COLINAS	UNITE 104	WESTLAKE VILLAGE	CA	91362	6853	56	06111	34.15586297	-118.8063858	Los Angeles County
87024	Fee-for-Service	1053678748	1053678748	1	1	POON, KEVIN A MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127266	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	6203	43	06085	37.37715796	-122.0651926	Santa Clara County
87036	Fee-for-Service	1164951299	1164951299	1	1	PLOCH, FH MD INC	2/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	35122	30	Radiology	0	In state provider	None	1020 NUT TREE ROAD	STE 190	VACAVILLE	CA	95687	4100	48	06095	38.35512	-121.94973	Solano County
87047	Fee-for-Service	1801466826	1801466826	1	1	PALOMAR HOSPITALIST MEDICAL	7/1/2021	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
87055	Fee-for-Service	1154520708	1154520708	1	1	PHENCO, JULIE ANN H MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124059	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
87080	Fee-for-Service	1245442748	1245442748	1	1	PETERS, ERIC D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 N 30TH ST	None	OMAHA	NE	68131	2137	00	None	41.2654263	-95.95644327	Douglas County
87101	Fee-for-Service	1639733736	1639733736	1	1	PURE SOUL HOSPICE INC	10/23/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10700 BURBANK BLVD	UNIT 5	NORTH HOLLYWOOD	CA	91601	2513	19	06037	34.17211552	-118.363959	Los Angeles County
87130	Fee-for-Service	1649327842	1649327842	1	1	PETROPOULOS, GREG LMFT	3/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4574 LIVE OAK CANYON RD	None	LA VERNE	CA	91750	2312	19	06037	34.128486	-117.7449615	Los Angeles County
87136	Fee-for-Service	1124004791	1124004791	1	1	PROSSER, WILLIAM T CRNA	12/1/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
87147	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	4/24/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
87157	Fee-for-Service	1275945230	1275945230	1	1	PATEL, PRIYANKA H MD	8/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151899	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
87190	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
87204	Fee-for-Service	1427184175	1427184175	1	1	PATEL, PRANAV M MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99434	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
87218	Fee-for-Service	1093832636	1093832636	1	1	PAREKH, AMIT MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113047	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
87230	Fee-for-Service	1831222322	1831222322	1	1	PAINOVICH, JEANNETTE M LAC	10/9/2014	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
87257	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
87322	Fee-for-Service	1285871137	1285871137	1	3	PINTO, NATASHA J MD	7/9/2019	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	106356	-	NOT APPLICABLE	0	In state provider	None	7200 BANCROFT AVENUE	SUITE 176	OAKLAND	CA	94605	2408	01	06001	37.768221	-122.17608	Alameda County
87340	Fee-for-Service	1548332018	1548332018	1	1	PAK, SABRINA M MD	7/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92997	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
87392	Fee-for-Service	1528002334	1528002334	1	1	PAK, SHANE S MD	10/15/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	52715	20	Orthopedic Surgery	0	In state provider	None	707 S GARFIELD AVE	STE 201	ALHAMBRA	CA	91801	5861	19	06037	34.088688	-118.123106	Los Angeles County
87423	Fee-for-Service	1780011726	1780011726	1	1	PORTIZ, PATRICK M MD	2/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127477	41	Internal Medicine	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
87430	Fee-for-Service	1801035886	1801035886	1	1	PORTALES, ARTURO DO	2/19/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	11246	01	General Practice	0	In state provider	None	27522 ANTONIO PKWY	P3	LADERA RANCH	CA	92694	2166	30	06059	33.56343335	-117.6292292	Orange County
87438	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	1/22/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
87460	Fee-for-Service	1477058329	1477058329	1	1	PADUA, ILYSSA N NP	11/27/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87476	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
87536	Fee-for-Service	1386151702	1386151702	1	1	PINNACLE MENTAL WELLNESS GRO	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	UP, A FAMILY COUNSELING	130 E LELAND RD	C	PITTSBURG	CA	94565	4983	07	06013	38.01186589	-121.8902232	Contra Costa County
87544	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
87570	Fee-for-Service	1497883433	1497883433	1	1	PICKETT, BRUCE A LCSW	4/9/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	865 BLACK WALNUT CT	None	MORGAN HILL	CA	95037	3722	43	06085	37.13961467	-121.6413921	Santa Clara County
87596	Fee-for-Service	1801084561	1801084561	1	1	PFLAUMER, EDWARD PHD	9/5/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	721 NEVADA ST	STE 203	REDLANDS	CA	92373	8051	36	06071	34.061715	-117.2174795	San Bernardino County
87613	Fee-for-Service	1831672724	1831672724	1	1	PANGAN, PHILLIP L NP	1/21/2019	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
87647	Fee-for-Service	1619002235	1619002235	1	1	PTRN DME INC	3/5/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4201 WILSHIRE BLVD	SUITE 111	LOS ANGELES	CA	90010	3601	19	06037	34.06175751	-118.319247	Los Angeles County
87684	Fee-for-Service	1750377412	1750377412	1	1	PERCY M PENTECOST, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
87722	Fee-for-Service	1497074108	1497074108	1	1	POONACHA, MELANIA S MD	4/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130281	None	None	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
87727	Fee-for-Service	1235453424	1235453424	1	2	P.E.E.C.E. KEEPERS, INC.	1/19/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6829 SAVINGS PL	None	SACRAMENTO	CA	95828	1292	34	06067	38.50036685	-121.4282862	Sacramento County
87728	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
87763	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
87776	Fee-for-Service	1417932476	1417932476	1	1	POTTKER, TAMARA I MD	4/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
87788	Fee-for-Service	1902937667	1902937667	1	1	PARNES, GLENN S MD	2/27/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	695 SANTA ROSA ST	None	SAN LUIS OBISPO	CA	93401	2801	40	06079	35.28525928	-120.6623277	San Luis Obispo County
87790	Fee-for-Service	1366493116	1366493116	1	1	PYKE, STEVEN N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78611	08	Family Practice	0	In state provider	None	165 ROWLAND WAY	STE 105	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
87794	Fee-for-Service	1255562484	1255562484	1	1	PONCE, MAYA LCSW	10/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	29419	-	NOT APPLICABLE	0	In state provider	None	440 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	1430	38	06075	37.76420358	-122.4074414	San Francisco County
87804	Fee-for-Service	1215469945	1215469945	1	1	PYUN, ALYSSA MD	9/28/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	162887	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
87831	Fee-for-Service	1578882965	1578882965	1	1	PACIFIC VASCUCARE INC	2/15/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1660 W 3RD ST	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
87833	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
87837	Fee-for-Service	1033629563	1033629563	1	1	PARRINELLA, KRISTIN R MD	9/16/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159772	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
87843	Fee-for-Service	1891772950	1891772950	1	1	PETERSON, MELINDA H PT	8/22/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	#200	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
87844	Fee-for-Service	1730332495	1730332495	1	1	PATEL, AKASH R MD	10/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126681	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
87870	Fee-for-Service	1013146646	1013146646	1	1	POURANDRIAS, CHRISTINE PHD	12/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10646 ZELZAH AVE	STE 207	GRANADA HILLS	CA	91344	5959	19	06037	34.26341579	-118.5233607	Los Angeles County
87909	Fee-for-Service	1356845325	1356845325	1	1	PLAFSKY, LIZA MD	9/24/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
87911	Fee-for-Service	1790213247	1790213247	1	2	PASADENA CLINICAL GROUP, A P	5/10/2022	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SYCHOLOGY CORPORATION	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
87913	Fee-for-Service	1922387711	1922387711	1	1	PULMONARY & SLEEP DISORDER	5/24/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53870	40	Pediatrics	0	In state provider	None	12555 GARDEN GROVE BLVD	STE 307	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
87964	Fee-for-Service	1861043549	1861043549	1	1	PRINCE, STEPHANIE R LCSW	10/7/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SS	2012 E ST	None	BAKERSFIELD	CA	93301	4223	15	06029	35.37754217	-119.0245776	Kern County
87987	Fee-for-Service	1760553119	1760553119	1	1	PHAM, DENNIS V MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82570	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
88012	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
88015	Fee-for-Service	1922552371	1922552371	1	1	PLATTER, ERIN MD	10/3/2024	363LP0222X	NA	Nurse Practitioner	026	PHYSICIANS	147449	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
88023	Fee-for-Service	1376920264	1376920264	1	1	PATEL, DARSHAN MD	4/30/2019	207R00000X	NA	Other	026	PHYSICIANS	156554	41	Internal Medicine	0	In state provider	None	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	48	06095	38.22519621	-122.1327459	Solano County
88025	Fee-for-Service	1508160664	1508160664	1	1	PREMIER NEUROLOGY MEDICAL GR	6/27/2022	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OUP INC	415 N. CRESCENT DR.	STE. 110	BEVERLY HILLS	CA	90210	6807	19	06037	34.07169249	-118.4003202	Los Angeles County
88033	Fee-for-Service	1912653999	1912653999	1	1	PREMIER PERIOPERATIVE PHYSIC	3/2/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IANS	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
88044	Fee-for-Service	1346698925	1346698925	1	1	PATEL-SANCHEZ, NAMRATA U MD	7/12/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160922	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
88054	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	3/9/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
88061	Fee-for-Service	1417932476	1417932476	1	1	POTTKER, TAMARA I MD	4/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
88122	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
88138	Fee-for-Service	1306838511	1306838511	1	1	PHAT DAI HOANG, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13065 W MCDOWELL RD	STE A105	AVONDALE	AZ	85392	0000	00	None	33.463341	-112.337433	Maricopa County
88140	Fee-for-Service	1487632196	1487632196	1	1	PAMULAPATI, SRINIVASA R MD	6/6/2020	207R00000X	NA	Other	026	PHYSICIANS	165857	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
88175	Fee-for-Service	1952855447	1952855447	1	1	PROHEALTH HOME CARE, INC	8/15/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1776 W MARCH LANE	STE 400A	STOCKTON	CA	95207	6450	39	06077	37.98763864	-121.3270969	San Joaquin County
88201	Fee-for-Service	1922387711	1922387711	1	1	PULMONARY & SLEEP DISORDER	5/24/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53870	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	12555 GARDEN GROVE BLVD	STE 307	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
88202	Fee-for-Service	1790213247	1790213247	1	2	PASADENA CLINICAL GROUP, A P	8/17/2022	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SYCHOLOGY CORPORATION	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
88209	Fee-for-Service	1285411405	1285411405	1	1	PARK, MINA PT	2/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	844 BRIDGE ST	STE C	COLUSA	CA	95932	2867	06	06011	39.20645023	-122.0035419	Colusa County
88299	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
88333	Fee-for-Service	1184251688	1184251688	1	1	PLANTAK, MIHAEL MD	5/15/2023	207P00000X	NA	Other	026	PHYSICIANS	183760	None	None	0	In state provider	None	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
88338	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
88384	Fee-for-Service	1316033517	1316033517	1	1	POLITOSKE, EDWARD J MD	7/31/1986	207R00000X	NA	Other	026	PHYSICIANS	41806	41	Internal Medicine	0	In state provider	None	341 MAGNOLIA AVE	STE 207	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
88390	Fee-for-Service	1083026108	1083026108	1	1	PANNEERSELVAM, DIVYA MD	9/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169426	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
88408	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	10/3/2012	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
88419	Fee-for-Service	1689840944	1689840944	1	1	PAHWA, ANOKH MD	3/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99463	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
88422	Fee-for-Service	1366594723	1366594723	1	1	PANESAR, JASPREET MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67145	10	Gastroenterology (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
88442	Fee-for-Service	1679081442	1679081442	1	1	PORTERVILLE PHARMACY INC	11/3/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1270 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1455	54	06107	36.0804543	-119.0462933	Tulare County
88467	Fee-for-Service	1295934792	1295934792	1	2	PAUL TC LIU MD, INC	1/18/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	2233 HUNTINGTON DR	12	SAN MARINO	CA	91108	2655	19	06037	34.12214824	-118.1058479	Los Angeles County
88476	Fee-for-Service	1386711265	1386711265	1	1	PEREZ, MYRIAM B MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68679	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
88479	Fee-for-Service	1528271707	1528271707	1	1	PATRICIA O BUEHLER M.D.	12/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2450 NE MARY ROSE PL	STE 110	BEND	OR	97701	7132	00	None	44.06107645	-121.2661478	Deschutes County
88490	Fee-for-Service	1790213247	1790213247	1	2	PASADENA CLINICAL GROUP, A P	8/3/2022	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SYCHOLOGY CORPORATION	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
88541	Fee-for-Service	1306994108	1306994108	1	1	PHAM, KIMPHUONG D MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82891	38	Geriatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
88551	Fee-for-Service	1831772870	1831772870	1	1	PATEL, ANISHA S DO	4/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20747	None	None	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
88574	Fee-for-Service	1750426532	1750426532	1	1	PENG, SHI-KAUNG MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	31546	01	General Practice	0	In state provider	None	1124 W CARSON ST	APT 1	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
88590	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
88609	Fee-for-Service	1215009782	1215009782	1	1	PUA, ROLAND J MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
88611	Fee-for-Service	1033142609	1033142609	2	1	PHARMERICA DRUG SYSTEMS LLC	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMERICA	833 MARLBOROUGH AVE	STE 100	RIVERSIDE	CA	92507	2133	33	06065	33.99750648	-117.32913	Riverside County
88627	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	12/8/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
88632	Fee-for-Service	1831580067	1831580067	1	1	PRESTIGE DIAGNOSTICS INC	2/16/2016	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1157 HILLTOP DR	None	REDDING	CA	96003	3814	45	06089	40.590918	-122.3557515	Shasta County
88642	Fee-for-Service	1225217169	1225217169	1	1	PAULINE HILTON ADVANCED	12/14/2007	261QP2300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PRACTICE NURSING SERVICE	1329 NORTH H ST	None	SAN BERNARDINO	CA	92405	5039	36	06071	34.123851	-117.300894	San Bernardino County
88672	Fee-for-Service	1316033517	1316033517	1	1	POLITOSKE, EDWARD J MD	7/31/1986	207R00000X	NA	Other	026	PHYSICIANS	41806	10	Gastroenterology (M.D. only)	0	In state provider	None	341 MAGNOLIA AVE	STE 207	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
88697	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
88731	Fee-for-Service	1023012556	1023012556	1	1	PATRICIA MARIE DAVIS M.D.	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10470 VISTA DEL SOL DR	STE 210	EL PASO	TX	79925	7928	00	None	31.75677074	-106.3450249	El Paso County
88749	Fee-for-Service	1013413517	1013413517	1	1	PICETTI, DOMINIC J MD	8/5/2022	208M00000X	NA	Other	026	PHYSICIANS	164045	None	None	0	In state provider	None	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
88782	Fee-for-Service	1558761395	1558761395	1	1	PARK, SE R CRNA	6/14/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
88788	Fee-for-Service	1053465864	1053465864	1	1	PYLE, GAIL G MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63175	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88803	Fee-for-Service	1447865787	1447865787	1	1	PRASAD, RINKY S CRNA	3/25/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
88817	Fee-for-Service	1972550762	1972550762	1	1	PEACH, SHARON E MD	7/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53730	None	None	0	In state provider	None	616 E CHAPEL STREET	None	SANTA MARIA	CA	93454	0616	42	06083	34.95426953	-120.427596	Santa Barbara County
88823	Fee-for-Service	1497803225	1497803225	1	1	PEMA, RADHA MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84244	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
88829	Fee-for-Service	1306994108	1306994108	1	1	PHAM, KIMPHUONG D MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82891	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
88868	Fee-for-Service	1467616151	1467616151	1	1	PEREZ, VANESSA C PHD	1/29/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
88875	Fee-for-Service	1194970509	1194970509	1	2	PATRON, BEATRIZ LMFT	8/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
88876	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
88881	Fee-for-Service	1801066063	1801066063	1	1	PERKIN, HUGH B MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98268	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
88896	Fee-for-Service	1215009782	1215009782	1	1	PUA, ROLAND J MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	38	Geriatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
88911	Fee-for-Service	1750503884	1750503884	1	1	PRICKETT, PATRICIA A LMFT	10/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3407 W 6TH ST	STE 518	LOS ANGELES	CA	90020	2552	19	06037	34.06363337	-118.295759	Los Angeles County
88914	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
88917	Fee-for-Service	1205698115	1205698115	1	1	PALMDALE ANESTHESIA, INC	3/1/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
88936	Fee-for-Service	1588719629	1588719629	1	1	PENA, JOSE M MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62167	40	Pediatrics	0	In state provider	None	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	41	06081	37.47644946	-122.2110919	San Mateo County
88955	Fee-for-Service	1780909077	1780909077	1	1	PEI, RONALD C P OD	10/31/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
88960	Fee-for-Service	1104905850	1104905850	1	1	POWELL, MARK Z MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	70304	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
88972	Fee-for-Service	1518476845	1518476845	1	1	PARTNERS IN CARE HOSPICE LLC	2/28/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	560 WALL ST	STE F	AUBURN	CA	95603	3996	31	06061	38.90941996	-121.0753971	Placer County
88985	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
89003	Fee-for-Service	1831190461	1831190461	1	1	PATEL, RENUKA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	205 N EAST AVE	None	JACKSON	MI	49201	1753	00	None	42.25035275	-84.39360669	Jackson County
89012	Fee-for-Service	1912394289	1912394289	1	1	PARIKH, ADITI R DO	10/17/2018	207R00000X	NA	Other	026	PHYSICIANS	15191	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
89013	Fee-for-Service	1447626627	1447626627	1	1	PARULAN, ETHEL C NP	9/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89042	Fee-for-Service	1487316550	1487316550	1	1	PARK, KYUNG C OD	6/14/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 TOWER WAY	STE 150	BAKERSFIELD	CA	93309	1586	15	06029	35.36363292	-119.0611362	Kern County
89053	Fee-for-Service	1710973409	1710973409	2	1	PHARMILYCARE INC	10/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8729 VALLEY BLVD	STE D	ROSEMEAD	CA	91770	1786	19	06037	34.0806454	-118.0795045	Los Angeles County
89105	Fee-for-Service	1265510069	1265510069	1	1	PULIGANDLA, BALARAM MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	49195	22	Pathology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
89111	Fee-for-Service	1538248547	1538248547	1	1	POLICASTRO, RONALD J MD	8/24/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	40687	10	Gastroenterology (M.D. only)	0	In state provider	INC	18111 BROOKHURST ST	SUITE 5200	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
89121	Fee-for-Service	1861428302	1861428302	1	1	PISINGER, PATRICIA MD	1/1/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69264	08	Family Practice	0	In state provider	None	180 OTAY LAKES RD	SUITE 300	SAN DIEGO	CA	90902	0000	37	06073	32.65928608	-117.0304661	San Diego
89141	Fee-for-Service	1861888265	1861888265	2	1	P.H.N. PHARMACIES INC	12/5/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12998 HESPERIA RD	STE 102	VICTORVILLE	CA	92395	8316	36	06071	34.48789715	-117.2906992	San Bernardino County
89147	Fee-for-Service	1396830881	1396830881	1	1	PAUL W JANSEN MD	12/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
89156	Fee-for-Service	1063419539	1063419539	1	1	PAUL, STUART R MD AMC	12/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41863	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	252 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817172	-121.6460689	Monterey County
89165	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
89180	Fee-for-Service	1386669018	1386669018	1	1	PRICE, RAYMOND R MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
89203	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
89217	Fee-for-Service	1912932138	1912932138	1	1	PEDIATRIC GASTROENTEROLOGY	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	OF CENTRAL FLORIDA PA	615 E PRINCETON ST	SUITE 310	ORLANDO	FL	32869	1597	00	None	28.57183136	-81.3696839	Orange County
89225	Fee-for-Service	1023104148	1023104148	1	1	PERSONAL BEST PHYSICAL	3/1/2011	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY	11911 ARTESIA BLVD	STE 207	CERRITOS	CA	90701	4060	19	06037	33.87314847	-118.079649	Los Angeles County
89238	Fee-for-Service	1558373183	1558373183	1	1	PADILLA, DARLINE K NP	7/1/2019	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
89259	Fee-for-Service	1518476845	1518476845	1	1	PARTNERS IN CARE HOSPICE LLC	2/28/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	560 WALL ST	STE F	AUBURN	CA	95603	3996	31	06061	38.90941996	-121.0753971	Placer County
89273	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
89344	Fee-for-Service	1114016698	1114016698	1	1	PHILLIPS, VICKY L MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	47905	08	Family Practice	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
89451	Fee-for-Service	1659559334	1659559334	1	1	PHAM, TREY Q MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4812	00	None	36.16257648	-115.170696	Clark County
89452	Fee-for-Service	1730526963	1730526963	2	1	PRIME HEALTHCARE ANAHEIM LLC	7/6/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3033 WEST ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
89454	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
89460	Fee-for-Service	1689948960	1689948960	1	1	PEARL, MEGHAN H MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119536	40	Pediatrics	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 265	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
89489	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
89498	Fee-for-Service	1255381000	1255381000	1	1	PURYEAR, JEROME MD	6/5/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171453	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
89516	Fee-for-Service	1174772545	1174772545	1	1	PAWAR, SUJRTA A MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105425	41	Internal Medicine	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
89526	Fee-for-Service	1588778252	1588778252	1	1	PU, LEPING MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	108476	30	Radiology	0	In state provider	None	1661 SOQUEL DRIVE	BUILDING G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
89529	Fee-for-Service	1588811319	1588811319	1	1	PA, SHUN MD	7/7/2008	207P00000X	NA	Other	026	PHYSICIANS	98070	66	Emergency Medicine (Urgent Care)	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	3419	24	06047	37.06346603	-120.8593647	Merced County
89530	Fee-for-Service	1720057623	1720057623	1	2	POWELL, NA'IMAH D MD	6/21/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	72993	08	Family Practice	0	In state provider	None	425 DIAMOND DRIVE	STE 104-105	LAKE ELSINORE	CA	92530	4495	33	06065	33.65802263	-117.3002985	Riverside County
89537	Fee-for-Service	1336247642	1336247642	1	1	PASADENA ENDOSCOPY CENTER	2/19/2002	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	55 W VALLEY ST	None	PASADENA	CA	91105	2015	19	06037	34.14243406	-118.1516843	Los Angeles County
89539	Fee-for-Service	1003949975	1003949975	1	1	PROHEALTH PARTNERS	8/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP	1045 ATLANTIC AVE	STE 705	LONG BEACH	CA	90813	3412	19	06037	33.780267	-118.1850795	Los Angeles County
89543	Fee-for-Service	1174853477	1174853477	1	1	PATEL, PRITUL R MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131369	None	None	0	In state provider	None	200 MEDICAL PALZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
89545	Fee-for-Service	1427347319	1427347319	1	1	PHAM, YASUYUKI MD	12/1/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	123996	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89560	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
89574	Fee-for-Service	1912978834	1912978834	1	1	PATEL, RAVI MD INC	12/1/1998	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	COMP BLOOD & CANCER CORP	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
89581	Fee-for-Service	1841731254	1841731254	1	1	PLIMPTON, STEVEN R MD	7/13/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158426	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89597	Fee-for-Service	1891555827	1891555827	1	1	PINO, LIZBETH CAROLINA	5/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
89610	Fee-for-Service	1619186053	1619186053	1	1	PETER JOO KIM	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
89617	Fee-for-Service	1780214874	1780214874	1	1	PREFERRED HOME HEALTH INC	1/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1101 E BROADWAY	SUITE 109	GLENDALE	CA	91205	1394	19	06037	34.14628021	-118.2414675	Los Angeles County
89628	Fee-for-Service	1235193616	1235193616	1	1	POSSELT, ANDREW M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81075	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
89652	Fee-for-Service	1609393453	1609393453	1	1	PARK, NAOMI LAC	1/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3030 WEST 6TH STREET	SUITE 100	LOS ANGELES	CA	90020	1506	19	06037	34.06367753	-118.2880516	Los Angeles County
89696	Fee-for-Service	1447200605	1447200605	1	1	PETER CONKLIN M.D.	5/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
89740	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
89741	Fee-for-Service	1659714475	1659714475	1	1	PEARRE, DIANA C MD	9/21/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147126	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89757	Fee-for-Service	1093871840	1093871840	1	1	PENSAK, MELANIE CCC-SLP	1/23/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	24600 SILVER CLOUD CT	104	MONTEREY	CA	93940	3128	27	06053	36.5721717	-121.8049621	Monterey County
89762	Fee-for-Service	1093722290	1093722290	1	1	PARK, ALICE S MD	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94437	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
89769	Fee-for-Service	1245376201	1245376201	1	1	PACHECO CORVERA, REBECA LMF	8/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
89776	Fee-for-Service	1538267307	1538267307	1	1	PATERNO, VICTORIA I MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43466	40	Pediatrics	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
89777	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
89787	Fee-for-Service	1063425072	1063425072	1	1	PESSL, AARON MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
89849	Fee-for-Service	1639252604	1639252604	1	17	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
89861	Fee-for-Service	1912978834	1912978834	1	1	PATEL, RAVI MD INC	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	COMP BLOOD & CANCER CORP	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
89880	Fee-for-Service	1356703235	1356703235	1	1	PERRY LEE	11/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
89910	Fee-for-Service	1861574378	1861574378	1	1	PREAM, SOCHEAT O LAC	2/23/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3525 FIRESTONE BLVD.	None	SOUTH GATE	CA	90280	3031	19	06037	33.95423052	-118.2050986	Los Angeles County
89927	Fee-for-Service	1154602688	1154602688	1	1	PARADA, EDNA F LMFT	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
89931	Fee-for-Service	1902921406	1902921406	1	1	PATEL, JITENBHAI J MD	12/13/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94128	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
89932	Fee-for-Service	1003819301	1003819301	1	1	POULSEN, ERIC J MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71284	18	Ophthalmology	0	In state provider	None	1360 E HERNDON AVE	STE 201	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
89940	Fee-for-Service	1801825435	1801825435	1	1	POPESCU, IOANA-MIHAELA	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92836	36	Psychiatry	0	In state provider	MD	3750 HOMESTEAD RD	None	SANTA CLARA	CA	95051	5961	43	06085	37.335762	-121.9980375	Santa Clara County
89965	Fee-for-Service	1457741837	1457741837	1	1	PACIFIC CENTRAL COAST HEALTH	11/29/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1304 ELLA STREET	STE A	SAN LUIS OBISPO	CA	93401	4100	40	06079	35.27704692	-120.6496857	San Luis Obispo County
89970	Fee-for-Service	1326433491	1326433491	1	1	PEITZMAN, EMILY R MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148421	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
89973	Fee-for-Service	1255426615	1255426615	1	1	POLLARD, SUSAN A LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25684	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
89981	Fee-for-Service	1568656411	1568656411	1	1	PICARELLA, THOMAS CRNA	4/9/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
90008	Fee-for-Service	1740523406	1740523406	1	1	PATEL, ROMA R MD	1/12/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	141391	None	None	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
90030	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
90067	Fee-for-Service	1841373800	1841373800	1	7	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
90150	Fee-for-Service	1912978834	1912978834	1	1	PATEL, RAVI MD INC	12/10/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	COMP BLOOD & CANCER CORP	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
90162	Fee-for-Service	1750811659	1750811659	1	1	PHAM, JONATHAN H MD	5/7/2020	207R00000X	NA	Other	026	PHYSICIANS	162262	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
90167	Fee-for-Service	1407206311	1407206311	1	1	PHYU, EI EI MD	10/27/2020	207R00000X	NA	Other	026	PHYSICIANS	168862	41	Internal Medicine	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
90174	Fee-for-Service	1972517902	1972517902	1	1	PAIR, ROBERT D RPT	2/28/1997	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5329 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0641	15	06029	35.36734574	-119.0620677	Kern County
90181	Fee-for-Service	1821408113	1821408113	1	1	PENNINGTON, MARY DO MD	6/1/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14664	38	Geriatrics	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
90186	Fee-for-Service	1861608630	1861608630	1	1	PIMSTONE, DANIEL J MD	9/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99978	36	Psychiatry	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
90191	Fee-for-Service	1164599981	1164599981	1	1	PONG, KENNETH W MD	7/10/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	45384	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
90196	Fee-for-Service	1205952454	1205952454	1	1	POPPAW, EUGENIE A CRNA	9/23/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
90204	Fee-for-Service	1386735777	1386735777	1	1	POLSKIY, PAVEL M MD	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84409	08	Family Practice	0	In state provider	None	5810 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
90223	Fee-for-Service	1578763413	1578763413	1	1	PARK, DAVID K MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	100165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
90233	Fee-for-Service	1306398326	1306398326	1	1	PRITCHARD, ASHLEE E	1/20/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
90250	Fee-for-Service	1801858964	1801858964	2	1	PREMIER PATHOLOGY LABORATORI	5/13/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ES INC A PROFESSIONAL ME	263 NORTH PEARSON DR	SUITE 108	PORTERVILLE	CA	93257	3333	54	06107	36.07063437	-119.0277512	Tulare County
90255	Fee-for-Service	1427371913	1427371913	1	1	PADREZ, KATHARINE G MD	4/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116396	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
90256	Fee-for-Service	1851786156	1851786156	1	1	PHAM, VAN Q DO	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16306	41	Internal Medicine	0	In state provider	None	3828 SCHAUFELE AVE	STE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
90288	Fee-for-Service	1780046276	1780046276	1	1	PETTY, KATE L MD	9/21/2023	207L00000X	NA	Other	026	PHYSICIANS	185984	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
90318	Fee-for-Service	1639252604	1639252604	1	26	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
90319	Fee-for-Service	1134141336	1134141336	1	1	PATTON, WILLIAM C MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	18872	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
90379	Fee-for-Service	1710937917	1710937917	1	1	POAGE, DAVID P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
90389	Fee-for-Service	1073108957	1073108957	1	1	PLANNED PARENTHOOD	12/31/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	2651 SOUTH C STREET	SUITE 100	OXNARD	CA	93033	3560	56	06111	34.17497898	-119.1811966	Ventura County
90438	Fee-for-Service	1912978834	1912978834	1	1	PATEL, RAVI MD INC	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	COMP BLOOD & CANCER CORP	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
90462	Fee-for-Service	1417035072	1417035072	1	1	POMBRA, JASMEEN MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56268	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
90474	Fee-for-Service	1669791646	1669791646	1	2	PANACEA GROUP INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3786 LA CRESCENTA AVE	SUITE 105	GLENDALE	CA	91208	1055	19	06037	34.210962	-118.2399715	Los Angeles County
90485	Fee-for-Service	1942239926	1942239926	1	2	PAIR & MAROTTA PHYSICAL THER	10/3/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	1160 E LERDO HWY	STE G	SHAFTER	CA	93263	9417	15	06029	35.49994334	-119.2589787	Kern County
90503	Fee-for-Service	1518048826	1518048826	1	1	PHILLIPS, SHEILA S MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64630	01	General Practice	0	In state provider	None	2021 SANTA MONICA BLVD	STE 612E	SANTA MONICA	CA	90404	2221	19	06037	34.02922048	-118.4793681	Los Angeles County
90594	Fee-for-Service	1922610062	1922610062	1	1	PALMER, LAUREN B LMFT	5/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
90608	Fee-for-Service	1134141336	1134141336	1	1	PATTON, WILLIAM C MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	18872	67	Endocrinology	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
90644	Fee-for-Service	1669747564	1669747564	1	1	PAKZAD, ZIMA MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120849	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
90654	Fee-for-Service	1588317499	1588317499	1	1	PETROSYAN ENTERPRISES, INC.	4/8/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2428 STEARNS ST	UNIT B	SIMI VALLEY	CA	93063	2418	56	06111	34.279614	-118.691284	Ventura County
90662	Fee-for-Service	1598797375	1598797375	1	1	PORDELL, REZA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36878	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
90682	Fee-for-Service	1609170232	1609170232	1	1	PREMIER HEALTH PARTNERS	1/31/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 NORTH 1ST STREET	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
90726	Fee-for-Service	1912978834	1912978834	1	1	PATEL, RAVI MD INC	3/8/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	COMP BLOOD & CANCER CORP	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
90774	Fee-for-Service	1942239926	1942239926	1	2	PAIR & MAROTTA PHYSICAL THER	3/18/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	1160 E LERDO HWY	STE G	SHAFTER	CA	93263	9417	15	06029	35.49994334	-119.2589787	Kern County
90792	Fee-for-Service	1518048826	1518048826	1	1	PHILLIPS, SHEILA S MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64630	40	Pediatrics	0	In state provider	None	2021 SANTA MONICA BLVD	STE 612E	SANTA MONICA	CA	90404	2221	19	06037	34.02922048	-118.4793681	Los Angeles County
90801	Fee-for-Service	1902987001	1902987001	1	1	PREWETT, JOHN R OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1429 S BROADWAY	None	SANTA MARIA	CA	93454	6913	42	06083	34.93645316	-120.436196	Santa Barbara County
90858	Fee-for-Service	1124480124	1124480124	1	1	PINNEY, JAMES R MD	7/29/2022	207R00000X	NA	Other	026	PHYSICIANS	152620	None	None	0	In state provider	None	12021 WILMINGTON AVE	BUILDING 11, SUITE 1000	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
90868	Fee-for-Service	1295361921	1295361921	1	1	POOLE, TAYLOR R	5/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
90872	Fee-for-Service	1891873600	1891873600	1	1	PONTEJOS, JUANITO L DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7205	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
90873	Fee-for-Service	1851561658	1851561658	1	1	POP, MIHAELA I MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104428	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
90883	Fee-for-Service	1992951859	1992951859	1	1	PARRAL, GLORIANA MSW LCSW	11/14/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18245 HIGHWAY 18	STE. 6	APPLE VALLEY	CA	92307	2217	36	06071	34.54026632	-117.2656302	San Bernardino County
90926	Fee-for-Service	1487819744	1487819744	1	1	PATEL, SNEHALKUMAR B MD	9/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
90943	Fee-for-Service	1538124656	1538124656	1	1	PROMPT MED. TRANSPORTATION	9/17/2007	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9835 EXPRESS DR	None	HIGHLAND	IN	46322	2608	00	None	41.534631	-87.469173	Lake County
90945	Fee-for-Service	1205545597	1205545597	1	1	PEREIRA, TRISTAN PT	1/25/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1160 N VENTURA RD	None	OXNARD	CA	93030	3802	56	06111	34.2133887	-119.1943554	Ventura County
90965	Fee-for-Service	1144766064	1144766064	1	1	PERFORMANCE PLUS PHYSICAL TH	2/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY, INC.	1392 E PALOMAR ST	503	CHULA VISTA	CA	91913	1892	37	06073	32.62360793	-116.9969964	San Diego County
90985	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
90993	Fee-for-Service	1518034545	1518034545	1	1	PILLAI, DHARMAPALAN V MD	9/16/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	30534	36	Psychiatry	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
91009	Fee-for-Service	1538892062	1538892062	1	1	PORTE, MONIQUE NP	10/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
91027	Fee-for-Service	1336451863	1336451863	1	1	PANDYA, HIMANI S MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112532	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
91034	Fee-for-Service	1598081705	1598081705	1	1	PACE, SARAH D MD	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148797	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 330	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
91035	Fee-for-Service	1053082586	1053082586	1	1	PIPELINE COMMUNITY SPECIALTY	12/5/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC	4036 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2561	19	06037	34.02390455	-118.1847825	Los Angeles County
91069	Fee-for-Service	1316943913	1316943913	1	2	PERRY, STEPHEN L MD	3/6/1996	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
91128	Fee-for-Service	1457849739	1457849739	1	1	PROPST, ROBERT J DO	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	17913	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
91141	Fee-for-Service	1841497591	1841497591	1	1	PARK, ALICE S	9/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
91147	Fee-for-Service	1629421995	1629421995	1	1	PHAM, MICHELLE OD	9/10/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 EASTLAKE PKWY	None	CHULA VISTA	CA	91915	4116	37	06073	32.63198831	-116.9665341	San Diego County
91156	Fee-for-Service	1528723376	1528723376	1	1	PHELAN, KRISTINE LMFT	12/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
91214	Fee-for-Service	1689838559	1689838559	1	1	PLANK, DAVID M MD	4/30/2021	2086S0122X	NA	General Surgery	026	PHYSICIANS	170508	None	None	0	In state provider	None	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
91219	Fee-for-Service	1922058221	1922058221	1	1	PREMIER EMERGENCY	11/17/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS OF CA MED GRP	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
91233	Fee-for-Service	1285664664	1285664664	1	1	PERIC, JOHN M MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79419	08	Family Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
91235	Fee-for-Service	1639691363	1639691363	1	1	PARKER, AYANNA B CD	12/16/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
91277	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
91279	Fee-for-Service	1619322898	1619322898	1	1	PARK, JI-KWAN MD	4/17/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	155176	18	Ophthalmology	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
91295	Fee-for-Service	1063554012	1063554012	1	1	POMPEI, PETER MD	3/1/1993	207R00000X	NA	Other	026	PHYSICIANS	78134	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
91319	Fee-for-Service	1093739799	1093739799	1	1	PATEL, JHAVER A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
91332	Fee-for-Service	1245505866	1245505866	2	4	PEDIATRIX CARDIOLOGY OF ORAN	12/20/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OUTHERN CALIFORNIA	2095 W VISTA WAY	SUITE 107	VISTA	CA	92083	6027	37	06073	33.18438885	-117.2876725	San Diego County
91361	Fee-for-Service	1932548229	1932548229	1	1	PEREZ, STEPHANIE PT	6/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
91386	Fee-for-Service	1285659250	1285659250	1	1	PARK, YUN S OD	7/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	428 W CAPITOL EXPY	None	SAN JOSE	CA	95136	1303	43	06085	37.27445052	-121.8506175	Santa Clara County
91405	Fee-for-Service	1588337232	1588337232	1	1	PETTUS, TARA S CRNA	2/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
91420	Fee-for-Service	1235111006	1235111006	1	1	PARADISE MEDICAL GROUP, INC.	12/20/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6470 PENTZ RD	SUITE B	PARADISE	CA	95969	3674	04	06007	39.77082001	-121.5795537	Butte County
91421	Fee-for-Service	1609860733	1609860733	1	1	PRIMAK, DMITRY MD	9/23/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	142611	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
91447	Fee-for-Service	1578099073	1578099073	1	1	PATEL, RACHEL C MD	10/28/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	181884	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
91467	Fee-for-Service	1982030425	1982030425	1	1	PEREZ, JULIA B LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
91501	Fee-for-Service	1174019715	1174019715	1	1	POULDAR, TIFFANY MD	10/25/2023	207L00000X	NA	Other	026	PHYSICIANS	166492	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91509	Fee-for-Service	1295812626	1295812626	1	1	PHOENIX HOUSE ORANGE COUNTY	2/28/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	1207 EAST FRUIT STREET	A, B, B2, B3, C, D, E, F	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
91518	Fee-for-Service	1659490498	1659490498	1	1	PENNY LANE CENTERS	6/20/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
91520	Fee-for-Service	1942239926	1942239926	1	4	PAIR & MAROTTA PHYSICAL THER	10/3/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	2603 G STREET	None	BAKERSFIELD	CA	93301	2828	15	06029	35.38311773	-119.0223525	Kern County
91546	Fee-for-Service	1215965462	1215965462	1	1	PIKE, ROBERT A MD	8/26/1993	207L00000X	NA	Other	026	PHYSICIANS	44860	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
91562	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
91565	Fee-for-Service	1629254966	1629254966	1	1	PADAL, MARIA C	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
91567	Fee-for-Service	1689695611	1689695611	1	1	PASHA, MARYAM M MD	7/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63603	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2131 WEST 3RD STREET	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
91583	Fee-for-Service	1063554012	1063554012	1	1	POMPEI, PETER MD	3/1/1993	207R00000X	NA	Other	026	PHYSICIANS	78134	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
91585	Fee-for-Service	1972035350	1972035350	1	1	PHAN, ELLYN M MD	11/9/2020	207R00000X	NA	Other	026	PHYSICIANS	169745	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
91588	Fee-for-Service	1194721373	1194721373	1	1	PUNZALAN, RAYMUNDO P MD	2/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50049	67	Endocrinology	0	In state provider	None	7015 CHESTNUT AVENUE	SUITE 101	FRESNO	CA	93720	0353	10	06019	36.8380303	-119.7362493	Fresno County
91602	Fee-for-Service	1083918585	1083918585	1	1	PIERCE, ERICK M CRNA	1/12/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
91610	Fee-for-Service	1396961777	1396961777	1	1	PATEL, BIJAL M MD	1/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126410	41	Internal Medicine	0	In state provider	None	1447 CEDARWOOD LANE	SUITE A	PLEASANTON	CA	94566	6174	01	06001	37.67102566	-121.8742221	Alameda County
91625	Fee-for-Service	1770694598	1770694598	1	1	PROSSER, KENNETH	4/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70988	40	Pediatrics	0	In state provider	None	990 SONOMA AVE	STE 5	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
91628	Fee-for-Service	1053506527	1053506527	1	1	PAIK, BRIAN J MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74739	01	General Practice	0	In state provider	None	27800 MEDICAL CENTER RD	SUITE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
91695	Fee-for-Service	1558765107	1558765107	1	1	PEREZ, KENDALL C LCSW	4/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 WOODRUFF AVE	STE 209	LONG BEACH	CA	90808	2149	19	06037	33.828786	-118.1165535	Los Angeles County
91705	Fee-for-Service	1972946259	1972946259	1	1	PHYU, HTAY MD	9/25/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	188378	None	None	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
91709	Fee-for-Service	1063749067	1063749067	1	1	PICHARDO, VICKY M LCSW	3/20/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 E HIGHLAND AVENUE	None	SAN BERNARDINO	CA	02404	3658	36	06071	34.1360043	-117.2826788	San Bernardino County
91712	Fee-for-Service	1881342087	1881342087	1	1	PIH HEALTH PHYSICIANS	6/3/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2200 W. 3RD ST.	SUITE 120	LOS ANGELES	CA	90057	1934	19	06037	34.06329642	-118.2739484	Los Angeles County
91734	Fee-for-Service	1588007124	1588007124	1	1	PAIGE, SHARON L MD	12/3/2019	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	131865	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
91809	Fee-for-Service	1942239926	1942239926	1	4	PAIR & MAROTTA PHYSICAL THER	5/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	2603 G STREET	None	BAKERSFIELD	CA	93301	2828	15	06029	35.38311773	-119.0223525	Kern County
91851	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
91858	Fee-for-Service	1598731275	1598731275	1	1	PETER BAMBAKIDIS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14519 DETROIT AVE	None	LAKEWOOD	OH	44107	4316	00	None	41.48527894	-81.79643923	Cuyahoga County
91896	Fee-for-Service	1396961777	1396961777	1	1	PATEL, BIJAL M MD	1/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126410	77	Infectious Disease	0	In state provider	None	1447 CEDARWOOD LANE	SUITE A	PLEASANTON	CA	94566	6174	01	06001	37.67102566	-121.8742221	Alameda County
91897	Fee-for-Service	1043394018	1043394018	1	1	PIERCE, DONALD A MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	31491	41	Internal Medicine	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
91916	Fee-for-Service	1144766064	1144766064	1	3	PERFORMANCE PLUS PHYSICAL TH	6/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY, INC.	3400 8TH STREET	STE 108	NATIONAL CITY	CA	91950	3167	37	06073	32.68571247	-117.0716254	San Diego County
91922	Fee-for-Service	1508062936	1508062936	1	1	POOL, MARGARET A LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
91937	Fee-for-Service	1982805107	1982805107	1	1	PALKOVACS, ELIZABETH M MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108654	18	Ophthalmology	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
91973	Fee-for-Service	1750491247	1750491247	1	2	PRIME HEALTHCARE SVS II	1/2/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
91976	Fee-for-Service	1942731484	1942731484	1	1	PIRVERDIAN, ATEENA MD	5/6/2020	390200000X	NA	Other	026	PHYSICIANS	16950	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
92007	Fee-for-Service	1285654921	1285654921	1	1	PORZIO, ROBERT M DO	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
92014	Fee-for-Service	1548239338	1548239338	1	1	PUREWAL, PRABHJIT S MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48423	68	Hematology	0	In state provider	INC	1805 N CALIFORNIA ST	SUITE 201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
92077	Fee-for-Service	1295234276	1295234276	1	1	PEIRIS, TIMOTHY J MD	8/12/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	173295	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
92088	Fee-for-Service	1801996962	1801996962	1	1	PARK, BYUNG-GOOK MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88228	08	Family Practice	0	In state provider	S HALPERN & J WATSON	550 WATER ST	STE A	SANTA CRUZ	CA	95060	4126	44	06087	36.98046158	-122.018718	Santa Cruz County
92108	Fee-for-Service	1003841917	1003841917	1	1	PACOLD, VIVIEN MD	11/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52805	40	Pediatrics	0	In state provider	None	68100 RAMON RD	STE C5	CATHEDRAL CITY	CA	92234	3390	33	06065	33.81599184	-116.4742249	Riverside County
92110	Fee-for-Service	1144246547	1144246547	1	1	POIRIER-BRODE, KAREN MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	26727	01	General Practice	0	In state provider	UCD PROF SVCS GRP	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
92122	Fee-for-Service	1942454749	1942454749	1	1	PENN, STEVE S OD	6/25/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVENUE	SUITE 110B	SAN DIMAS	CA	91773	2541	19	06037	34.10669347	-117.814932	Los Angeles County
92136	Fee-for-Service	1366427734	1366427734	1	1	PARADISE FAMILY HEALTH	2/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER MEDICAL GRP, INC	655 EUCLID AVE	STE 207	NATIONAL CITY	CA	91950	2968	37	06073	32.68353398	-117.082625	San Diego County
92143	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
92151	Fee-for-Service	1942650486	1942650486	1	1	PHUNG, DANIEL C MD	7/18/2022	2085N0700X	NA	MRI Provider	026	PHYSICIANS	172922	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
92155	Fee-for-Service	1275580599	1275580599	1	1	POPPEL,SCOTT VAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PHOENIX MEMORIAL HOSP	1201 S 7TH AVE	None	PHOENIX	AZ	85007	3995	00	None	33.4359	-112.0814325	Maricopa County
92207	Fee-for-Service	1104243666	1104243666	1	1	POSCH, LEILA C MD	8/12/2020	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	168792	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92228	Fee-for-Service	1871616227	1871616227	1	1	PINTO, NELANGI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
92305	Fee-for-Service	1548239338	1548239338	1	1	PUREWAL, PRABHJIT S MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48423	78	Neoplastic Diseases/Oncology	0	In state provider	INC	1805 N CALIFORNIA ST	SUITE 201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
92380	Fee-for-Service	1407903479	1407903479	1	1	PAGE, LORRAINE ROBIN MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73569	08	Family Practice	0	In state provider	None	225 CABRILLO HWY S	STE 100A	HALF MOON BAY	CA	94019	1738	41	06081	37.46542425	-122.4337617	San Mateo County
92383	Fee-for-Service	1285621110	1285621110	1	1	PLAVIN, STANFORD R MD	8/24/2023	207L00000X	NA	Other	026	PHYSICIANS	136300	None	None	0	In state provider	None	16506 LAKEWOOD BLVD	SUITE 200	BELLFLOWER	CA	90706	5164	19	06037	33.88470916	-118.1424401	Los Angeles County
92399	Fee-for-Service	1306272661	1306272661	1	1	POMERANTZ, MICHAL M MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
92403	Fee-for-Service	1619167087	1619167087	1	1	PEKEROL, MEHMET C MD INC	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51117	77	Infectious Disease	0	In state provider	None	5901 W OLYMPIC BLVD	STE 501	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
92416	Fee-for-Service	1962598284	1962598284	1	1	PALTZER, JUNE Y PHD	2/23/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
92428	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
92431	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
92433	Fee-for-Service	1376046912	1376046912	1	1	PASCUA, JOHN D LCSW	12/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
92434	Fee-for-Service	1417417072	1417417072	1	1	PAZ, ALFRED J DO	7/25/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
92473	Fee-for-Service	1215059951	1215059951	1	1	PARKER, ERIKA M MD	5/12/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	95012	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92474	Fee-for-Service	1043841190	1043841190	1	1	PADRON, FATIMA CRNA	2/21/2020	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
92486	Fee-for-Service	1851004261	1851004261	1	1	PANG, MING WAI	5/12/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
92501	Fee-for-Service	1396933081	1396933081	1	1	PATEL, MAMTA D MD	9/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170923	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
92520	Fee-for-Service	1699768275	1699768275	1	1	PANDIAN, M GANESA MD	12/11/2002	207ZC0500X	NA	Other	026	PHYSICIANS	35476	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6850 SEPULVEDA BLVD	STE 216	VAN NUYS	CA	91405	4452	19	06037	34.1955	-118.4661705	Los Angeles County
92555	Fee-for-Service	1740677889	1740677889	1	1	PIEN, IRENE MD	9/26/2022	2082S0105X	NA	General Surgery	026	PHYSICIANS	146879	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
92584	Fee-for-Service	1750415659	1750415659	1	1	POWELL, CALVIN E LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3238 PALMER DR	None	LOS ANGELES	CA	90065	4925	19	06037	34.13365476	-118.234787	Los Angeles County
92599	Fee-for-Service	1831237833	1831237833	1	1	PANICALI, JOSEPH MD	6/19/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66048	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
92612	Fee-for-Service	1760995625	1760995625	1	1	PIONEERS MEMORIAL HEALTHCARE	6/5/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	565 MAIN STREET	None	BRAWLEY	CA	92227	2423	13	06025	32.97865752	-115.532307	Imperial County
92638	Fee-for-Service	1669147062	1669147062	1	1	PAULRAJ, SELVI R PHD	2/25/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92689	Fee-for-Service	1619167087	1619167087	1	1	PEKEROL, MEHMET C MD INC	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51117	47	Miscellaneous	0	In state provider	None	5901 W OLYMPIC BLVD	STE 501	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
92715	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
92719	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
92722	Fee-for-Service	1104103209	1104103209	1	1	PRICE, JANET L LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
92764	Fee-for-Service	1700838497	1700838497	1	1	PETTIT, LINDSAY F CNM	7/22/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
92793	Fee-for-Service	1417417460	1417417460	1	1	PAULEY, VIVIAN R MD	9/2/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178666	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
92802	Fee-for-Service	1104999838	1104999838	1	1	POTTS, JEANNETTE M MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53574	34	Urology and Urological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
92813	Fee-for-Service	1912998071	1912998071	1	1	PARADA, THEODOR S MD INC	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1800 SULLIVAN AVE	RM 407	DALY CITY	CA	94015	2224	41	06081	37.68077723	-122.4728941	San Mateo County
92839	Fee-for-Service	1750945184	1750945184	1	1	PIA, SHERMILA MD	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92874	Fee-for-Service	1871580522	1871580522	1	1	PATTON, BRENDA C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
92878	Fee-for-Service	1841498276	1841498276	1	1	PAIGE FORREST MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA ST	None	PITTSBURGH	PA	15213	2593	00	None	40.44350017	-79.95952606	Allegheny County
92884	Fee-for-Service	1679518773	1679518773	1	1	PALENSCHAT, DOUGLAS A MD	9/26/2008	208600000X	NA	General Surgery	026	PHYSICIANS	23820	02	General Surgery	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	0000	08	06015	41.77272521	-124.1940494	Del Norte County
92888	Fee-for-Service	1831237833	1831237833	1	1	PANICALI, JOSEPH MD	6/19/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66048	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
92897	Fee-for-Service	1760995625	1760995625	1	1	PIONEERS MEMORIAL HEALTHCARE	6/5/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	565 MAIN STREET	None	BRAWLEY	CA	92227	2423	13	06025	32.97865752	-115.532307	Imperial County
92898	Fee-for-Service	1649693664	1649693664	1	1	PERRIS OASES INC	12/24/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	21222 DAWES ST	None	PERRIS	CA	92570	9069	33	06065	33.84081832	-117.2925761	Riverside County
92909	Fee-for-Service	1740419605	1740419605	1	1	PARAGON PATHOLOGY MEDICAL AS	10/18/2017	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	SOCIATES, INC.	900 HYDE ST	PATHOLOGY DEPARTMENT	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
92924	Fee-for-Service	1164659033	1164659033	1	1	PONCE, SONIA G MD	9/18/2019	207R00000X	NA	Other	026	PHYSICIANS	145008	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
92974	Fee-for-Service	1073703245	1073703245	1	1	PEDIATRIC SURGICAL ASSOC	10/29/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	INC AMC	396 S MAIN ST	STE 200	ORANGE	CA	92868	3834	30	06059	33.78244003	-117.8673363	Orange County
93001	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
93007	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	8/28/2017	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
93024	Fee-for-Service	1780756866	1780756866	1	1	PEDIATRIC MED ASSOC OF	4/16/1991	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	EAST BAY	101 CALLAN AVE	STE 401	SAN LEANDRO	CA	94577	4523	01	06001	37.72594042	-122.1562404	Alameda County
93030	Fee-for-Service	1346364809	1346364809	1	1	PERRY, MICHAEL S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
93049	Fee-for-Service	1821033150	1821033150	1	1	PACKER, JAY M MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42128	22	Pathology (M.D. only)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
93081	Fee-for-Service	1699054221	1699054221	1	1	PEREZ, WEI	7/29/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2563 GOLD HILL STREET	None	WEST SACRAMENTO	CA	95691	6067	57	06113	38.5508822	-121.5271039	Yolo County
93085	Fee-for-Service	1194758680	1194758680	1	1	PERRIN, STEVEN P CNMW	1/31/1987	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
93090	Fee-for-Service	1104999838	1104999838	1	1	POTTS, JEANNETTE M MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53574	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
93102	Fee-for-Service	1932647468	1932647468	1	1	PACIFIC COAST PSYCHOLOGY GRO	11/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	UP, INC.	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
93106	Fee-for-Service	1912970906	1912970906	1	1	PARKVIEW HEALTHCARE CTR	4/1/1979	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OPERATING COMPANY LLC	1514 E LINCOLN AVE	None	ANAHEIM	CA	92805	2219	30	06059	33.83939888	-117.8968656	Orange County
93114	Fee-for-Service	1124319470	1124319470	1	1	PFISTERER, MICHAEL J MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155854	04	Otology, Laryngology, Rhinology	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
93118	Fee-for-Service	1386132710	1386132710	1	1	PALUMBO, APRIL C LMFT	2/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
93155	Fee-for-Service	1730373481	1730373481	1	1	PEPPER, HANNA D NP	4/7/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1450 TREAT BLVD	SUITE 220A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
93171	Fee-for-Service	1942593918	1942593918	1	1	PACIFIC INTERVENTIONAL	11/10/2011	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	VASCULAR ACCESS CENTER	6076 BRISTOL PARKWAY	None	CULVER CITY	CA	90230	6600	19	06037	33.98557948	-118.3873452	Los Angeles County
93175	Fee-for-Service	1851690382	1851690382	1	1	PRESS, JENNIFER L LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
93182	Fee-for-Service	1477890325	1477890325	1	1	POMA, ERIN B CCC-SLP	5/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
93187	Fee-for-Service	1629333810	1629333810	1	1	PAKDAMAN, MICHAEL N MD	2/3/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	131651	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
93194	Fee-for-Service	1598790826	1598790826	1	1	PAN, LESTER C MD	3/25/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55280	41	Internal Medicine	0	In state provider	None	1740 FRUITRIDGE RD	None	SACRAMENTO	CA	95822	3037	34	06067	38.524374	-121.498542	Sacramento County
93218	Fee-for-Service	1881068708	1881068708	1	1	PLUMAS HOSPITAL DISTRICT	2/1/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	176 HOT SPRINGS RD	None	GREENVILLE	CA	95947	9747	32	06063	40.14002241	-120.9370145	Plumas County
93239	Fee-for-Service	1346694346	1346694346	1	1	PRIME CARE HEALTH SERVICES	11/9/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	800 W CARSON STREET	SUITE 24	TORRANCE	CA	90502	1001	19	06037	33.83157647	-118.2890745	Los Angeles County
93265	Fee-for-Service	1073703245	1073703245	1	1	PEDIATRIC SURGICAL ASSOC	10/29/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC AMC	396 S MAIN ST	STE 200	ORANGE	CA	92868	3834	30	06059	33.78244003	-117.8673363	Orange County
93268	Fee-for-Service	1003874702	1003874702	2	7	PROHEALTH ADVANCED IMAGING M	5/11/2021	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	EDICAL GROUP INC	23456 HAWTHORNE BLVD	120	TORRANCE	CA	90505	7862	19	06037	33.812631	-118.3510145	Los Angeles County
93270	Fee-for-Service	1659646719	1659646719	1	1	PALMERLEE, LESLIE M MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150229	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
93276	Fee-for-Service	1679100457	1679100457	1	1	PHILLIPS, CHRISTOPHER G MD	4/4/2023	207P00000X	NA	Other	026	PHYSICIANS	183265	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
93282	Fee-for-Service	1720136690	1720136690	1	1	PAIGE, DONALD G MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49250	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
93291	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
93296	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
93316	Fee-for-Service	1952724817	1952724817	1	1	PACIFIC NEUROBEHAVIORAL CLIN	12/22/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IC, INC.	3636 4TH AVE	SUITE 310	SAN DIEGO	CA	92103	4280	37	06073	32.74395987	-117.1616056	San Diego County
93323	Fee-for-Service	1316551575	1316551575	1	1	PRIORITY HOME HEALTH GROUP	2/18/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17620 SHERMAN WAY	STE 206	VAN NUYS	CA	91406	3527	19	06037	34.20105176	-118.5171046	Los Angeles County
93359	Fee-for-Service	1366594731	1366594731	1	1	PRIOR, CHARLES ANTHONY	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	54079	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
93369	Fee-for-Service	1699054221	1699054221	1	1	PEREZ, WEI	7/29/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2563 GOLD HILL STREET	None	WEST SACRAMENTO	CA	95691	6067	57	06113	38.5508822	-121.5271039	Yolo County
93403	Fee-for-Service	1700103827	1700103827	1	1	PETALUMA VALLEY HEARING	9/22/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER AND AUDIOLOGY AND	106 LYNCH CREEK WAY	SUITE 9A	PETALUMA	CA	94954	2356	49	06097	38.25206172	-122.634113	Sonoma County
93453	Fee-for-Service	1659773349	1659773349	1	1	PACIFIC HEART AND LUNG	5/20/2016	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SURGEONS INC	3650 SOUTH ST	STE 206	LAKEWOOD	CA	90712	1523	19	06037	33.86019847	-118.149255	Los Angeles County
93479	Fee-for-Service	1538206131	1538206131	1	1	PECKHAM, JOHN J MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61160	None	None	0	In state provider	None	131B PLAZA DR	STE 12	SANTA MARIA	CA	93454	0000	42	06083	34.93750499	-120.4354595	Santa Barbara County
93487	Fee-for-Service	1053575837	1053575837	1	2	PREMIER PAIN CONSULTANTS	11/19/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	150 LAGUNA RD	STE A	FULLERTON	CA	92835	3614	30	06059	33.89367364	-117.9302191	Orange County
93508	Fee-for-Service	1528231768	1528231768	1	2	PREWITT, LAUREN A DO	10/8/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9370	15	Obstetrics (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
93509	Fee-for-Service	1881068708	1881068708	1	1	PLUMAS HOSPITAL DISTRICT	2/1/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	176 HOT SPRINGS RD	None	GREENVILLE	CA	95947	9747	32	06063	40.14002241	-120.9370145	Plumas County
93526	Fee-for-Service	1710475199	1710475199	1	1	PASTERNACK, LAURA J	4/18/2023	207L00000X	NA	Other	026	PHYSICIANS	182101	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
93527	Fee-for-Service	1417347683	1417347683	2	1	PIERRE, TRACY LPCC	12/2/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	201 N BRAND BLVD	SUITE 200	GLENDALE	CA	91203	3590	19	06037	34.14829897	-118.255124	Los Angeles County
93538	Fee-for-Service	1851355101	1851355101	1	1	PHAM, TRUNG NGOC	12/8/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45592	08	Family Practice	0	In state provider	None	9500 BOLSA AVE	STE A1	WESTMINSTER	CA	92683	5943	30	06059	33.74475113	-117.9634694	Orange County
93551	Fee-for-Service	1992890388	1992890388	1	1	PROS IN REHAB	11/10/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1101 S WINCHESTER BLVD	STE L-237	SAN JOSE	CA	95128	3904	43	06085	37.305693	-121.950129	Santa Clara County
93564	Fee-for-Service	1588862486	1588862486	1	1	PRIMEAU, MICHELLE M MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116353	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93578	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	8/28/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
93585	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
93588	Fee-for-Service	1164429684	1164429684	1	1	PROVIDENCE HEALTH SYSTEM -	1/30/1984	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	250 E OLIVE AVE	STE 202	BURBANK	CA	91502	1211	19	06037	34.18178147	-118.3077725	Los Angeles County
93605	Fee-for-Service	1134607906	1134607906	1	1	PUBLICS MEDICAL SUPPLY	2/26/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	& EQUIPMENT INC	5728 E. OLYMPIC BLVD	None	COMMERCE	CA	90022	5120	19	06037	34.01389682	-118.1473523	Los Angeles County
93643	Fee-for-Service	1396400131	1396400131	1	1	PHILIPS, DEEPA CNM	12/16/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
93663	Fee-for-Service	1033434774	1033434774	1	1	PANGULURI, PRAVEEN MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119162	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
93679	Fee-for-Service	1023309531	1023309531	1	1	PRESS, CHRISTOPHER D MD	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122597	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
93682	Fee-for-Service	1568724854	1568724854	1	1	PIETRUS, TOMASZ W MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129021	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
93688	Fee-for-Service	1699863381	1699863381	1	1	PENA, LLOYD S MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83776	None	None	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
93701	Fee-for-Service	1699424234	1699424234	1	1	PIETRYKOWSKI, JOHN MD	3/21/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	320 SANTA FE DRIVE	107-B	ENCINITAS	CA	92024	1334	37	06073	33.038847	-117.285579	San Diego County
93730	Fee-for-Service	1023002029	1023002029	1	1	PRIMA, PRIMARY MED ASSOC	2/11/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2850 6TH AVE	STE 116	SAN DIEGO	CA	92103	6309	37	06073	32.735205	-117.1594475	San Diego County
93734	Fee-for-Service	1295717361	1295717361	1	1	POGGEL, LAURA E MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67713	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
93758	Fee-for-Service	1598140238	1598140238	1	1	PHADKE, OMKAR K MD	12/12/2024	2080P0216X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
93799	Fee-for-Service	1528231768	1528231768	1	2	PREWITT, LAUREN A DO	10/8/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9370	09	Gynecology (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
93824	Fee-for-Service	1538525506	1538525506	1	1	PEARMAN, AUBREY M	8/10/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
93837	Fee-for-Service	1518142124	1518142124	1	1	PETERS, GREGORY T MD	3/28/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	106752	None	None	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
93867	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	8/8/2017	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
93872	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	10/16/2012	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
93880	Fee-for-Service	1083032635	1083032635	1	1	PEDERSEN, HEATHER PHD	10/1/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
93907	Fee-for-Service	1275657157	1275657157	1	1	PICKART, CAITLIN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88876	36	Psychiatry	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
93910	Fee-for-Service	1851613939	1851613939	1	2	PILLAI, DR SINDU MD INC	6/1/2015	174400000X	NA	Other	026	PHYSICIANS	66720	40	Pediatrics	0	In state provider	None	35100 MAKENA AVENUE	200	MURRIETA	CA	92563	1404	33	06065	0	0	None
93943	Fee-for-Service	1164734224	1164734224	1	1	PEYVANDI, SHABNAM MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104137	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
93985	Fee-for-Service	1346319845	1346319845	1	1	PORAT, LIAT PHD	12/28/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
94008	Fee-for-Service	1326428137	1326428137	1	1	PADGETT, TYLER B DO	8/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18530	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
94018	Fee-for-Service	1023002029	1023002029	1	1	PRIMA, PRIMARY MED ASSOC	2/11/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	2850 6TH AVE	STE 116	SAN DIEGO	CA	92103	6309	37	06073	32.735205	-117.1594475	San Diego County
94025	Fee-for-Service	1467630954	1467630954	1	1	PARRIS, TCHAIKO M MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126626	30	Radiology	0	In state provider	None	25455 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5963	33	06065	33.55689911	-117.1863428	Riverside County
94037	Fee-for-Service	1699794735	1699794735	1	1	PETERSEN, JEFFREY B MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79786	01	General Practice	0	In state provider	None	1035 SOUTH MAIN ST	None	FALLBROOK	CA	92028	3338	37	06073	33.373188	-117.2515065	San Diego County
94044	Fee-for-Service	1598140238	1598140238	1	1	PHADKE, OMKAR K MD	12/12/2024	2080P0216X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
94056	Fee-for-Service	1629170956	1629170956	1	1	PERRY, ROD W MD	12/5/1986	174400000X	NA	Other	026	PHYSICIANS	33909	41	Internal Medicine	0	In state provider	None	424 28TH ST	None	OAKLAND	CA	94609	3603	01	06001	37.81660247	-122.2659563	Alameda County
94057	Fee-for-Service	1578521266	1578521266	1	1	PANDIT, LALITA MD	1/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	47707	78	Neoplastic Diseases/Oncology	0	In state provider	None	11160 WARNER AVE	STE 417	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
94060	Fee-for-Service	1740393446	1740393446	1	1	PIETRUSZKA, MARVIN MD	9/17/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	30858	08	Family Practice	0	In state provider	DEL CARMEN MEDICAL CTR	19234 VANOWEN ST	None	RESEDA	CA	91335	5000	19	06037	34.19381648	-118.5527385	Los Angeles County
94071	Fee-for-Service	1992903231	1992903231	1	1	PATTI, FRANKLYN LMFT	12/6/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
94082	Fee-for-Service	1245827823	1245827823	1	1	PRO HOSPICE CARE INC	2/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	324 E FOOTHILL BLVD	STE 102	ARCADIA	CA	91006	2582	19	06037	34.1510457	-118.021995	Los Angeles County
94124	Fee-for-Service	1235654930	1235654930	1	1	POLLACK, GINA A LCSW	1/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
94146	Fee-for-Service	1407252166	1407252166	1	1	PHARMACY PARTNERS INC	12/26/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2490 HONOLULU AVE	SUITE 110	MONTROSE	CA	91020	1800	19	06037	34.20724586	-118.2331114	Los Angeles County
94153	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
94161	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
94162	Fee-for-Service	1437110459	1437110459	1	1	PHAM, CAU X MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40031	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
94166	Fee-for-Service	1558566877	1558566877	1	1	PATEL, UMESH N MD	12/17/2007	207R00000X	NA	Other	026	PHYSICIANS	98453	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
94170	Fee-for-Service	1265660468	1265660468	1	1	PATEL, KUNAL MD	6/7/2023	207L00000X	NA	Other	026	PHYSICIANS	175262	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
94184	Fee-for-Service	1912468166	1912468166	1	1	PATEL, PRIYA A MD	9/14/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181819	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
94195	Fee-for-Service	1922503739	1922503739	1	1	POLSTER, DOUGLAS R PHD	5/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
94226	Fee-for-Service	1386722825	1386722825	1	1	PATEL, KETAN H MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92099	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
94243	Fee-for-Service	1679779425	1679779425	1	1	PORSHIN, MARSHA C LMFT	9/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
94285	Fee-for-Service	1437170008	1437170008	1	1	PENA, JOSE R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50688	41	Internal Medicine	0	In state provider	None	5577 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2306	37	06073	32.74774	-117.0759891	San Diego County
94315	Fee-for-Service	1144229923	1144229923	1	1	PIRRITANO, ROBERT R DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	ADVANTAGE CHIROPRACTIC	23470 OLIVE WOOD PLAZA D	STE 150	MORENO VALLEY	CA	92553	5220	33	06065	33.94013493	-117.2532525	Riverside County
94317	Fee-for-Service	1780166454	1780166454	1	1	PALANZA, MARISSA OT	1/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
94322	Fee-for-Service	1730337254	1730337254	1	1	PRICE, ROBIN R MD	2/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109790	08	Family Practice	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
94324	Fee-for-Service	1023174380	1023174380	1	1	PILLAI, PRASAD MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116899	78	Neoplastic Diseases/Oncology	0	In state provider	None	4721 DALLAS RANCH RD	None	ANTIOCH	CA	94531	8811	07	06013	37.97016362	-121.7967323	Contra Costa County
94337	Fee-for-Service	1932736451	1932736451	1	1	POUSTI, BOBAK MD	9/3/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	190309	07	Dermatology	0	In state provider	None	655 EUCLID AVE	SUITE 304	NATIONAL CITY	CA	91950	2978	37	06073	32.68353398	-117.082625	San Diego County
94344	Fee-for-Service	1730361189	1730361189	1	1	PATEL, SHAILESH MD INC	2/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42502	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2625 W ALAMEDA AVE	STE 506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
94347	Fee-for-Service	1578521266	1578521266	1	1	PANDIT, LALITA MD	1/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	47707	68	Hematology	0	In state provider	None	11160 WARNER AVE	STE 417	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
94349	Fee-for-Service	1740393446	1740393446	1	1	PIETRUSZKA, MARVIN MD	9/17/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	30858	22	Pathology (M.D. only)	0	In state provider	DEL CARMEN MEDICAL CTR	19234 VANOWEN ST	None	RESEDA	CA	91335	5000	19	06037	34.19381648	-118.5527385	Los Angeles County
94350	Fee-for-Service	1003568676	1003568676	1	1	PATRICK P SASSANI, MD, MEDIC	1/7/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	LOGY SPECIALISTS OF THE	14624 SHERMAN WAY	STE 506	VAN NUYS	CA	91405	2241	19	06037	34.20078354	-118.450843	Los Angeles County
94368	Fee-for-Service	1245827823	1245827823	1	1	PRO HOSPICE CARE INC	2/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	324 E FOOTHILL BLVD	STE 102	ARCADIA	CA	91006	2582	19	06037	34.1510457	-118.021995	Los Angeles County
94375	Fee-for-Service	1144306218	1144306218	1	1	PEABODY, THOMAS F	1/1/1997	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	345 LORTON AVE	STE 104	BURLINGAME	CA	94010	4134	41	06081	37.58037401	-122.347427	San Mateo County
94404	Fee-for-Service	1881898799	1881898799	1	1	PARK, EUNICE Y	10/5/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
94443	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
94446	Fee-for-Service	1992804546	1992804546	1	1	PATEL, NIRAV M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95184	08	Family Practice	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
94448	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	2/10/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
94469	Fee-for-Service	1639554439	1639554439	1	1	PEREZ-ALVAREZ, INGRID MD	8/3/2017	207ZP0102X	NA	Other	026	PHYSICIANS	128076	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94480	Fee-for-Service	1700808904	1700808904	1	1	PARTAMIAN, LEON G MD INC	2/28/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40265	18	Ophthalmology	0	In state provider	None	18546 ROSCOE BLVD	STE 200	NORTHRIDGE	CA	91324	5453	19	06037	34.22069869	-118.537684	Los Angeles County
94485	Fee-for-Service	1063746998	1063746998	1	1	PANZER, ATHENA S PHD	11/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
94541	Fee-for-Service	1356629513	1356629513	1	1	PALKAMSETTI, SIREESHA MD	10/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154743	40	Pediatrics	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
94565	Fee-for-Service	1699965053	1699965053	1	1	PLUMMER, ELLEN S MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
94609	Fee-for-Service	1730337254	1730337254	1	1	PRICE, ROBIN R MD	2/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109790	01	General Practice	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
94613	Fee-for-Service	1023174380	1023174380	1	1	PILLAI, PRASAD MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116899	68	Hematology	0	In state provider	None	4721 DALLAS RANCH RD	None	ANTIOCH	CA	94531	8811	07	06013	37.97016362	-121.7967323	Contra Costa County
94631	Fee-for-Service	1578521266	1578521266	1	1	PANDIT, LALITA MD	1/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	47707	41	Internal Medicine	0	In state provider	None	11160 WARNER AVE	STE 417	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
94638	Fee-for-Service	1558380428	1558380428	1	1	PATEL, SHALIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21720 KINGSLAND BLVD	STE 308	KATY	TX	77450	2551	00	None	29.77505051	-95.7460995	Harris County
94648	Fee-for-Service	1811459084	1811459084	1	1	POLIZZI, CHRISTINE Y DO	6/27/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20035	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94660	Fee-for-Service	1801483383	1801483383	1	1	PRAXIS GENOMICS LLC	8/11/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	6115 PEACHTREE DUNWOODY	STE 220	ATLANTA	GA	30328	5684	00	None	33.92125077	-84.35132353	Fulton County
94692	Fee-for-Service	1437531274	1437531274	1	1	PAULSEN, ANNIE F LMFT	9/26/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	91307	-	NOT APPLICABLE	0	In state provider	None	1322 N AVALON BLVD	None	WILMINGTON	CA	90744	2639	19	06037	33.78953748	-118.263169	Los Angeles County
94695	Fee-for-Service	1669762944	1669762944	2	1	PAYLESS PHARMACY INC	11/19/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2303 NORTHGATE BLVD	None	SACRAMENTO	CA	95833	2504	34	06067	38.6088525	-121.4756518	Sacramento County
94723	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
94731	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
94735	Fee-for-Service	1992804546	1992804546	1	1	PATEL, NIRAV M MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95184	41	Internal Medicine	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
94738	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	6/23/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
94765	Fee-for-Service	1053625525	1053625525	1	1	PATEL, LISA H MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123687	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
94790	Fee-for-Service	1235106386	1235106386	1	1	PELZ,ROBERT K MD	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 HILLYARD ST	STE S 200	EUGENE	OR	97401	8143	00	None	44.04616862	-123.082151	Lane County
94804	Fee-for-Service	1013961648	1013961648	1	1	PAYNE, BRIAN C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67059	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
94810	Fee-for-Service	1801101597	1801101597	1	1	PACIFIC MEDICAL INC	9/11/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1180 W OLIVE AVE	#H	MERCED	CA	95348	1900	24	06047	37.31910454	-120.4885665	Merced County
94839	Fee-for-Service	1508551276	1508551276	1	1	PREMIER SURGICAL INSTITUTE I	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	NC	5500 MING AVE	320	BAKERSFIELD	CA	93309	4689	15	06029	35.33787572	-119.0620525	Kern County
94843	Fee-for-Service	1477631075	1477631075	1	1	PARK, JAE S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	80497	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
94851	Fee-for-Service	1053923649	1053923649	1	1	PEACE AND LOVE SERVICES	1/11/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	105 W ALAMEDA AVE	SUITE 200	BURBANK	CA	91502	2259	19	06037	34.17127378	-118.303279	Los Angeles County
94854	Fee-for-Service	1699965053	1699965053	1	1	PLUMMER, ELLEN S MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
94859	Fee-for-Service	1659833556	1659833556	1	1	PREVALLET, ALEXANDER N DO	7/19/2022	207R00000X	NA	Other	026	PHYSICIANS	19716	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
94870	Fee-for-Service	1447554035	1447554035	1	1	PETER, SHANON T MD	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118076	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
94872	Fee-for-Service	1730245390	1730245390	1	1	PITMAN, SEAN D MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76877	22	Pathology (M.D. only)	0	In state provider	None	2036 RAILROAD AVE	None	REDDING	CA	96001	1801	45	06089	40.57806515	-122.3920754	Shasta County
94880	Fee-for-Service	1336522952	1336522952	1	1	PARMAR, DEEPIKA MD	10/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146287	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
94940	Fee-for-Service	1679763353	1679763353	1	1	PROTELL, PETER H MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120517	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
94989	Fee-for-Service	1669778965	1669778965	1	1	PARTNERS URGENT CARE-	4/3/2012	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	EASTLAKE	2315 OTAY LAKES RD	None	CHULA VISTA	CA	91914	1162	37	06073	32.64859608	-116.9647496	San Diego County
95008	Fee-for-Service	1538989363	1538989363	1	1	PEARCE, DANIEL J MD	11/20/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
95010	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95018	Fee-for-Service	1639252604	1639252604	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
95024	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95083	Fee-for-Service	1891142956	1891142956	1	1	PANDEY, AMIT K MD	8/1/2019	208M00000X	NA	Other	026	PHYSICIANS	152725	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
95136	Fee-for-Service	1306871918	1306871918	1	1	PETERS, VANESSA M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	79987	01	General Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
95138	Fee-for-Service	1053923649	1053923649	1	1	PEACE AND LOVE SERVICES	1/11/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	105 W ALAMEDA AVE	SUITE 200	BURBANK	CA	91502	2259	19	06037	34.17127378	-118.303279	Los Angeles County
95141	Fee-for-Service	1699965053	1699965053	1	1	PLUMMER, ELLEN S MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
95150	Fee-for-Service	1518006014	1518006014	1	1	PROTZEL PATHOLOGY LAB	5/18/1984	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9735 WILSHIRE BLVD	STE 249	BEVERLY HILLS	CA	90212	2107	19	06037	34.06711051	-118.4074605	Los Angeles County
95152	Fee-for-Service	1689847980	1689847980	1	1	PATEL, YASH MD	1/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121589	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	SUITE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
95168	Fee-for-Service	1114451242	1114451242	1	1	PIA, JASON MD	7/12/2021	207L00000X	NA	Other	026	PHYSICIANS	160668	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
95181	Fee-for-Service	1730479734	1730479734	1	1	POPOOLA, OLUBUNMI A A MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125754	84	Surgery-Head and Neck	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
95259	Fee-for-Service	1639887706	1639887706	1	1	PINOLE OPERATIONS, LP	10/4/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2850 ESTATES AVE	None	PINOLE	CA	94564	1416	07	06013	37.99439353	-122.2832077	Contra Costa County
95267	Fee-for-Service	1942360110	1942360110	1	1	POXON, MONIKA L PSYD	9/13/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
95270	Fee-for-Service	1275995193	1275995193	1	1	PELICANO-GOERS, LEYRA T NP	6/24/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
95297	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	8/2/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95299	Fee-for-Service	1205815107	1205815107	1	1	PARK, YONG H MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75600	30	Radiology	0	In state provider	None	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
95311	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95387	Fee-for-Service	1073938114	1073938114	2	1	PEACHLAND PHARMACY, INC.	11/9/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25050 PEACHLAND AVE	100	NEWHALL	CA	91321	2523	19	06037	34.37812733	-118.5467925	Los Angeles County
95462	Fee-for-Service	1225116999	1225116999	1	1	PAULY, MARY PAT MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
95473	Fee-for-Service	1407897192	1407897192	1	1	POLLARD, JOHN S MD	2/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92587	22	Pathology (M.D. only)	0	In state provider	None	2111 E DAKOTA AVE	None	FRESNO	CA	93726	4805	10	06019	36.78683711	-119.785712	Fresno County
95560	Fee-for-Service	1912292830	1912292830	1	1	PATEL, AMISH D MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130583	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	SUITE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
95578	Fee-for-Service	1245867209	1245867209	1	1	PATEL, RUPA MD	4/3/2024	207L00000X	NA	Other	026	PHYSICIANS	190689	05	Anesthesiology	0	In state provider	None	5565 W LAS POSITAS BLVD	SUITE 260	PLEASANTON	CA	94588	4001	01	06001	37.69215143	-121.8800337	Alameda County
95586	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95589	Fee-for-Service	1205815107	1205815107	1	1	PARK, YONG H MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75600	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
95590	Fee-for-Service	1104888544	1104888544	1	1	PARTRIDGE, BRETT J MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116352	10	Gastroenterology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
95598	Fee-for-Service	1609046671	1609046671	1	1	PARTNERS IN HEALTHCARE, INC	10/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1120 MONTANA STREET	None	GOODING	ID	83330	1858	00	None	42.93362669	-114.710338	Gooding County
95600	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95635	Fee-for-Service	1487135760	1487135760	1	1	POLLOM, JESSICA B CRNA	6/10/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
95664	Fee-for-Service	1689009227	1689009227	1	1	PROGRESSIVE FOOT AND ANKLE	2/15/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INSTITUTE PC	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
95689	Fee-for-Service	1194898999	1194898999	1	1	PAPIKIAN, HAREL PSYD	5/31/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
95707	Fee-for-Service	1194161406	1194161406	1	1	PARIKH, MILIND D DO	2/8/2019	208M00000X	NA	Other	026	PHYSICIANS	13745	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
95719	Fee-for-Service	1164785341	1164785341	1	1	PROBST, LISA M LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
95728	Fee-for-Service	1720090962	1720090962	1	1	PARRY, BARBARA L MD	3/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40784	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
95743	Fee-for-Service	1588727473	1588727473	1	1	PARK, SUNMIN MD AMC	9/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	74656	18	Ophthalmology	0	In state provider	None	2727 W OLYMPIC BLVD	STE 313	LOS ANGELES	CA	90006	2699	19	06037	34.0527015	-118.2931155	Los Angeles County
95749	Fee-for-Service	1225116999	1225116999	1	1	PAULY, MARY PAT MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33907	10	Gastroenterology (M.D. only)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
95799	Fee-for-Service	1750974101	1750974101	1	1	PRECISION MEDICAL SUPPLY, LL	7/16/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	C	6060 W MANCHESTER AVE	STE 310	LOS ANGELES	CA	90045	4267	19	06037	33.95976851	-118.390734	Los Angeles County
95801	Fee-for-Service	1477905313	1477905313	1	1	PATEL, NEEL S MD	4/23/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
95802	Fee-for-Service	1699114504	1699114504	1	1	PARKER, JONATHAN MD	10/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135965	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
95824	Fee-for-Service	1316091531	1316091531	1	1	PHAN, ALEX H MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83716	25	Physical Medicine and Rehabilitation	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
95858	Fee-for-Service	1285165225	1285165225	1	1	PECK, CONNOR M DO	12/13/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
95871	Fee-for-Service	1053987990	1053987990	1	1	PEMBERTON, AMANDA LMFT	7/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
95873	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	8/26/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95884	Fee-for-Service	1609046671	1609046671	1	1	PARTNERS IN HEALTHCARE, INC	10/3/2008	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1120 MONTANA STREET	None	GOODING	ID	83330	1858	00	None	42.93362669	-114.710338	Gooding County
95888	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
95917	Fee-for-Service	1700029642	1700029642	1	1	PALOMAR DIALYSIS, LLC	2/3/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3201 DOOLAN RD	STE 175	LIVERMORE	CA	94551	9605	01	06001	37.70430429	-121.8232456	Alameda County
95949	Fee-for-Service	1003954355	1003954355	2	1	PEAK, JEFFREY C MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	78221	05	Anesthesiology	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
96004	Fee-for-Service	1013352640	1013352640	1	1	PEREZ, MONICA D LCSW	10/16/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
96087	Fee-for-Service	1669870739	1669870739	1	1	PETALUMA HEALTH CENTER INC	7/29/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	APCC	5900 STATE FARM DRIVE	STE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
96095	Fee-for-Service	1205926565	1205926565	1	1	POLONSKY, MONTY B MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62039	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
96143	Fee-for-Service	1104878446	1104878446	1	1	PHILIPPE MASSER M.D.	1/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
96155	Fee-for-Service	1871629519	1871629519	1	1	PHAN, NGOC T MD	8/27/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94038	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
96164	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	5/20/2019	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
96176	Fee-for-Service	1639252604	1639252604	1	5	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
96195	Fee-for-Service	1407859234	1407859234	1	1	PACIFIC RIM ELECTROPHYSI	12/6/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP INC	1700 CESAR E CHAVEZ AVE	SUITE 2700	LOS ANGELES	CA	90033	2434	19	06037	34.05101259	-118.217259	Los Angeles County
96202	Fee-for-Service	1073510277	1073510277	1	1	PEACEHEALTH	1/24/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2310	00	None	46.1309207	-122.9408931	Cowlitz County
96213	Fee-for-Service	1851542575	1851542575	1	1	PICCIONI, DAVID E MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100663	13	Neurology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
96310	Fee-for-Service	1881272714	1881272714	1	1	PARIDA, AKASH DO	9/28/2024	207R00000X	NA	Other	026	PHYSICIANS	22604	41	Internal Medicine	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
96323	Fee-for-Service	1306547096	1306547096	1	1	PERKINS, ANTHONY	12/29/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4568 FEATHER RIVER DR	C	STOCKTON	CA	95219	6503	39	06077	37.98287413	-121.347226	San Joaquin County
96373	Fee-for-Service	1669870739	1669870739	1	1	PETALUMA HEALTH CENTER INC	7/29/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	APCC	5900 STATE FARM DRIVE	STE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
96386	Fee-for-Service	1205926565	1205926565	1	1	POLONSKY, MONTY B MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62039	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
96417	Fee-for-Service	1043484801	1043484801	1	1	PIERCE, AIMEE L MD	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96322	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
96426	Fee-for-Service	1811454028	1811454028	1	1	PATEL, JESSICA Y DO	9/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19866	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
96428	Fee-for-Service	1134654957	1134654957	1	1	PATTEN, ERIC M MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	161354	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
96432	Fee-for-Service	1003199126	1003199126	1	1	PRINZ, BONNIE B MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72656	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
96449	Fee-for-Service	1396031456	1396031456	1	1	PAYNE, BRIDGETT A MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125611	05	Anesthesiology	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
96451	Fee-for-Service	1518120286	1518120286	1	1	PRUETT, KIMBERLY M MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104220	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96452	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	6/12/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
96460	Fee-for-Service	1568765089	1568765089	1	1	PAGE, AMIE T	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
96461	Fee-for-Service	1427001338	1427001338	1	1	PELED, ZIV M MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93593	24	Plastic Surgery	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
96467	Fee-for-Service	1831333970	1831333970	1	1	PUMERANTZ, BETH S LMFT	3/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	517 N. MOUNTAIN AVE.	114	UPLAND	CA	91786	5016	36	06071	34.100271	-117.6702865	San Bernardino County
96478	Fee-for-Service	1730844234	1730844234	1	1	PERFECT HOME CARE	9/6/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1010 W MAGNOLIA BLVD	UNIT 117	BURBANK	CA	91506	1650	19	06037	34.17693917	-118.3200284	Los Angeles County
96484	Fee-for-Service	1366691529	1366691529	2	1	PATEL, RAKESH H MD	6/20/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
96490	Fee-for-Service	1073510277	1073510277	1	1	PEACEHEALTH	1/24/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2310	00	None	46.1309207	-122.9408931	Cowlitz County
96511	Fee-for-Service	1336764927	1336764927	1	1	PIKE, BRANDON DO	10/6/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	21426	None	None	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
96542	Fee-for-Service	1700958774	1700958774	1	2	POTASH, ALBERT G LMFT	3/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24050 MADISON ST	SUITE 217	TORRANCE	CA	90505	6017	19	06037	33.80594851	-118.348558	Los Angeles County
96588	Fee-for-Service	1336355106	1336355106	2	1	PATIENTS FIRST HOME HEALTH	2/14/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	23210 S CRENSHAW BLVD	SUITE 200	TORRANCE	CA	90505	3188	19	06037	33.814737	-118.3280325	Los Angeles County
96628	Fee-for-Service	1043682255	1043682255	1	1	PUCELY, RANDI NP	4/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
96631	Fee-for-Service	1609038470	1609038470	1	1	PLATE, SUSAN L PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
96636	Fee-for-Service	1861651861	1861651861	1	1	PACKER-ROSENTHAL, SHERRIN J	5/28/2021	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
96640	Fee-for-Service	1407902240	1407902240	1	1	PRAIRIE MEDICAL GRP INC	5/20/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	323 N PRAIRIE AVE	STE 460	INGLEWOOD	CA	90301	7099	19	06037	33.966333	-118.3439975	Los Angeles County
96661	Fee-for-Service	1669870739	1669870739	1	1	PETALUMA HEALTH CENTER INC	6/13/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	APCC	5900 STATE FARM DRIVE	STE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
96663	Fee-for-Service	1487852711	1487852711	1	1	PILESKI, LETICIA CRISTINA L	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
96672	Fee-for-Service	1861504763	1861504763	1	1	PURSLEY, RYAN MD	11/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
96684	Fee-for-Service	1750490827	1750490827	1	1	PATEL, TUSHAR M MD	12/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53344	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
96709	Fee-for-Service	1386104057	1386104057	1	1	PIRVERDIAN, ARTEEN DO	3/13/2025	207RN0300X	NA	Nephrology	026	PHYSICIANS	19935	45	Nephrology (Renal-Kidney)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
96728	Fee-for-Service	1578611380	1578611380	1	1	PEZESHKPOUR, GHOLAM H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42944	22	Pathology (M.D. only)	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
96738	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
96756	Fee-for-Service	1134746670	1134746670	1	1	PANDE, PRITHVI	6/21/2023	207R00000X	NA	Other	026	PHYSICIANS	186865	None	None	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
96827	Fee-for-Service	1700958774	1700958774	1	2	POTASH, ALBERT G LMFT	3/24/2022	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	24050 MADISON ST	SUITE 217	TORRANCE	CA	90505	6017	19	06037	33.80594851	-118.348558	Los Angeles County
96843	Fee-for-Service	1417078999	1417078999	1	1	PANDYA, AVNI B MD	7/14/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117083	08	Family Practice	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
96852	Fee-for-Service	1730327164	1730327164	1	1	PLEASANT, TRENA RENEE	1/20/2009	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	202 CALDERA ST	None	PERRIS VALLEY	CA	92570	5528	33	06065	33.73741785	-117.22987	Riverside County
96870	Fee-for-Service	1063517365	1063517365	1	1	POLESKY, ANDREA H MD	12/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81333	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
96875	Fee-for-Service	1770759268	1770759268	1	1	PANNU, HARPREET S MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103557	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96891	Fee-for-Service	1649212846	1649212846	1	1	PERALTA, JANESSA I MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110592	40	Pediatrics	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
96950	Fee-for-Service	1669870739	1669870739	1	1	PETALUMA HEALTH CENTER INC	11/1/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	APCC	5900 STATE FARM DRIVE	STE 200	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
96968	Fee-for-Service	1518908094	1518908094	1	1	PAK, HOOSHANG MD	8/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	36596	14	Neurological Surgery	0	In state provider	None	2888 LONG BEACH BLVD	STE 240	LONG BEACH	CA	90806	1570	19	06037	33.809706	-118.189343	Los Angeles County
96971	Fee-for-Service	1467485078	1467485078	1	1	PONIACHIK, SAMUEL I MD	7/31/1992	207R00000X	NA	Other	026	PHYSICIANS	74757	41	Internal Medicine	0	In state provider	None	1844 S MAIN ST	None	LOS ANGELES	CA	90015	3612	19	06037	34.03132007	-118.2643399	Los Angeles County
96974	Fee-for-Service	1750490827	1750490827	1	1	PATEL, TUSHAR M MD	12/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53344	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
97016	Fee-for-Service	1578611380	1578611380	1	1	PEZESHKPOUR, GHOLAM H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42944	30	Radiology	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
97018	Fee-for-Service	1144455825	1144455825	1	1	PATEL, VISHAL G MD	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107877	01	General Practice	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
97021	Fee-for-Service	1245684935	1245684935	1	1	PATEL, SAHARSH MD	7/2/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153173	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
97027	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
97060	Fee-for-Service	1861032682	1861032682	1	1	PINEDA, KAYLA LCSW	1/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23121 VERDUGO DRIVE	SUITE 105	LAGUNA HILLS	CA	92653	1003	30	06059	33.62655523	-117.7292097	Orange County
97085	Fee-for-Service	1033285820	1033285820	1	1	PORTER, SAMUEL J MD AMC	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22916	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	321 N LARCHMONT BLVD	SUITE 618	LOS ANGELES	CA	90004	6406	19	06037	34.0769016	-118.323663	Los Angeles County
97105	Fee-for-Service	1871757989	1871757989	1	1	PARIKH, PAYAL D DO	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10898	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAYS	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
97116	Fee-for-Service	1174601066	1174601066	1	1	PIEL, RICHARD L MD	3/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80907	41	Internal Medicine	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
97119	Fee-for-Service	1770900912	1770900912	1	1	PURO, ALANA C MD	9/5/2017	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 100	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
97129	Fee-for-Service	1871685941	1871685941	1	1	PATT, JAY DC	12/26/2018	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	29	06057	39.23512508	-121.0306878	Nevada County
97132	Fee-for-Service	1366001653	1366001653	1	1	PRECISE HEALTHCARE INC	1/9/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17500 FOOTHILL BLVD	A-7A	FONTANA	CA	92335	3736	36	06071	34.1067065	-117.4218885	San Bernardino County
97140	Fee-for-Service	1730327164	1730327164	1	1	PLEASANT, TRENA RENEE	1/20/2009	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	202 CALDERA ST	None	PERRIS VALLEY	CA	92570	5528	33	06065	33.73741785	-117.22987	Riverside County
97171	Fee-for-Service	1497700553	1497700553	1	1	PIKE, KAREN L MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60848	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
97181	Fee-for-Service	1316173008	1316173008	1	1	PULIKKOTTIL, BENSON J MD	6/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	2	Out of state provider	None	601 E HAMPDEN AVENUE	STE 310	ENGLEWOOD	CO	80113	2769	00	None	39.65319363	-104.980147	Arapahoe County
97196	Fee-for-Service	1922075043	1922075043	1	1	PHAM, ANNE N MD	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130189	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
97245	Fee-for-Service	1467447904	1467447904	1	1	PATEL, RENUKA D MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43090	41	Internal Medicine	0	In state provider	None	8357 FLORENCE AVE	None	DOWNEY	CA	90240	3928	19	06037	33.95073125	-118.1239974	Los Angeles County
97248	Fee-for-Service	1982196564	1982196564	1	1	PRISACARI, VERA I MD	4/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178265	36	Psychiatry	0	In state provider	None	3425 COFFEE RD	2A	MODESTO	CA	95355	1582	50	06099	37.687914	-120.9761055	Stanislaus County
97275	Fee-for-Service	1194073155	1194073155	1	1	PARK, SUE JONG LCSW	7/13/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
97295	Fee-for-Service	1770550162	1770550162	1	1	PIACQUADIO, DANIEL MD	8/31/1987	207N00000X	NA	Dermatology	026	PHYSICIANS	57303	07	Dermatology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
97308	Fee-for-Service	1437701646	1437701646	1	1	PRISTINE HOSPICE AND	2/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	800 S BROOKHURST ST	STE 3A	ANAHEIM	CA	92804	4301	30	06059	33.821514	-117.9589105	Orange County
97315	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	7/25/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
97316	Fee-for-Service	1588629919	1588629919	1	1	PATHOLOGY SERVICES, INC	6/21/2018	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3017 TELEGRAPH AVE	STE 100	BERKELEY	CA	94705	2049	01	06001	37.85557186	-122.2598376	Alameda County
97328	Fee-for-Service	1942228960	1942228960	1	1	PUTMAN, CHRISTOPHER M MD	9/10/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	154845	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
97375	Fee-for-Service	1932543675	1932543675	1	1	PATACXIL, WYZSCK M MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133325	None	None	0	In state provider	None	340 VICTORIA ST	None	COSTA MESA	CA	92627	1914	30	06059	33.65263167	-117.9138606	Orange County
97377	Fee-for-Service	1417185273	1417185273	1	1	PONTICIELLO, DANIEL R MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120221	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 100	MISSION VIEJO	CA	92691	6389	30	06059	33.56286021	-117.6673449	Orange County
97384	Fee-for-Service	1942402524	1942402524	1	1	PANG, ARNOLD T DO	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9712	08	Family Practice	0	In state provider	None	1025 W OLYMPIC AVE	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
97403	Fee-for-Service	1053420547	1053420547	1	1	PAYLESS DRUG STORE 5730	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	25906 NEWPORT DR	None	SUN CITY	CA	92587	0000	33	06065	33.70132541	-117.2449576	Riverside County
97412	Fee-for-Service	1245285147	1245285147	1	1	PUGATCH, DAVID L MD	12/1/2008	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	88383	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDREN'S	PLACE	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
97419	Fee-for-Service	1306888920	1306888920	1	1	PRITCHARD, JAMES H MD	8/1/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	32168	42	Nuclear Medicine	0	In state provider	None	9730 WILSHIRE BLVD	RM 21	BEVERLY HILLS	CA	90212	2022	19	06037	34.06705051	-118.4074425	Los Angeles County
97428	Fee-for-Service	1558599779	1558599779	1	1	PAGANO, JESSICA A MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117029	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
97445	Fee-for-Service	1609937754	1609937754	1	1	PEINADO, CHRISTOPHER R MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86493	05	Anesthesiology	0	In state provider	MD	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
97450	Fee-for-Service	1669709523	1669709523	1	1	PROHEALTH PARTNERS	6/25/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	A MEDICAL GROUP INC	1777 BELLFLOWER BLVD	STE 210	LONG BEACH	CA	90815	4020	19	06037	33.78791149	-118.1240221	Los Angeles County
97458	Fee-for-Service	1770316325	1770316325	1	1	PARK, SEAN PT	12/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 S. VIRGIL AVE	201	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
97461	Fee-for-Service	1659818128	1659818128	1	1	PITYSINGH, ANTHEA PT	8/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15928 VENTURA BLVD	STE 218	ENCINO	CA	91436	4413	19	06037	34.15585301	-118.4801465	Los Angeles County
97481	Fee-for-Service	1417909847	1417909847	1	1	PETERS, TIMOTHY D MD	12/30/1994	207RR0500X	NA	Other	026	PHYSICIANS	76391	41	Internal Medicine	0	In state provider	None	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
97485	Fee-for-Service	1760480503	1760480503	1	1	PHOENIX CHILDRENS HOSPITAL	3/1/2018	282NC2000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
97531	Fee-for-Service	1689881039	1689881039	1	1	PENTA, CHAKRADHAR MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98881	25	Physical Medicine and Rehabilitation	0	In state provider	None	11406 LOMA LINDA DR	STE 300	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
97585	Fee-for-Service	1316236565	1316236565	1	1	PATEL, VIVEK-SAGAR M MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156753	04	Otology, Laryngology, Rhinology	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
97593	Fee-for-Service	1801848213	1801848213	1	1	PEDIATRIC URGENT CARE OF SAC	2/1/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RAMENTO, INC	7601 HOSPITAL DR	SUITE 101B	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
97598	Fee-for-Service	1437701646	1437701646	1	1	PRISTINE HOSPICE AND	2/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	800 S BROOKHURST ST	STE 3A	ANAHEIM	CA	92804	4301	30	06059	33.821514	-117.9589105	Orange County
97603	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
97609	Fee-for-Service	1689037384	1689037384	1	1	PRASAD, RUPA MD	6/15/2021	390200000X	NA	Other	026	PHYSICIANS	152691	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
97613	Fee-for-Service	1306895156	1306895156	1	1	PREYS, ZOYA MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65600	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5901 W OLYMPIC BLVD	STE 503	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
97616	Fee-for-Service	1730293838	1730293838	1	1	PEARCE, WILLIAM MD	12/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	80700	34	Urology and Urological Surgery	0	In state provider	None	1310 W STEWART DRIVE	SUITE 502	ORANGE	CA	92868	3865	30	06059	33.78236048	-117.8664975	Orange County
97662	Fee-for-Service	1780126284	1780126284	1	1	PHAM, KEVIN PT	8/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
97665	Fee-for-Service	1417185273	1417185273	1	1	PONTICIELLO, DANIEL R MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120221	01	General Practice	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 100	MISSION VIEJO	CA	92691	6389	30	06059	33.56286021	-117.6673449	Orange County
97701	Fee-for-Service	1245285147	1245285147	1	1	PUGATCH, DAVID L MD	12/1/2008	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	88383	77	Infectious Disease	0	In state provider	None	9300 VALLEY CHILDREN'S	PLACE	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
97719	Fee-for-Service	1114964525	1114964525	1	1	PUTHIAPARAMPIL, T J MD	4/18/2003	2084P0800X	NA	Psychiatry	026	PHYSICIANS	36048	36	Psychiatry	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
97723	Fee-for-Service	1144484379	1144484379	1	1	PONRARTANA, SKORN MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100835	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
97738	Fee-for-Service	1669709523	1669709523	1	1	PROHEALTH PARTNERS	6/25/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	1777 BELLFLOWER BLVD	STE 210	LONG BEACH	CA	90815	4020	19	06037	33.78791149	-118.1240221	Los Angeles County
97741	Fee-for-Service	1609937754	1609937754	1	1	PEINADO, CHRISTOPHER R MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86493	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
97746	Fee-for-Service	1295734507	1295734507	2	1	PARKS, RICHARD L MD	3/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	47152	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12486 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96785241	-118.0451556	Los Angeles County
97774	Fee-for-Service	1760480503	1760480503	1	1	PHOENIX CHILDRENS HOSPITAL	3/1/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
97826	Fee-for-Service	1023241502	1023241502	1	1	PALMIOTTO, JENNIFER LMFT	6/16/2020	174400000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 KENYON ST	101/102	SAN DIEGO	CA	92110	5333	37	06073	32.75016963	-117.2160064	San Diego County
97845	Fee-for-Service	1578892436	1578892436	1	1	PATEL, TRISHA R LMFT	2/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
97865	Fee-for-Service	1215236401	1215236401	1	1	PILLAR TOPALOGLU, ANGELIQUE	6/8/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	166243	18	Ophthalmology	0	In state provider	J MD	3737 MORAGA AVE	STE A 105	SAN DIEGO	CA	92117	5458	37	06073	32.8086683	-117.2109991	San Diego County
97878	Fee-for-Service	1710393350	1710393350	1	1	PEREZ, EMELIA MD	5/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155977	None	None	0	In state provider	None	2925 SYCAMORE DR	STE 204	SIMI VALLEY	CA	93065	1208	56	06111	34.288398	-118.7439175	Ventura County
97885	Fee-for-Service	1386018604	1386018604	1	1	PARKER, MATHEW J	4/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
97889	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
97900	Fee-for-Service	1710587670	1710587670	1	2	PHYSICIANS OF SOUTHERN CALIF	4/29/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	ORNIA INC	1304 W HOLT BLVD	SUITE A	ONTARIO	CA	91762	3640	36	06071	34.063569	-117.674856	San Bernardino County
97915	Fee-for-Service	1689966244	1689966244	1	1	PINGATORE, CARMELLA J LAC	3/2/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	110 E MAIN ST	None	GRASS VALLEY	CA	95945	6506	29	06057	39.21925123	-121.0616811	Nevada County
98028	Fee-for-Service	1821072182	1821072182	1	1	PEREZ, RICHARD V.	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	72725	02	General Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
98054	Fee-for-Service	1740247899	1740247899	1	1	POWELL, ANTHONY M MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80236	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
98083	Fee-for-Service	1972994853	1972994853	1	3	POGODIN, TIMUR R MD	6/10/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	133706	01	General Practice	0	In state provider	None	27141 HIDAWAY AVE	204	SANTA CLARITA	CA	91351	4147	19	06037	34.41483	-118.469039	Los Angeles County
98145	Fee-for-Service	1659696169	1659696169	1	1	PAREKH, MEGHA MD	10/4/2017	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	121706	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
98155	Fee-for-Service	1508948837	1508948837	1	1	POWER CENTER PHYSICAL THERAP	9/22/2014	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y, INC.	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
98170	Fee-for-Service	1164955266	1164955266	1	1	PUTHUMANA, ANTHONY J MD	9/12/2022	208M00000X	NA	Other	026	PHYSICIANS	174996	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
98174	Fee-for-Service	1386792455	1386792455	1	1	PORTMORE, AMY C MD	3/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79688	41	Internal Medicine	0	In state provider	None	805 VETERANS BLVD	None	REDWOOD CITY	CA	94301	2302	41	06081	37.49076853	-122.2291439	San Mateo County
98178	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	8/28/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
98189	Fee-for-Service	1710587670	1710587670	1	2	PHYSICIANS OF SOUTHERN CALIF	11/3/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ORNIA INC	1304 W HOLT BLVD	SUITE A	ONTARIO	CA	91762	3640	36	06071	34.063569	-117.674856	San Bernardino County
98201	Fee-for-Service	1962729251	1962729251	1	1	PEREZ, MERYL A MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123918	77	Infectious Disease	0	In state provider	None	6403 COYLE AVENUE	SUITE 450	CARMICHAEL	CA	95608	0361	34	06067	38.668347	-121.3148745	Sacramento County
98269	Fee-for-Service	1093871154	1093871154	1	1	PEARCE, MELISSA D DO	10/5/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10033	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3163	50	06099	37.62692973	-121.0131742	Stanislaus County
98289	Fee-for-Service	1295888576	1295888576	1	1	PINHEL, MARIA C LMFT	5/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	430 EAST CARRILLO ST	SUITE 3	SANTA BARBARA	CA	93101	1402	42	06083	34.42661795	-119.696399	Santa Barbara County
98396	Fee-for-Service	1285745745	1285745745	1	1	PRICE, KELLIE	4/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
98410	Fee-for-Service	1285125195	1285125195	1	1	PLATTER, LINDSAY F MD	9/13/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17660	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
98422	Fee-for-Service	1407406630	1407406630	1	1	PLANNED PARENTHOOD PASADENA	11/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	5903 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4229	19	06037	34.11066158	-118.1906817	Los Angeles County
98437	Fee-for-Service	1508948837	1508948837	1	1	POWER CENTER PHYSICAL THERAP	3/16/2024	225100000X	NA	Physical Therapist	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	Y, INC.	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
98466	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	6/21/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
98485	Fee-for-Service	1346204799	1346204799	1	1	PETERSON, RICHARD M MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93932	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
98488	Fee-for-Service	1154460970	1154460970	1	1	POUNDS, DAVID S PHD	1/3/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	42111 RD 415	None	COARSEGOLD	CA	93614	9022	20	06039	37.243782	-119.780028	Madera County
98489	Fee-for-Service	1962729251	1962729251	1	1	PEREZ, MERYL A MD	4/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123918	41	Internal Medicine	0	In state provider	None	6403 COYLE AVENUE	SUITE 450	CARMICHAEL	CA	95608	0361	34	06067	38.668347	-121.3148745	Sacramento County
98495	Fee-for-Service	1780756866	1780756866	1	2	PEDIATRIC MED ASSOC OF	4/16/1991	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	EAST BAY	345 9TH ST	STE 204	OAKLAND	CA	94607	4206	01	06001	37.79975865	-122.2705956	Alameda County
98497	Fee-for-Service	1689696197	1689696197	1	1	PAYLESS DRUG STORE 5935	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	580 BAILEY RD	None	PITTSBURG	CA	94565	4304	07	06013	38.01714765	-121.9419736	Contra Costa County
98513	Fee-for-Service	1255565321	1255565321	1	1	PAPAZIAN, JENNY H MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114625	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98553	Fee-for-Service	1588875967	1588875967	1	1	PANKAJ K PATEL DMD &	9/21/2006	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHAILESH K PATEL DDS	5712 PIRRONE RD	None	SALIDA	CA	95368	9313	50	06099	37.7211691	-121.0982235	Stanislaus County
98572	Fee-for-Service	1174690051	1174690051	1	1	POUYA, PARMIS MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84021	38	Geriatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
98597	Fee-for-Service	1518455302	1518455302	1	1	PAX HOUSE, INC.	7/16/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	750 E WALNUT ST	None	PASADENA	CA	91101	1638	19	06037	34.14955203	-118.1349664	Los Angeles County
98601	Fee-for-Service	1205063286	1205063286	1	1	PHILLIPS, HEBER S DO	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
98626	Fee-for-Service	1972994853	1972994853	1	1	POGODIN, TIMUR R MD	1/4/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	133706	-	NOT APPLICABLE	0	In state provider	None	656 N PARK AVENUE	None	POMONA	CA	91768	3679	19	06037	34.06417421	-117.7547068	Los Angeles County
98646	Fee-for-Service	1376569475	1376569475	1	1	PECK, MARCIA C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75655	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
98715	Fee-for-Service	1225186349	1225186349	1	1	PARKER, ELLEN E MD	5/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93445	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
98718	Fee-for-Service	1033395975	1033395975	1	1	PENG, TIEN I MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136381	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
98754	Fee-for-Service	1639252604	1639252604	1	25	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
98760	Fee-for-Service	1053546655	1053546655	1	1	PEREZ, JODIE PSYD	2/12/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
98800	Fee-for-Service	1043604077	1043604077	1	1	PHAM, MINH-TRI N MD	9/9/2021	208600000X	NA	General Surgery	026	PHYSICIANS	173337	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
98846	Fee-for-Service	1073699757	1073699757	1	1	PATEL, SUNITA PHD	7/19/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
98848	Fee-for-Service	1740397421	1740397421	1	1	PAREKH, NIMISHA K MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96159	10	Gastroenterology (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
98850	Fee-for-Service	1669870739	1669870739	1	2	PETALUMA HEALTH CENTER INC	4/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1225 N MCDOWELL BLVD	None	PETALUMA	CA	94954	1112	49	06097	38.2702492	-122.6613983	Sonoma County
98863	Fee-for-Service	1174690051	1174690051	1	1	POUYA, PARMIS MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84021	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
98876	Fee-for-Service	1114217338	1114217338	1	1	PATEL, RIPAL H MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
98901	Fee-for-Service	1699793240	1699793240	1	1	PARVEEN, RAFIA MD	4/11/1988	207R00000X	NA	Other	026	PHYSICIANS	44705	41	Internal Medicine	0	In state provider	None	200 JOSE FIGUERES AVE	STE 390	SAN JOSE	CA	95116	1591	43	06085	37.36122014	-121.8505998	Santa Clara County
98903	Fee-for-Service	1447327317	1447327317	1	1	POLIAKOFF, RAYMOND M MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	28053	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98937	Fee-for-Service	1629846670	1629846670	1	1	PACIFIC VASCULAR ACCESS CARE	4/1/2024	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, INC	11411 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	5009	19	06037	33.93667091	-118.1309273	Los Angeles County
98945	Fee-for-Service	1952334583	1952334583	1	1	PYREDDY, LOVRDU P MD	6/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94932	41	Internal Medicine	0	In state provider	None	1660 E HERNDON AVE	STE 101	FRESNO	CA	93720	3346	10	06019	36.8375615	-119.7575595	Fresno County
98962	Fee-for-Service	1922559442	1922559442	1	1	PARK, ELLEN S NP	5/26/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6900 LINCOLN AVENUE	None	BUENA PARK	CA	90620	4148	30	06059	33.83179154	-118.012518	Orange County
99045	Fee-for-Service	1114177300	1114177300	1	1	PARK, SUSIE MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	100359	30	Radiology	0	In state provider	None	414 E SAN BERNARDINO RD	None	COVINA	CA	91723	1704	19	06037	34.09060121	-117.8831282	Los Angeles County
99070	Fee-for-Service	1659790962	1659790962	1	1	PETER, ASHOK C MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145847	08	Family Practice	0	In state provider	None	17073 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41987484	-117.2906045	San Bernardino County
99074	Fee-for-Service	1043700735	1043700735	1	1	PRABHAKAR, NITIN MD	10/6/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	164044	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
99084	Fee-for-Service	1952825788	1952825788	1	1	PARKER, LAUREN LMFT	6/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 GATEWAY DR	210 AND 230	LINCOLN	CA	95648	3306	31	06061	38.88433725	-121.2931529	Placer County
99092	Fee-for-Service	1063481562	1063481562	1	1	PLANNED PARENTHOOD/	12/1/1977	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	1421 E 17TH ST	None	SANTA ANA	CA	92705	8505	30	06059	33.75994564	-117.847815	Orange County
99137	Fee-for-Service	1669870739	1669870739	1	2	PETALUMA HEALTH CENTER INC	4/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1225 N MCDOWELL BLVD	None	PETALUMA	CA	94954	1112	49	06097	38.2702492	-122.6613983	Sonoma County
99141	Fee-for-Service	1679067078	1679067078	1	1	PUDEWA, PAMELA LMFT	6/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
99189	Fee-for-Service	1447327317	1447327317	1	1	POLIAKOFF, RAYMOND M MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	28053	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99191	Fee-for-Service	1316365323	1316365323	1	1	PARK, HOWARD Y MD	10/6/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	141655	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
99200	Fee-for-Service	1649428053	1649428053	1	1	PADDA, SUKHMANI K MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109102	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99227	Fee-for-Service	1629846670	1629846670	1	1	PACIFIC VASCULAR ACCESS CARE	4/1/2024	2085R0204X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	, INC	11411 BROOKSHIRE AVE	STE 301	DOWNEY	CA	90241	5009	19	06037	33.93667091	-118.1309273	Los Angeles County
99231	Fee-for-Service	1952334583	1952334583	1	1	PYREDDY, LOVRDU P MD	6/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94932	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1660 E HERNDON AVE	STE 101	FRESNO	CA	93720	3346	10	06019	36.8375615	-119.7575595	Fresno County
99265	Fee-for-Service	1710419171	1710419171	1	1	PANJWANI, SURAJ MD	8/20/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	205 RIVER PARK CIR	None	FRESNO	CA	93720	1571	10	06019	36.85456375	-119.7863981	Fresno County
99272	Fee-for-Service	1013226877	1013226877	1	1	POURRABBANI, SHAHIN MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112416	01	General Practice	0	In state provider	None	4950 SAN BERNARDINO ST	SUITE 200	MONTCLAIR	CA	91763	2212	36	06071	34.07768363	-117.6968874	San Bernardino County
99287	Fee-for-Service	1295728962	1295728962	1	1	PLISKO, ANDY MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50741	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
99319	Fee-for-Service	1275756314	1275756314	1	1	POONAMALLEE, UDAYSHANKAR	12/31/1987	174400000X	NA	Other	026	PHYSICIANS	59055	34	Urology and Urological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
99329	Fee-for-Service	1043548324	1043548324	1	1	PENA, GUADALUPE G LMFT	9/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1672 W AVENUE J	202	LANCASTER	CA	93534	2861	19	06037	34.68938947	-118.1609775	Los Angeles County
99337	Fee-for-Service	1548414337	1548414337	1	1	PATEL, FALGUNI K MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105594	26	Psychiatry (child)	0	In state provider	None	851 TRAEGER AVENUE	None	SAN BRUNO	CA	94066	3022	41	06081	37.62776422	-122.4223323	San Mateo County
99338	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
99357	Fee-for-Service	1215175070	1215175070	1	1	PENN, JULIET M MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105540	41	Internal Medicine	0	In state provider	None	2040 VIBORG RD	None	SOLVANG	CA	93463	2272	42	06083	34.6024706	-120.1275138	Santa Barbara County
99363	Fee-for-Service	1457835837	1457835837	1	1	PHAM, DZUNG T RCP	11/26/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
99451	Fee-for-Service	1710140819	1710140819	1	1	PRITCHARD, AMY M DO	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13216	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
99452	Fee-for-Service	1932271657	1932271657	1	1	PEARSON, EARL S MD INC	1/5/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	41796	07	Dermatology	0	In state provider	None	573 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3270	54	06107	36.06956792	-119.0296869	Tulare County
99460	Fee-for-Service	1891935862	1891935862	1	1	PARKSIDE MEDICAL GROUP INC	1/26/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	1310 SAN BERNARDINO ROAD	SUITE 102	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
99488	Fee-for-Service	1649428053	1649428053	1	1	PADDA, SUKHMANI K MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109102	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99507	Fee-for-Service	1952695371	1952695371	1	1	PUTNAM, KATHRYN C MD	11/17/2017	207L00000X	NA	Other	026	PHYSICIANS	149359	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
99516	Fee-for-Service	1487732038	1487732038	1	1	PADIN, CHERYL MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
99519	Fee-for-Service	1477197259	1477197259	1	1	PESCHONG, ESSIE M	11/15/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	18751 CEDAR CREST DR	None	CANYON COUNTRY	CA	91387	1454	19	06037	34.38977814	-118.454637	Los Angeles County
99541	Fee-for-Service	1649217217	1649217217	1	1	PHAM, THI K L MD	11/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60749	41	Internal Medicine	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
99555	Fee-for-Service	1124587225	1124587225	1	1	PEREZ AGUDELO, MARIA L MD	9/7/2022	208M00000X	NA	Other	026	PHYSICIANS	181615	None	None	0	In state provider	None	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
99569	Fee-for-Service	1386930600	1386930600	1	1	PEKUROVSKY, ALEXANDER MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135936	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
99583	Fee-for-Service	1124048442	1124048442	1	1	POTWARDOWSKI, ERIC G DO	12/6/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9576	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99602	Fee-for-Service	1720535123	1720535123	1	1	PRACK, EMILY A CRNA	12/4/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
99606	Fee-for-Service	1891236212	1891236212	1	1	PURGIANTO, ANTHONY MD	11/18/2021	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
99608	Fee-for-Service	1730668757	1730668757	1	1	PHAN, JENNY LCSW	7/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
99615	Fee-for-Service	1265948061	1265948061	1	1	PATEL, NIHAL MD	7/19/2024	207R00000X	NA	Other	026	PHYSICIANS	184033	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
99624	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	10/28/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
99636	Fee-for-Service	1992725576	1992725576	1	1	PAQUETTE, RONALD L MD	1/1/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	59889	69	Unknown	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
99647	Fee-for-Service	1215175070	1215175070	1	1	PENN, JULIET M MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105540	78	Neoplastic Diseases/Oncology	0	In state provider	None	2040 VIBORG RD	None	SOLVANG	CA	93463	2272	42	06083	34.6024706	-120.1275138	Santa Barbara County
99658	Fee-for-Service	1982670592	1982670592	1	1	PICK, ROBERT A DO	10/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	4258	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2638 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
99677	Fee-for-Service	1194003616	1194003616	1	1	PICA, KATHERINE B LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99709	Fee-for-Service	1285625509	1285625509	1	3	PLEASANTON EMERGENCY	12/26/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP	4000 DUBLIN BLVD	STE 150	DUBLIN	CA	94568	3180	01	06001	37.70553949	-121.872609	Alameda County
99748	Fee-for-Service	1891935862	1891935862	1	1	PARKSIDE MEDICAL GROUP INC	1/26/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1310 SAN BERNARDINO ROAD	SUITE 102	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
99776	Fee-for-Service	1649428053	1649428053	1	1	PADDA, SUKHMANI K MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109102	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99799	Fee-for-Service	1558866798	1558866798	1	1	PARK, DANIEL B MD	7/17/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	165578	None	None	0	In state provider	None	9808 VENICE BLVD	STE 400	CULVER CITY	CA	90232	6800	19	06037	34.0236396	-118.3980847	Los Angeles County
99803	Fee-for-Service	1790850212	1790850212	1	1	PRECISION ORTHOPEDICS	1/1/1986	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	A MEDICAL CORPORATION	240 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
99805	Fee-for-Service	1295919504	1295919504	1	1	PENN, BRANDON M DO	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10077	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
99806	Fee-for-Service	1477197259	1477197259	1	1	PESCHONG, ESSIE M	11/15/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	18751 CEDAR CREST DR	None	CANYON COUNTRY	CA	91387	1454	19	06037	34.38977814	-118.454637	Los Angeles County
99830	Fee-for-Service	1649217217	1649217217	1	1	PHAM, THI K L MD	11/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60749	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
99857	Fee-for-Service	1801949524	1801949524	1	1	PUZON, DONNA M NP	4/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
99867	Fee-for-Service	1336286566	1336286566	1	1	PALOMO, MARIA J LMFT	9/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99873	Fee-for-Service	1841258753	1841258753	1	1	POSEN, ROBERT DO	2/28/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	6270	None	None	0	In state provider	None	827 DEEP VALLEY DR	STE 310	PLS VRDS PNSL	CA	90274	3655	19	06037	33.76922598	-118.367828	Los Angeles County
99881	Fee-for-Service	1275100802	1275100802	1	1	PARKER, CHRISTAL Y NP	7/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
99896	Fee-for-Service	1134820632	1134820632	1	1	POSITIVE CORE BELIEFS COUNSE	10/3/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LING	29970 TECHNOLOGY DR	STE 215E	MURRIETA	CA	92563	2648	33	06065	33.5604702	-117.1370275	Riverside County
99908	Fee-for-Service	1164415535	1164415535	1	1	PHAN, NGHIA T DO	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10219	01	General Practice	0	In state provider	None	795 E SECOND STREET	SUITE 5	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
99912	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	5/18/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
99918	Fee-for-Service	1902156557	1902156557	1	1	PENG, SHARON A	12/20/2024	207R00000X	NA	Other	026	PHYSICIANS	175012	68	Hematology	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
99925	Fee-for-Service	1992725576	1992725576	1	1	PAQUETTE, RONALD L MD	1/1/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	59889	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
99927	Fee-for-Service	1740361476	1740361476	1	1	PARKE, JOHN S PHD	6/10/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2501 HARRISON STREET	None	OAKLAND	CA	94612	3811	01	06001	37.81349235	-122.2609539	Alameda County
99943	Fee-for-Service	1790799039	1790799039	1	1	PABLEO, GEOFFREY B MD	6/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85030	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
99956	Fee-for-Service	1689146532	1689146532	1	1	PROCARE HOSPICE INC	1/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1614 VICTORY BLVD	STE 102	GLENDALE	CA	91201	2946	19	06037	34.16011082	-118.298801	Los Angeles County
99971	Fee-for-Service	1588969638	1588969638	1	1	PROHEALTH PARTNERS A MEDICAL	4/4/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	4401 ATLANTIC AVE	STE 202	LONG BEACH	CA	90807	2252	19	06037	33.836976	-118.185096	Los Angeles County
100044	Fee-for-Service	1972205276	1972205276	1	1	PCD SENIOR #1,LLC	6/14/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2150 N PALM CANYON DR	None	PALM SPRINGS	CA	92262	2832	33	06065	33.84874849	-116.5482729	Riverside County
100072	Fee-for-Service	1376953257	1376953257	1	1	PARK, JESSIE S PHD	9/9/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
100084	Fee-for-Service	1710076997	1710076997	1	1	PLANNED PARENTHOOD LOS	2/12/1987	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES POMONA CENTER	1550 N GAREY AVE	None	POMONA	CA	91767	3826	19	06037	34.07356342	-117.7522392	Los Angeles County
100106	Fee-for-Service	1114246816	1114246816	1	1	PREMIER HEALTHCARE SERVICES	10/9/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	950 SOUTH BASCOM AVE	SUITE 3113	SAN JOSE	CA	95128	3539	43	06085	37.309176	-121.9317525	Santa Clara County
100112	Fee-for-Service	1407822984	1407822984	1	1	PERTS, DAVID A MD	10/10/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	53069	41	Internal Medicine	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
100121	Fee-for-Service	1386939296	1386939296	1	1	PRIBNOW, ALLISON K MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122020	68	Hematology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
100173	Fee-for-Service	1639365133	1639365133	1	1	PENICHET, MARISOL G MD	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84142	22	Pathology (M.D. only)	0	In state provider	None	11 W DEL MAR BLVD	SUITE 300	PASADENA	CA	91105	2505	19	06037	34.14074037	-118.1508578	Los Angeles County
100198	Fee-for-Service	1164415535	1164415535	1	1	PHAN, NGHIA T DO	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10219	08	Family Practice	0	In state provider	None	795 E SECOND STREET	SUITE 5	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
100200	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
100207	Fee-for-Service	1902156557	1902156557	1	1	PENG, SHARON A	12/20/2024	207R00000X	NA	Other	026	PHYSICIANS	175012	41	Internal Medicine	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
100242	Fee-for-Service	1689146532	1689146532	1	1	PROCARE HOSPICE INC	1/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1614 VICTORY BLVD	STE 102	GLENDALE	CA	91201	2946	19	06037	34.16011082	-118.298801	Los Angeles County
100258	Fee-for-Service	1770926263	1770926263	1	1	PEREZ, ZACHARY D MD	8/27/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	135713	67	Endocrinology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
100282	Fee-for-Service	1699755397	1699755397	2	1	PACIFIC URGENT CARE INC	7/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1782 W HAMMER LN	None	STOCKTON	CA	95209	2922	39	06077	38.0210584	-121.3358534	San Joaquin County
100301	Fee-for-Service	1255821419	1255821419	1	1	PALMIERI, CHARLES F LMFT	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
100311	Fee-for-Service	1558385492	1558385492	1	1	PERERA, SHANIKA D MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82812	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
100321	Fee-for-Service	1952814048	1952814048	1	1	PETERSON, DYLAN J	5/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
100348	Fee-for-Service	1881848109	1881848109	1	1	PINHEIRO, MEAGHAN M MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105912	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100375	Fee-for-Service	1174712988	1174712988	1	1	PELZ, KATHLEEN	12/1/1997	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	5880 W LAS POSITAS BLVD	STE 31	PLEASANTON	CA	94588	8552	01	06001	37.68371601	-121.8980138	Alameda County
100385	Fee-for-Service	1174575336	1174575336	1	1	PARALITICCI, RAUL E MD	3/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88525	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
100394	Fee-for-Service	1962405084	1962405084	1	1	PISTONE, DANIEL N MD	5/6/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	132973	None	None	0	In state provider	None	721 N EUCLID	None	ANAHEIM	CA	92801	0000	30	06059	33.84206214	-117.9416317	Orange County
100419	Fee-for-Service	1003325978	1003325978	1	1	PHELPS, LAUREN LMFT	7/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1244 PINE ST.	#202	PASO ROBLES	CA	93446	3217	40	06079	35.62767551	-120.6889043	San Luis Obispo County
100423	Fee-for-Service	1477675114	1477675114	1	1	PAK, CAROLINE J	1/13/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
100426	Fee-for-Service	1538359591	1538359591	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC ENDOCRINOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
100490	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
100508	Fee-for-Service	1376711085	1376711085	1	1	PIRBHAI, ZAINAB A LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE 808	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
100531	Fee-for-Service	1093169237	1093169237	1	1	PEARSON, DARION M MD	8/6/2020	207L00000X	NA	Other	026	PHYSICIANS	168790	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
100545	Fee-for-Service	1164859302	1164859302	1	1	POWELL, MAY N NP	10/29/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
100569	Fee-for-Service	1699755397	1699755397	2	1	PACIFIC URGENT CARE INC	7/13/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1782 W HAMMER LN	None	STOCKTON	CA	95209	2922	39	06077	38.0210584	-121.3358534	San Joaquin County
100589	Fee-for-Service	1285132175	1285132175	1	1	PLUVIOSE, GERDY M NP	7/31/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
100643	Fee-for-Service	1316280522	1316280522	1	1	PHAM, JAX H DO MD	5/29/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16420	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
100645	Fee-for-Service	1962817270	1962817270	1	1	POLOSINA, EVGENIA MD	7/30/2018	390200000X	NA	Other	026	PHYSICIANS	156137	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
100670	Fee-for-Service	1578577995	1578577995	1	1	PENIX, JERRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
100707	Fee-for-Service	1730736596	1730736596	1	1	PAM SPECIALTY HOSPITAL OF RE	1/20/2022	282E00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ARKS	2375 EAST PRATER WAY	7TH FLOOR	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
100719	Fee-for-Service	1538359591	1538359591	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	PEDIATRIC ENDOCRINOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
100737	Fee-for-Service	1609301472	1609301472	1	1	PRANGE, REBECCA J CRNA	5/21/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100768	Fee-for-Service	1104184548	1104184548	1	1	PHAM, VICTORIA H MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130190	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
100778	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
100799	Fee-for-Service	1124635172	1124635172	1	1	PEREZ, MONICA LPCC	10/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
100811	Fee-for-Service	1154357945	1154357945	1	1	PAQUETTE, ROBERT J MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
100823	Fee-for-Service	1891107066	1891107066	2	1	PHARMEDQUEST PHARMACY SERVIC	10/22/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	522 S SAN PEDRO ST	141	LOS ANGELES	CA	90013	2102	19	06037	34.0436196	-118.2442541	Los Angeles County
100845	Fee-for-Service	1386758795	1386758795	1	1	PAGE, MICHAEL L MD	2/1/1984	207P00000X	NA	Other	026	PHYSICIANS	34424	41	Internal Medicine	0	In state provider	None	616 GARFIELD AVE	None	SOUTH PASADENA	CA	91030	2213	19	06037	34.120022	-118.1452099	Los Angeles County
100869	Fee-for-Service	1275619447	1275619447	1	1	PARK, DAVID J MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75876	78	Neoplastic Diseases/Oncology	0	In state provider	None	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3820	30	06059	33.89443025	-117.9288328	Orange County
100878	Fee-for-Service	1801858113	1801858113	1	1	PATEL,SUMIR M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1520 S DOBSON STE #302	None	MESA	AZ	85202	0000	00	None	33.387444	-111.876894	Maricopa County
100919	Fee-for-Service	1396799185	1396799185	1	1	PEREZ, JOSE M MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88799	02	General Surgery	0	In state provider	None	1510 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2588	19	06037	34.12709764	-118.2577911	Los Angeles County
100935	Fee-for-Service	1770603300	1770603300	1	1	PARRA, VICTOR J LCSW	6/14/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
100936	Fee-for-Service	1578607131	1578607131	1	1	POOLE, JENNIFER G DO	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13815	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
100943	Fee-for-Service	1609573476	1609573476	1	1	PANORAMA PHARMACY INC	8/23/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8215 WOODMAN AVE	STE A	PANORAMA CITY	CA	91402	5426	19	06037	34.22045512	-118.4325456	Los Angeles County
100947	Fee-for-Service	1164588141	1164588141	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	933B CENTINELA AVE	None	INGLEWOOD	CA	90302	1501	19	06037	33.97605481	-118.356238	Los Angeles County
100958	Fee-for-Service	1356324131	1356324131	1	1	PARK, DAVID C	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S EUCLID ST	None	FULLERTON	CA	92832	3153	30	06059	33.85674633	-117.9418424	Orange County
100965	Fee-for-Service	1093823494	1093823494	1	1	PARK,KEVIN S MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67776	20	Orthopedic Surgery	0	In state provider	None	11411 BROOKSHIRE AVE	STE 307	DOWNEY	CA	90241	5005	19	06037	33.93667091	-118.1309273	Los Angeles County
100978	Fee-for-Service	1528750312	1528750312	1	1	PIRES, WHITNEY	11/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
100991	Fee-for-Service	1730736596	1730736596	1	1	PAM SPECIALTY HOSPITAL OF RE	1/20/2022	282E00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ARKS	2375 EAST PRATER WAY	7TH FLOOR	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
101003	Fee-for-Service	1093717951	1093717951	1	1	PETERSON, ROBERT K MD	7/24/1998	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	84728	20	Orthopedic Surgery	0	In state provider	None	635 ANDERSON RD	STE 18	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
101036	Fee-for-Service	1881695914	1881695914	1	1	PARK, RONALD E MD AMC	5/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55144	40	Pediatrics	0	In state provider	None	235 N RANCHO SANTA FE RD	STE 205	SAN MARCOS	CA	92069	1277	37	06073	33.15254739	-117.1963074	San Diego County
101056	Fee-for-Service	1225473705	1225473705	1	1	PRIORITY CARE PHARMACY, INC.	2/11/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5902 VAN NUYS BOULEVARD	None	VAN NUYS	CA	91401	3623	19	06037	34.177698	-118.4487105	Los Angeles County
101062	Fee-for-Service	1588160469	1588160469	1	1	POSPOS, SARAH MD	2/13/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174673	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
101065	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
101106	Fee-for-Service	1134736143	1134736143	1	1	PALOMINO, CARANINA CNM	6/21/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
101160	Fee-for-Service	1679533681	1679533681	1	1	PRESTON, CORY G OD	1/15/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
101191	Fee-for-Service	1194712570	1194712570	1	1	PINEDA, ELMER B MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62380	34	Urology and Urological Surgery	0	In state provider	None	160 E ARTESIA ST	STE 220	POMONA	CA	91767	2921	19	06037	34.07556833	-117.7507835	Los Angeles County
101194	Fee-for-Service	1437135019	1437135019	1	1	PITTALUGA, BONNIE M MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83989	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
101207	Fee-for-Service	1306851076	1306851076	1	1	PARTOVI, BEHNAM PHD	6/19/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5335 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91607	2711	19	06037	34.16789941	-118.3965279	Los Angeles County
101211	Fee-for-Service	1104321025	1104321025	1	1	PERLMAN, NICOLA C MD	1/14/2025	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	177356	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101215	Fee-for-Service	1104297894	1104297894	1	1	PETERSON, NANCY E CNP	2/24/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
101235	Fee-for-Service	1164588141	1164588141	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	933B CENTINELA AVE	None	INGLEWOOD	CA	90302	1501	19	06037	33.97605481	-118.356238	Los Angeles County
101270	Fee-for-Service	1780812420	1780812420	1	1	PERRIN, GINETTE PHD	5/13/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
101280	Fee-for-Service	1417121054	1417121054	1	1	PETKAR, ANIMESH	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131108	None	None	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
101292	Fee-for-Service	1093717951	1093717951	1	1	PETERSON, ROBERT K MD	7/24/1998	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	84728	66	Emergency Medicine (Urgent Care)	0	In state provider	None	635 ANDERSON RD	STE 18	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
101323	Fee-for-Service	1770674350	1770674350	1	1	PHC-ELKO, INC	9/13/2001	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NORTHEASTERN NEVADA REG	2001 ERRECART BLVD	None	ELKO	NV	89801	8333	00	None	40.82273666	-115.7288989	Elko County
101354	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
101375	Fee-for-Service	1568765345	1568765345	1	1	PODDER, RUMA LMFT	9/4/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2200 PACIFIC COAST HWY	STE 302	HERMOSA BEACH	CA	90254	2700	19	06037	33.87079831	-118.3947051	Los Angeles County
101387	Fee-for-Service	1073698130	1073698130	1	1	PRIBBLE, JAMES M MD	2/14/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
101388	Fee-for-Service	1407992456	1407992456	1	1	PAVONE, SUSAN L LMFT	9/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
101390	Fee-for-Service	1750937520	1750937520	1	1	PREMJI, ALYKHAN M	1/30/2024	208600000X	NA	General Surgery	026	PHYSICIANS	180098	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
101417	Fee-for-Service	1568551521	1568551521	1	1	PETERSEN, RYAN J MD	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
101433	Fee-for-Service	1437234499	1437234499	1	1	PETERSON, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5301 E GRANT RD	None	TUCSON	AZ	85712	2805	00	None	32.252391	-110.8790055	Pima County
101449	Fee-for-Service	1225447584	1225447584	1	1	PAXSON, CAROLINE LCSW	7/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2955 SHATTUCK AVENUE	#4	BERKELEY	CA	94705	3416	01	06001	37.85574785	-122.2665517	Alameda County
101488	Fee-for-Service	1477714699	1477714699	1	1	PIROLLI, TIMOTHY J MD	9/26/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	109182	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
101522	Fee-for-Service	1164588141	1164588141	1	1	PARKLANE MEDICAL GROUP	5/26/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	933B CENTINELA AVE	None	INGLEWOOD	CA	90302	1501	19	06037	33.97605481	-118.356238	Los Angeles County
101529	Fee-for-Service	1811045412	1811045412	1	1	PRASAD, SRIDHAR K MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75286	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
101534	Fee-for-Service	1326119306	1326119306	1	1	PORTER, AMY H MD	12/1/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	84089	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
101535	Fee-for-Service	1316047145	1316047145	1	1	PADMINI A KASHIKAR	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
101570	Fee-for-Service	1205404068	1205404068	1	1	PRIMA CARE HOME HEALTH INC	8/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2500 E FOOTHILL BLVD	SUITE 508	PASADENA	CA	91107	3473	19	06037	34.14979547	-118.097982	Los Angeles County
101592	Fee-for-Service	1326077587	1326077587	1	1	PACINO, EDWARD MD	5/14/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78877	41	Internal Medicine	0	In state provider	None	1355 SAN PABLO ST	FL 1	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
101601	Fee-for-Service	1497809735	1497809735	1	1	PHOENIX HOUSE OF LOS ANGELES	6/9/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	503 OCEAN FRONT WALK	None	VENICE	CA	90291	2403	19	06037	33.99316887	-118.4791801	Los Angeles County
101607	Fee-for-Service	1861740136	1861740136	1	1	PADILLA, EVA M MD	5/29/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156405	40	Pediatrics	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
101611	Fee-for-Service	1770674350	1770674350	1	1	PHC-ELKO, INC	9/13/2001	282NR1301X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NORTHEASTERN NEVADA REG	2001 ERRECART BLVD	None	ELKO	NV	89801	8333	00	None	40.82273666	-115.7288989	Elko County
101622	Fee-for-Service	1841411709	1841411709	1	1	PETERS, JACOB K MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	33404	01	General Practice	0	In state provider	None	1415 N ACACIA AVENUE	None	REEDLEY	CA	93654	2102	10	06019	36.60882634	-119.4510393	Fresno County
101629	Fee-for-Service	1306074893	1306074893	1	1	POUR MOLKARA, DELARAM MD	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94039	None	None	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
101638	Fee-for-Service	1669467148	1669467148	1	1	PINTELON,LYN M OD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7308	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8990 GARFIELD ST	STE 6	RIVERSIDE	CA	92503	3922	33	06065	33.92882844	-117.4396777	Riverside County
101639	Fee-for-Service	1396984126	1396984126	1	1	PIRRUCCELLO, JAMES P MD	3/20/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	183783	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
101641	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
101667	Fee-for-Service	1104846831	1104846831	1	1	PEREZ-LAWSCHA, THERESA LMFT	12/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5931 STANLEY AVE	# 1	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
101676	Fee-for-Service	1104930437	1104930437	1	1	PROCHERA, ANN MARIE T MD	2/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81872	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
101714	Fee-for-Service	1285835512	1285835512	1	1	PARDO, PATRICIA E MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99323	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
101729	Fee-for-Service	1992747521	1992747521	1	1	PIRAU, MIHAELA MD	12/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52442	26	Psychiatry (child)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
101769	Fee-for-Service	1063690717	1063690717	1	1	PARMAR, HARPREET S MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136114	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1148-3 NORMAN DRIVE	None	MANTECA	CA	95336	5961	39	06077	37.79420383	-121.2001656	San Joaquin County
101793	Fee-for-Service	1598053795	1598053795	1	1	PRIMARY ANESTHESIA SERVICES	4/5/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	PC	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
101802	Fee-for-Service	1275180580	1275180580	1	3	PROSCRIPT PHARMACY INC	8/29/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7462 N FRESNO ST	None	FRESNO	CA	93720	2404	10	06019	36.845919	-119.7836615	Fresno County
101805	Fee-for-Service	1255527917	1255527917	1	1	PATERNO, CAROLINE C MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100898	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
101826	Fee-for-Service	1184730046	1184730046	1	1	PECHOTA, JOANN LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	115 BRADFORD ST	None	SONORA	CA	95370	4956	55	06109	37.983899	-120.3849081	Tuolumne County
101858	Fee-for-Service	1821721994	1821721994	1	1	PROSPERITY SENIOR LIVING LLC	4/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1455 ANITA STREET	None	UPLAND	CA	91786	2815	36	06071	34.10908203	-117.6297827	San Bernardino County
101887	Fee-for-Service	1255337630	1255337630	1	1	PAMPALONE, AJ DO	3/8/2025	207RN0300X	NA	Nephrology	026	PHYSICIANS	22364	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
101908	Fee-for-Service	1841411709	1841411709	1	1	PETERS, JACOB K MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	33404	40	Pediatrics	0	In state provider	None	1415 N ACACIA AVENUE	None	REEDLEY	CA	93654	2102	10	06019	36.60882634	-119.4510393	Fresno County
101920	Fee-for-Service	1750647913	1750647913	1	1	PHILIP DAUGHERTY	1/9/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 N 3RD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
101922	Fee-for-Service	1124663455	1124663455	1	1	PHYSICIAN AT HOME INC	7/10/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7923 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4225	30	06059	33.77386849	-117.994176	Orange County
101924	Fee-for-Service	1194705202	1194705202	1	1	PALO VERDE HEALTHCARE	1/1/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
101928	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	8/28/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
101947	Fee-for-Service	1871525378	1871525378	1	1	PUCK, JENNIFER M MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87720	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
102002	Fee-for-Service	1811200538	1811200538	1	1	PREMIER SURGICAL ASSOCIATES	2/18/2011	193400000X	NA	Other	026	PHYSICIANS	88275	02	General Surgery	0	In state provider	INC	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
102009	Fee-for-Service	1538738265	1538738265	1	1	PESQUEIRA, JUAN P MD	4/10/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
102015	Fee-for-Service	1720209042	1720209042	1	1	PROJECT SIX	6/6/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9205 VALJEAN AVE	None	NORTH HILLS	CA	91343	3819	19	06037	34.23778116	-118.4873	Los Angeles County
102051	Fee-for-Service	1568526457	1568526457	1	1	PARIKH, SEFALI D MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108379	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
102068	Fee-for-Service	1285263574	1285263574	1	1	PEGASUS TRANSIT INC	5/21/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	210 BEEDY ST	None	OXNARD	CA	93036	1006	56	06111	34.2562782	-119.156447	Ventura County
102076	Fee-for-Service	1649718172	1649718172	1	1	PROFESSIONAL IMAGING NETWORK	1/29/2019	261QR0208X	NA	Mammography Provider	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	6363 WILSHIRE BOULEVARD	SUITE 320	LOS ANGELES	CA	90048	5728	19	06037	34.06367823	-118.3675294	Los Angeles County
102081	Fee-for-Service	1598053795	1598053795	1	1	PRIMARY ANESTHESIA SERVICES	4/5/2012	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	PC	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
102088	Fee-for-Service	1083697007	1083697007	1	1	PHENG, SOTHY L MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132666	41	Internal Medicine	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
102094	Fee-for-Service	1609009612	1609009612	1	1	PONCE, JERRY F O	12/22/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
102095	Fee-for-Service	1275609307	1275609307	1	1	PACIFIC PALMS ASSOCIATES INC	12/23/2014	207L00000X	NA	Other	026	PHYSICIANS	7333	05	Anesthesiology	0	In state provider	None	250 SOUTH GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
102114	Fee-for-Service	1033629001	1033629001	1	1	PEREZ, SHARON S CRNA	1/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
102169	Fee-for-Service	1104879923	1104879923	1	1	PRINDIVILLE, THOMAS MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40251	10	Gastroenterology (M.D. only)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
102173	Fee-for-Service	1255337630	1255337630	1	1	PAMPALONE, AJ DO	3/8/2025	207RN0300X	NA	Nephrology	026	PHYSICIANS	22364	45	Nephrology (Renal-Kidney)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
102199	Fee-for-Service	1295979060	1295979060	1	1	PEREZ, AIDE R MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106670	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
102202	Fee-for-Service	1598816308	1598816308	1	1	PATEL, KISHAN B MD	1/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99724	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
102214	Fee-for-Service	1194705202	1194705202	1	1	PALO VERDE HEALTHCARE	1/1/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	250 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.61293	-114.5955035	Riverside County
102217	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
102221	Fee-for-Service	1437316668	1437316668	1	1	PURAWAT, SAPNA MD	7/7/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	160805	None	None	0	In state provider	None	1811 GRAND CANAL BLVD ST	None	STOCKTON	CA	95207	8107	39	06077	37.98649588	-121.3277333	San Joaquin County
102223	Fee-for-Service	1902966377	1902966377	1	1	PAN, ANN H MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77795	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
102251	Fee-for-Service	1932432192	1932432192	1	1	PALMER, EVA M LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
102255	Fee-for-Service	1972278067	1972278067	1	1	PUTNAM, CHAD P	2/7/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1185 MAGNOLIA AVENUE	SUITE C-D	CORONA	CA	92879	3218	33	06065	33.86372325	-117.5461972	Riverside County
102271	Fee-for-Service	1669851481	1669851481	1	1	PHILLIPS, AMANDA	5/26/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4667 RANCHVIEW CIRCLE	None	HUNTINGTON BEACH	CA	92649	3862	30	06059	33.71857752	-118.048374	Orange County
102275	Fee-for-Service	1972057404	1972057404	1	1	PARKS, JENNIFER K OD	11/3/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
102286	Fee-for-Service	1558380923	1558380923	1	1	PILLARS, JAMES R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	3707	00	None	41.98844808	-87.81251188	Cook County
102296	Fee-for-Service	1497895973	1497895973	1	1	PINA, MARY E CRNA	11/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
102307	Fee-for-Service	1922584747	1922584747	1	1	PAVEL MOLDAVSKIY MD PC	9/24/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	None	46	Hand Surgery	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
102311	Fee-for-Service	1437705456	1437705456	1	2	PINNACLE SJIR	2/10/2021	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	145 TREVINO AVE	None	MANTECA	CA	95337	4200	39	06077	37.79842002	-121.2404921	San Joaquin County
102365	Fee-for-Service	1609933696	1609933696	1	1	PIAZZA, FRED J PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
102382	Fee-for-Service	1528380607	1528380607	1	1	PARK, JUNG HWA S LAC	3/15/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 N TUSTIN AVE	SUITE 302	SANTA ANA	CA	92705	3612	30	06059	33.752286	-117.8341735	Orange County
102438	Fee-for-Service	1750017588	1750017588	1	1	POSEY, CHERYL L LCSW	12/9/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16195 SISKIYOU RD.	120B	APPLE VALLEY	CA	92307	1346	36	06071	34.54549098	-117.2671509	San Bernardino County
102439	Fee-for-Service	1912359449	1912359449	1	1	PROREHAB HEALTHCARE GROUP	12/29/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF COMPANIES	4725 FIRST ST	SUITE 274	PLEASANTON	CA	94566	7136	01	06001	37.65692944	-121.8767827	Alameda County
102441	Fee-for-Service	1780630087	1780630087	1	2	PETROLEUM HELICOPTER INC	1/1/2005	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	PHI AIR MED/AIR MED TEAM	10713 AIRPORT RD	None	COLUMBIA	CA	95310	9727	55	06109	38.03139	-120.413511	Tuolumne County
102469	Fee-for-Service	1144253675	1144253675	1	1	PALMER, SHAWN L MD INC	2/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66126	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2160 E BIDWELL ST	None	FOLSOM	CA	95630	6453	34	06067	38.667483	-121.143969	Sacramento County
102510	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
102517	Fee-for-Service	1982871729	1982871729	1	1	PEDIATRICS & NEONATOLOGY	4/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MED GRP OF ORANGE CO INC	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
102533	Fee-for-Service	1710220439	1710220439	1	2	PACIFIC CENTRAL COAST HEALTH	12/11/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	316 STRATFORD AVE	SUITE A	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
102560	Fee-for-Service	1669851481	1669851481	1	1	PHILLIPS, AMANDA	5/26/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4667 RANCHVIEW CIRCLE	None	HUNTINGTON BEACH	CA	92649	3862	30	06059	33.71857752	-118.048374	Orange County
102562	Fee-for-Service	1265737142	1265737142	1	1	PRENTICE, CHAU N	5/31/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 B VERNON ST	None	ROSEVILLE	CA	95678	2600	31	06061	38.74793156	-121.2853565	Placer County
102565	Fee-for-Service	1548619034	1548619034	1	1	PITTMAN, LATARSHA C CNP	10/1/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
102578	Fee-for-Service	1962716415	1962716415	1	1	PROHEALTH PARTNERS A MEDICAL	2/16/2016	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	350 W 5TH ST	STE 209	SAN PEDRO	CA	90731	2752	19	06037	33.73971779	-118.2852574	Los Angeles County
102585	Fee-for-Service	1669405650	1669405650	1	2	PATTERSON, ELENA O MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64360	05	Anesthesiology	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
102596	Fee-for-Service	1922584747	1922584747	1	1	PAVEL MOLDAVSKIY MD PC	9/24/2018	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
102604	Fee-for-Service	1730575051	1730575051	1	1	PATEL, SAGAR MD	6/22/2021	390200000X	NA	Other	026	PHYSICIANS	167012	None	None	0	In state provider	None	1100 N TUSTIN AVE	UNIT A	SANTA ANA	CA	92705	3505	30	06059	33.754707	-117.8342455	Orange County
102628	Fee-for-Service	1962549279	1962549279	1	1	PEACE, SHERRI I MD INC	7/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72196	None	None	0	In state provider	None	8930 S SEPULVEDA BLVD	STE 104	LOS ANGELES	CA	90045	3606	19	06037	33.955128	-118.3961915	Los Angeles County
102635	Fee-for-Service	1902107840	1902107840	1	1	PAI, SOUMYA MD	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	118125	02	General Surgery	0	In state provider	None	1105 E SPRUCE AVE	STE 201	FRESNO	CA	93720	3313	10	06019	36.839466	-119.762685	Fresno County
102685	Fee-for-Service	1548469372	1548469372	1	1	PAXTON, BEN MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	101 CIVIC CENTER LN LAKE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
102693	Fee-for-Service	1386693109	1386693109	1	1	PACIFIC IMAGING LLC	10/12/2010	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	510 N PROSPECT AVE	STE 101	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
102728	Fee-for-Service	1316911100	1316911100	1	1	POMONA VALLEY OPTOMETRY	6/23/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1900 ROYALTY DR	STE 100	POMONA	CA	91767	3048	19	06037	34.07754346	-117.7463466	Los Angeles County
102733	Fee-for-Service	1346561412	1346561412	1	1	PENWELL, SEAN M MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121260	01	General Practice	0	In state provider	None	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
102740	Fee-for-Service	1922207471	1922207471	1	1	PURI, NISHANT MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110054	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
102746	Fee-for-Service	1477572725	1477572725	1	1	PLOTKIN, DAVID P PHD	5/11/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
102750	Fee-for-Service	1881801413	1881801413	1	1	PERKINS, ERIK F MD	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	69544	13	Neurology (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
102758	Fee-for-Service	1144253675	1144253675	1	1	PALMER, SHAWN L MD INC	2/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66126	18	Ophthalmology	0	In state provider	None	2160 E BIDWELL ST	None	FOLSOM	CA	95630	6453	34	06067	38.667483	-121.143969	Sacramento County
102784	Fee-for-Service	1891951638	1891951638	1	1	PENG, YEN-YI MD	2/5/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	236 W 6TH ST	STE 401	RENO	NV	89503	4553	00	None	39.53151304	-119.8186228	Washoe County
102794	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
102813	Fee-for-Service	1457748089	1457748089	1	1	PINO, ALEJANDRO MD	8/18/2021	390200000X	NA	Other	026	PHYSICIANS	172405	None	None	0	In state provider	None	326 SANTA FE DRIVE	100	ENCINITAS	CA	92024	5138	37	06073	33.040332	-117.285102	San Diego County
102820	Fee-for-Service	1841503570	1841503570	1	1	PORTOCARRERO, DONALD J	8/28/2017	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	11058	10	Gastroenterology (M.D. only)	0	In state provider	None	850 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	6700	19	06037	34.05097684	-118.1379979	Los Angeles County
102839	Fee-for-Service	1346305703	1346305703	1	1	POWELL, KHARIS E PHD	8/22/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	755 S. FAIRMONT AVE.	A2	LODI	CA	95240	4643	39	06077	38.125089	-121.285886	San Joaquin County
102871	Fee-for-Service	1316617665	1316617665	1	1	PEREZ GARCIA, ABIGAIL	9/30/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21077 TELEGRAPH RD	None	RIVERSIDE	CA	92507	0049	33	06065	34.00741012	-117.2948401	Riverside County
102872	Fee-for-Service	1699986034	1699986034	1	2	PACIFIC HEALTH SERVICES INC	8/17/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2501 W BURBANK BLVD	SUITE 309	BURBANK	CA	91505	2347	19	06037	34.17861961	-118.3385265	Los Angeles County
102889	Fee-for-Service	1649500844	1649500844	1	1	PANCHAL, DHANU J MD	2/5/2022	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	121775	None	None	0	In state provider	None	115 CAPITOL STREET	None	SALINAS	CA	93906	2013	27	06053	36.67556044	-121.660579	Monterey County
102903	Fee-for-Service	1023190808	1023190808	1	1	PAI, DAVID S MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99155	45	Nephrology (Renal-Kidney)	0	In state provider	None	77 CADILLAC DR	STE 130	SACRAMENTO	CA	95825	8337	34	06067	38.572551	-121.4181585	Sacramento County
102911	Fee-for-Service	1184246050	1184246050	1	1	PFLUGRATH, ANGELA MD	11/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20562	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
102952	Fee-for-Service	1780051441	1780051441	1	2	PEKLO, SARAH LMFT	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
102956	Fee-for-Service	1053861328	1053861328	1	1	PEOPLE COORDINATED SERVICES	6/13/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	OF SOUTHERN CALIFORNIA	3021 S VERMONT AVE	None	LOS ANGELES	CA	90007	3033	19	06037	34.027218	-118.2915675	Los Angeles County
102976	Fee-for-Service	1801474796	1801474796	1	1	PEI, BING MD	8/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102978	Fee-for-Service	1053082586	1053082586	1	2	PIPELINE COMMUNITY SPECIALTY	12/5/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC	4060 EAST WHITTIER BLVD.	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
102997	Fee-for-Service	1326374737	1326374737	1	1	PAHLAVANI, MEHRI CRNA	2/9/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
103016	Fee-for-Service	1861540890	1861540890	1	1	PHAM, DIANE V MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93131	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
103029	Fee-for-Service	1396903043	1396903043	1	1	PATEL, MILAN C MD INC	6/10/2008	207R00000X	NA	Other	026	PHYSICIANS	82214	13	Neurology (M.D. only)	0	In state provider	None	4767 SOQUEL DR	None	SOQUEL	CA	95073	2457	44	06087	36.98856536	-121.956175	Santa Cruz County
103048	Fee-for-Service	1972714954	1972714954	1	1	PATEL, MINITA S MD	7/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55869	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
103063	Fee-for-Service	1457457640	1457457640	1	1	PATTENGALE, PAUL K MD	9/1/1995	207ZP0213X	NA	Other	026	PHYSICIANS	27859	22	Pathology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
103066	Fee-for-Service	1942833066	1942833066	1	1	PAUL, HEATHER L CNP	9/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	01	06001	37.53249631	-121.9198141	Alameda County
103081	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
103092	Fee-for-Service	1114287711	1114287711	1	1	PANOSSIAN, HAIG MD	5/12/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	157546	None	None	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
103107	Fee-for-Service	1740432475	1740432475	1	1	PAPAJOHN, ANDRE J LCSW	3/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
103121	Fee-for-Service	1295812204	1295812204	1	1	PEREZ, FRANCIS X MD	11/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
103157	Fee-for-Service	1316617665	1316617665	1	1	PEREZ GARCIA, ABIGAIL	9/30/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21077 TELEGRAPH RD	None	RIVERSIDE	CA	92507	0049	33	06065	34.00741012	-117.2948401	Riverside County
103194	Fee-for-Service	1619296142	1619296142	1	1	PATEL, KAUSHIK V MD INC	1/24/2011	207R00000X	NA	Other	026	PHYSICIANS	48373	None	None	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
103246	Fee-for-Service	1508165721	1508165721	1	1	PITTA, MICHAEL Z MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146659	20	Orthopedic Surgery	0	In state provider	None	12 UPPER RAGSDALE	STE A	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
103254	Fee-for-Service	1548225428	1548225428	1	1	PHYSICIANS IMMUNODIAGNOSTIC	8/18/1994	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY	512 S VERDUGO DR	None	BURBANK	CA	91502	2344	19	06037	34.170102	-118.3124179	Los Angeles County
103257	Fee-for-Service	1528190931	1528190931	2	1	PORT CITY OPERATING COMPANY	6/1/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
103259	Fee-for-Service	1366478372	1366478372	1	1	PARK, JAY H MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	171205	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
103269	Fee-for-Service	1881283877	1881283877	1	1	PHARMACY ALLY, INC	7/29/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3400 W BALL RD	STE 211A	ANAHEIM	CA	92804	3738	30	06059	33.81724472	-118.0083216	Orange County
103299	Fee-for-Service	1972736189	1972736189	1	1	PARKER, MARLOW E LCSW	1/16/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	686 RIO LINDO AVE	SUITE 13	CHICO	CA	95926	1818	04	06007	39.75287709	-121.8473661	Butte County
103304	Fee-for-Service	1376980169	1376980169	1	1	PAREDES, ROBERT R MD INC	6/24/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	41527	08	Family Practice	0	In state provider	None	31411 CAMINO CAPISTRANO	SUITE 100	SAN JUAN CAPISTRA	CA	92675	2660	30	06059	33.50646704	-117.6650296	Orange County
103317	Fee-for-Service	1396903043	1396903043	1	1	PATEL, MILAN C MD INC	6/10/2008	207R00000X	NA	Other	026	PHYSICIANS	82214	41	Internal Medicine	0	In state provider	None	4767 SOQUEL DR	None	SOQUEL	CA	95073	2457	44	06087	36.98856536	-121.956175	Santa Cruz County
103334	Fee-for-Service	1841378502	1841378502	1	1	POSEY, ELIZABETH B MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54596	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
103350	Fee-for-Service	1881792356	1881792356	1	1	PRIETO, FRANCISCO J MD	7/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57405	08	Family Practice	0	In state provider	None	1219 30TH ST	None	SACRAMENTO	CA	95816	5208	34	06067	38.570175	-121.4674245	Sacramento County
103371	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
103414	Fee-for-Service	1215617501	1215617501	1	1	PORTER, LEIGH CCC-SLP	10/16/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
103461	Fee-for-Service	1306043195	1306043195	1	1	PETROFF, LINDA MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103388	None	None	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
103505	Fee-for-Service	1780002154	1780002154	1	1	POGATCHNIK, BRIAN P MD	6/17/2019	390200000X	NA	Other	026	PHYSICIANS	161060	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
103511	Fee-for-Service	1316045966	1316045966	1	1	PILLAI, LAKSHMIKUMAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 STADIUM DR	None	MORGANTOWN	WV	26506	7911	00	None	39.65345878	-79.95562791	Monongalia County
103516	Fee-for-Service	1740444157	1740444157	1	1	PRIMA MEDICAL GROUP INC	10/8/2008	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3 HARBOR DR	STE 111	SAUSALITO	CA	94965	1421	21	06041	37.86773211	-122.4997676	Marin County
103544	Fee-for-Service	1528190931	1528190931	2	1	PORT CITY OPERATING COMPANY	6/1/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
103553	Fee-for-Service	1710975727	1710975727	1	1	PLANNED PARENTHOOD/	3/15/1990	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	303 W LINCOLN AVE	STE 105	ANAHEIM	CA	92805	2928	30	06059	33.83508976	-117.9177981	Orange County
103559	Fee-for-Service	1083668248	1083668248	1	1	PANT, SUSHMA MD	1/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	58840	78	Neoplastic Diseases/Oncology	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
103579	Fee-for-Service	1649207101	1649207101	1	1	POPE, TROY T MD	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90927	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
103606	Fee-for-Service	1386694040	1386694040	1	1	PIAMPIANO, PETER P MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67523	None	None	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
103624	Fee-for-Service	1841378502	1841378502	1	1	POSEY, ELIZABETH B MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54596	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
103657	Fee-for-Service	1639252604	1639252604	1	4	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
103668	Fee-for-Service	1346453578	1346453578	1	1	PEREZ JR., JOB LMFT	6/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
103679	Fee-for-Service	1093703563	1093703563	1	1	PENA, ERIC A MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	555 BLACK OAK DR	STE 200	MEDFORD	OR	97504	8491	00	None	42.318873	-122.835653	Jackson County
103689	Fee-for-Service	1871253971	1871253971	1	1	PATEL, SANIL	4/18/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
103707	Fee-for-Service	1437513918	1437513918	1	1	PATTEN, ALLISON DO	9/26/2023	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
103720	Fee-for-Service	1891709192	1891709192	1	1	PORTERCARE ADVENTIST HEALTH	10/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	100 HEALTH PARK DR	None	LOUISVILLE	CO	80027	9583	00	None	39.95140925	-105.1512857	Boulder County
103741	Fee-for-Service	1114131737	1114131737	1	1	PHAM, THU D PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
103754	Fee-for-Service	1700890514	1700890514	1	1	PROVIDENCE HEALTH SYSTEM-	11/1/2005	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	5315 TORRANCE BLVD	SUITE B 169	TORRANCE	CA	90503	4011	19	06037	33.83759847	-118.370277	Los Angeles County
103782	Fee-for-Service	1417110586	1417110586	1	1	PAWAR, GAGAN MD	5/24/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	116898	08	Family Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
103787	Fee-for-Service	1548223712	1548223712	1	1	PHAM, HAI H MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70164	41	Internal Medicine	0	In state provider	None	9600 BOLSA AVE	STE F	WESTMINSTER	CA	92683	5949	30	06059	33.74479453	-117.9619155	Orange County
103795	Fee-for-Service	1164596912	1164596912	1	1	PERRY, JEANINE M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
103816	Fee-for-Service	1003913831	1003913831	1	1	PAMARAN, MARIA V MD	9/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53592	40	Pediatrics	0	In state provider	None	10230 ARTESIA BLVD	STE 302	BELLFLOWER	CA	90706	6769	19	06037	33.8728276	-118.1160403	Los Angeles County
103821	Fee-for-Service	1699298752	1699298752	1	1	PERLOFF, ISAAC D	10/26/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
103850	Fee-for-Service	1083668248	1083668248	1	1	PANT, SUSHMA MD	1/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	58840	68	Hematology	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
103857	Fee-for-Service	1982698759	1982698759	1	1	POLLICK, CHARLES MD	4/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51040	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	41210 11TH ST W	STE G	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
103862	Fee-for-Service	1700144656	1700144656	1	1	PADILLA, CESAR R MD	4/22/2021	207L00000X	NA	Other	026	PHYSICIANS	131221	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
103867	Fee-for-Service	1578228219	1578228219	1	1	PRIETO, CARINA M NP	3/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23080 ALESSANDRO BLVD	#202	MORENO VALLEY	CA	92553	9674	33	06065	33.91731429	-117.2599095	Riverside County
103892	Fee-for-Service	1851795587	1851795587	1	1	PAIGE-HILLEY, MICHELLE M NP	12/4/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
103899	Fee-for-Service	1801112024	1801112024	1	1	PIROLO, JOSEPH M MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	117997	20	Orthopedic Surgery	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
103905	Fee-for-Service	1568826923	1568826923	1	1	PRATT, LANDON	9/6/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
103906	Fee-for-Service	1962072280	1962072280	1	1	PURE QUALITY HOSPICE	10/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	241 E COLORADO BLVD	STE 200	PASADENA	CA	91101	6138	19	06037	34.14584445	-118.14543	Los Angeles County
103940	Fee-for-Service	1730212432	1730212432	1	2	PROHEALTH PARTNERS	8/21/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP	2777 PACIFIC AVE	SUITE E	LONG BEACH	CA	90806	2626	19	06037	33.80761478	-118.193744	Los Angeles County
103954	Fee-for-Service	1023032588	1023032588	1	1	PROVIDENCE HEALTH AND	3/11/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES MT	500 W BROADWAY ST	None	MISSOULA	MT	59802	4096	00	None	46.87419951	-114.0007525	Missoula County
103967	Fee-for-Service	1952431181	1952431181	1	1	PONTEJOS-MURPHY, TERESIT	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67602	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
103984	Fee-for-Service	1588850382	1588850382	1	1	PRESTON-HSU, ELISABETH J MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112666	25	Physical Medicine and Rehabilitation	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
104009	Fee-for-Service	1790761138	1790761138	1	1	PRESBYTERIAN HEALTHCARE	5/15/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1202 HIGHWAY 60 WEST	None	SOCORRO	NM	87801	3914	00	None	34.0381073	-106.9123466	Socorro County
104017	Fee-for-Service	1336173269	1336173269	1	3	PROVIDENCE HEALTH SYSTEM	8/22/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	181 S BUENA VISTA ST	SUITE 110	BURBANK	CA	91505	4504	19	06037	34.15958049	-118.328816	Los Angeles County
104021	Fee-for-Service	1447836333	1447836333	1	1	PREFERRED HOSPICE INC	9/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1101 E BROADWAY	STE 206	GLENDALE	CA	91205	1394	19	06037	34.14628021	-118.2414675	Los Angeles County
104069	Fee-for-Service	1770533069	1770533069	1	1	PFEFFER, ANDREA M CNM	3/21/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
104078	Fee-for-Service	1457514168	1457514168	1	1	PATEL, NEHALI MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120571	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104098	Fee-for-Service	1457607913	1457607913	1	1	PATEL, SHILPA V MD	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122339	41	Internal Medicine	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
104105	Fee-for-Service	1861643066	1861643066	1	1	PANDEY, NEHA MD	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98266	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104106	Fee-for-Service	1811123607	1811123607	1	1	PIKE, LYNN M	6/11/2009	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9454 RANCH PARK WAY	None	ELK GROVE	CA	95624	1821	34	06067	38.413143	-121.3766865	Sacramento County
104163	Fee-for-Service	1295730604	1295730604	1	1	PEKEROL, MEHMET C MD INC	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51117	77	Infectious Disease	0	In state provider	None	9201 W SUNSET BLVD	SUITE 616	WEST HOLLYWOOD	CA	90069	3707	19	06037	34.09054375	-118.392295	Los Angeles County
104167	Fee-for-Service	1760469258	1760469258	1	1	PRYOR, SHEPHERD G MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96325	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
104192	Fee-for-Service	1962072280	1962072280	1	1	PURE QUALITY HOSPICE	10/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	241 E COLORADO BLVD	STE 200	PASADENA	CA	91101	6138	19	06037	34.14584445	-118.14543	Los Angeles County
104194	Fee-for-Service	1477871655	1477871655	1	1	PARK, BRIAN K MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141524	20	Orthopedic Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
104242	Fee-for-Service	1023032588	1023032588	1	1	PROVIDENCE HEALTH AND	3/11/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES MT	500 W BROADWAY ST	None	MISSOULA	MT	59802	4096	00	None	46.87419951	-114.0007525	Missoula County
104249	Fee-for-Service	1326006800	1326006800	1	1	PETCHER, RONALD C MD	11/27/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	31847	30	Radiology	0	In state provider	None	10 CONGRESS ST	STE 102	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
104295	Fee-for-Service	1790761138	1790761138	1	1	PRESBYTERIAN HEALTHCARE	5/15/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1202 HIGHWAY 60 WEST	None	SOCORRO	NM	87801	3914	00	None	34.0381073	-106.9123466	Socorro County
104307	Fee-for-Service	1285754598	1285754598	1	2	PLANNED PARENTHOOD/ORANGE AN	2/28/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	D SAN BERNARDINO COUNT	303 W. LINCOLN AVENUE	SUITE 105	ANAHEIM	CA	92805	2928	30	06059	33.83508976	-117.9177981	Orange County
104310	Fee-for-Service	1447836333	1447836333	1	1	PREFERRED HOSPICE INC	9/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1101 E BROADWAY	STE 206	GLENDALE	CA	91205	1394	19	06037	34.14628021	-118.2414675	Los Angeles County
104339	Fee-for-Service	1275160632	1275160632	1	1	PROTOPSALTIS, NICHOLAS J	1/30/2025	207ZP0105X	NA	Other	026	PHYSICIANS	182801	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104360	Fee-for-Service	1396032702	1396032702	1	1	PADILLA, YVETTE MD	6/23/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	123336	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 S WELLS RD	SUITE 100	VENTURA	CA	93004	1302	56	06111	34.29321532	-119.1597424	Ventura County
104366	Fee-for-Service	1871602367	1871602367	1	1	PAYLESS DRUG STORE 6059	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	2111 GOLDEN CENTRE LN	None	RANCHO CORDOVA	CA	95670	4477	34	06067	38.626596	-121.264011	Sacramento County
104367	Fee-for-Service	1457514168	1457514168	1	1	PATEL, NEHALI MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120571	10	Gastroenterology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104369	Fee-for-Service	1649519646	1649519646	1	1	PURDOM II, KENNETH R MD INC	10/3/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21180	None	None	0	In state provider	None	12311 S NORWALK BLVD	None	NORWALK	CA	90650	2039	19	06037	33.91930525	-118.0727385	Los Angeles County
104412	Fee-for-Service	1477689651	1477689651	1	1	PURI, SURINDER P MD	9/11/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40165	08	Family Practice	0	In state provider	None	9346 CORBIN AVE	None	NORTHRIDGE	CA	91324	2405	19	06037	34.240563	-118.562272	Los Angeles County
104416	Fee-for-Service	1114124849	1114124849	1	2	PROMISING FUTURES-AGAPE	10/11/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HILLSIDE	12960 HA HANA RD	None	LAKESIDE	CA	92040	5004	37	06073	32.84168178	-116.9101981	San Diego County
104438	Fee-for-Service	1700249190	1700249190	1	1	PETTERSON, MATTHEW B MD	6/11/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171286	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
104440	Fee-for-Service	1447691282	1447691282	1	1	PRIDE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3033 N AVON ST	SUITE B	BURBANK	CA	91504	2014	19	06037	34.2057003	-118.3477203	Los Angeles County
104451	Fee-for-Service	1295730604	1295730604	1	1	PEKEROL, MEHMET C MD INC	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51117	41	Internal Medicine	0	In state provider	None	9201 W SUNSET BLVD	SUITE 616	WEST HOLLYWOOD	CA	90069	3707	19	06037	34.09054375	-118.392295	Los Angeles County
104512	Fee-for-Service	1467540021	1467540021	1	1	PECKSON, LOUELLA L MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53093	40	Pediatrics	0	In state provider	FRIENDLY HILLS MED GRP	14624 SHERMAN WAY	STE 506	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
104530	Fee-for-Service	1770901365	1770901365	1	1	PEGGY SANDBERG PROFESSIONAL	9/20/2016	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	NURSING CORP	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
104622	Fee-for-Service	1407099633	1407099633	1	1	PACKARD, RENE R S MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118124	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
104639	Fee-for-Service	1821010315	1821010315	2	1	PROVIDENCE HEALTH SYSTEM	8/2/2006	3336I0012X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
104651	Fee-for-Service	1659021608	1659021608	1	1	PALASSOU, KELSEY LMFT	10/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
104661	Fee-for-Service	1790044998	1790044998	1	1	PEROTTI, DEENA H MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128271	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
104666	Fee-for-Service	1962701417	1962701417	1	1	PADDOCK, MADISON E MD	9/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130385	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
104728	Fee-for-Service	1447691282	1447691282	1	1	PRIDE HOSPICE CARE INC	12/15/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3033 N AVON ST	SUITE B	BURBANK	CA	91504	2014	19	06037	34.2057003	-118.3477203	Los Angeles County
104733	Fee-for-Service	1942811260	1942811260	1	1	PETER MANN MD INC	8/24/2023	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	7634 GIRARD AVE	None	LA JOLLA	CA	92037	4420	37	06073	32.84272306	-117.2732995	San Diego County
104749	Fee-for-Service	1992200315	1992200315	1	1	PAPUKHYAN, HAYK V MD	2/10/2023	207R00000X	NA	Other	026	PHYSICIANS	174237	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
104799	Fee-for-Service	1467540021	1467540021	1	1	PECKSON, LOUELLA L MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53093	01	General Practice	0	In state provider	FRIENDLY HILLS MED GRP	14624 SHERMAN WAY	STE 506	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
104801	Fee-for-Service	1891954020	1891954020	1	1	PASYAR, NEDA MD	11/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109547	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
104867	Fee-for-Service	1023181898	1023181898	1	1	PATEL, REINA M. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
104873	Fee-for-Service	1407817265	1407817265	1	1	PHAN, TRANG OD	11/21/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31573 RANCHO PUEBLO RD	STE 101	TEMECULA	CA	92592	4835	33	06065	33.4795997	-117.1092187	Riverside County
104893	Fee-for-Service	1982043519	1982043519	1	1	PREIKSCHAT, AMANDA R	8/8/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
104908	Fee-for-Service	1063634541	1063634541	1	1	PEPPERMINT RIDGE	5/28/2002	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ROGER RESIDENCE	825 MAGNOLIA AVE	None	CORONA	CA	92879	3129	33	06065	33.86004536	-117.5526662	Riverside County
104911	Fee-for-Service	1407099633	1407099633	1	1	PACKARD, RENE R S MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	118124	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
104933	Fee-for-Service	1780856914	1780856914	3	1	PALMIERI PHARMACY INC	2/2/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 MAGNOLIA AVE	SUITE 116	CORONA	CA	92879	3123	33	06065	33.85979137	-117.5527252	Riverside County
104958	Fee-for-Service	1427662030	1427662030	1	1	PARSONS, JOHN C AU	11/6/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 SAN PABLO STREET	SUITE 5901	LOS ANGELES	CA	90033	5313	19	06037	34.06189518	-118.203256	Los Angeles County
104965	Fee-for-Service	1609291947	1609291947	1	1	PENA, ALEXANDRA M LMFT	10/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
104983	Fee-for-Service	1861889644	1861889644	1	1	PROHASKA, THOMAS A MD	8/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150882	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
105021	Fee-for-Service	1326045709	1326045709	1	1	PASSAGE ENTERPRISES INC	4/25/2003	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY CARE HOSPICE	222 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3356	19	06037	34.13597982	-117.8676393	Los Angeles County
105068	Fee-for-Service	1336173269	1336173269	1	1	PROVIDENCE HEALTH SYSTEM	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	501 S BUENA VISTA	None	BURBANK	CA	91505	4866	19	06037	34.15729818	-118.3277073	Los Angeles County
105083	Fee-for-Service	1326651449	1326651449	1	1	PRESTIGE HOSPICE CARE	5/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNY	STE 101A	SANTA CLARITA	CA	91355	1256	19	06037	34.43517857	-118.5722781	Los Angeles County
105088	Fee-for-Service	1467540021	1467540021	1	1	PECKSON, LOUELLA L MD	8/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53093	66	Emergency Medicine (Urgent Care)	0	In state provider	FRIENDLY HILLS MED GRP	14624 SHERMAN WAY	STE 506	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
105107	Fee-for-Service	1437125770	1437125770	1	1	PATEL, TEJAS I MD	8/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88498	41	Internal Medicine	0	In state provider	None	14901 RINALDI ST	STE 200	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
105108	Fee-for-Service	1013335199	1013335199	1	1	PONEC, RYAN M MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141382	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
105115	Fee-for-Service	1720401607	1720401607	1	1	PIONEERS MEMORIAL HEALTHCARE	1/16/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	751 W LEGION RD	SUITE 103	BRAWLEY	CA	92227	7780	13	06025	32.95996012	-115.5538196	Imperial County
105164	Fee-for-Service	1356382295	1356382295	1	1	PAMULA, RAMESH B MD	12/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55426	33	Thoracic Surgery	0	In state provider	None	30 RIVER PARK	#260	FRESNO	CA	93720	1545	10	06019	36.85760572	-119.7885206	Fresno County
105174	Fee-for-Service	1417338047	1417338047	1	1	PEAIRS, ALLISON J	8/4/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
105185	Fee-for-Service	1912164583	1912164583	1	1	POYAN MEHR, ALI MD	9/28/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	158232	45	Nephrology (Renal-Kidney)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
105215	Fee-for-Service	1114052867	1114052867	1	1	PONCEDELEON, ANTONIETA LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109100	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
105266	Fee-for-Service	1841560802	1841560802	1	1	PAUL W PARK MEDICAL GROUP	1/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	91067	18	Ophthalmology	0	In state provider	INC	4278 W 3RD STREET	None	LOS ANGELES	CA	90020	3449	19	06037	34.06895995	-118.3074675	Los Angeles County
105306	Fee-for-Service	1326045709	1326045709	1	1	PASSAGE ENTERPRISES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY CARE HOSPICE	222 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3356	19	06037	34.13597982	-117.8676393	Los Angeles County
105307	Fee-for-Service	1952403396	1952403396	1	1	PHAM, DAVID P DO	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7848	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
105350	Fee-for-Service	1093255374	1093255374	1	1	POTTS, KATIE LMFT	2/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
105359	Fee-for-Service	1336173269	1336173269	1	1	PROVIDENCE HEALTH SYSTEM	4/1/1983	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	501 S BUENA VISTA	None	BURBANK	CA	91505	4866	19	06037	34.15729818	-118.3277073	Los Angeles County
105370	Fee-for-Service	1326651449	1326651449	1	1	PRESTIGE HOSPICE CARE	5/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNY	STE 101A	SANTA CLARITA	CA	91355	1256	19	06037	34.43517857	-118.5722781	Los Angeles County
105393	Fee-for-Service	1801800594	1801800594	1	1	PORTERCARE ADVENTIST HEALTH	5/10/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	2525 S DOWNING ST	None	DENVER	CO	80210	5817	00	None	39.670326	-104.9735195	Denver County
105402	Fee-for-Service	1720401607	1720401607	1	1	PIONEERS MEMORIAL HEALTHCARE	3/21/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	751 W LEGION RD	SUITE 103	BRAWLEY	CA	92227	7780	13	06025	32.95996012	-115.5538196	Imperial County
105436	Fee-for-Service	1073122156	1073122156	1	1	PATHWAYS FAMILY COUNSELING P	11/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11590 W BERNARDO CT	230	SAN DIEGO	CA	92127	1662	37	06073	33.020508	-117.0809128	San Diego County
105471	Fee-for-Service	1184877003	1184877003	1	1	POON, SELINA MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141460	None	None	0	In state provider	None	3160 GENEVA ST	None	LOS ANGELES	CA	90020	1117	19	06037	34.06768353	-118.286397	Los Angeles County
105481	Fee-for-Service	1689622995	1689622995	1	1	POWHANI, AMAR MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88289	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
105496	Fee-for-Service	1538294129	1538294129	1	1	PILYUGINA, SVETLANA A MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89078	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
105611	Fee-for-Service	1265503239	1265503239	1	1	PROVENGHI, MICHAEL S MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86795	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
105656	Fee-for-Service	1922494194	1922494194	1	1	PATEL, JANUSHE P MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153672	41	Internal Medicine	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
105672	Fee-for-Service	1538249776	1538249776	1	1	PAIEMENT, GUY D MD	4/13/1994	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	43183	20	Orthopedic Surgery	0	In state provider	None	1001 POTRERO AVE	STE 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
105682	Fee-for-Service	1801800594	1801800594	1	1	PORTERCARE ADVENTIST HEALTH	5/10/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	2525 S DOWNING ST	None	DENVER	CO	80210	5817	00	None	39.670326	-104.9735195	Denver County
105684	Fee-for-Service	1679924757	1679924757	1	1	PISANELLI, MATTHEW J	1/28/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
105687	Fee-for-Service	1639458680	1639458680	1	1	PIFER, REBECCA NP	3/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
105691	Fee-for-Service	1720401607	1720401607	1	1	PIONEERS MEMORIAL HEALTHCARE	1/16/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	751 W LEGION RD	SUITE 103	BRAWLEY	CA	92227	7780	13	06025	32.95996012	-115.5538196	Imperial County
105731	Fee-for-Service	1528598133	1528598133	1	1	PIRAK, JONATHAN DPM	12/12/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	12520 MAGNOLIA BLVD	#304	VALLEY VILLAGE	CA	91607	2355	19	06037	34.16485451	-118.406106	Los Angeles County
105767	Fee-for-Service	1326402132	1326402132	1	1	PALAKODETY, NAGA SWATHI MD	8/2/2022	208M00000X	NA	Other	026	PHYSICIANS	159122	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
105788	Fee-for-Service	1386723419	1386723419	1	1	PRITIKIN, JONATHAN MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
105828	Fee-for-Service	1225635576	1225635576	1	1	PROACTIVE HOSPICE INC	10/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2777 PACIFIC AVE	STE L1	LONG BEACH	CA	90806	2625	19	06037	33.80761478	-118.193744	Los Angeles County
105830	Fee-for-Service	1881030666	1881030666	1	1	PARK, JUN K MD INC	4/15/2014	207L00000X	NA	Other	026	PHYSICIANS	98074	01	General Practice	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
105843	Fee-for-Service	1174511067	1174511067	1	1	PIERCE, RANDALL A MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59581	30	Radiology	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
105848	Fee-for-Service	1710992284	1710992284	1	1	PITLICK, PAUL T MD	7/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	21607	35	Pediatric Cardiology (M.D. only)	0	In state provider	DEPT OF PEDIATRICS	STANFORD UNIV MED CENTER	None	STANFORD	CA	94305	0000	43	06085	37.41407916	-122.1574664	Santa Clara County
105889	Fee-for-Service	1285625509	1285625509	1	2	PLEASANTON EMERGENCY	2/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP	1133 E STANLEY BLVD	None	LIVERMORE	CA	94550	4200	01	06001	37.67914693	-121.7810206	Alameda County
105935	Fee-for-Service	1750455069	1750455069	1	1	PERALTA, CARMEN A MD	8/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87278	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
105944	Fee-for-Service	1689200842	1689200842	1	1	PRECISE HOSPICE INC	6/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1720 E WASHINGTON BLVD	STE 224	PASADENA	CA	91104	2784	19	06037	34.16909687	-118.1150986	Los Angeles County
105962	Fee-for-Service	1083888515	1083888515	1	1	PEACEHEALTH	8/17/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
105994	Fee-for-Service	1407232937	1407232937	1	1	PENA, RAQUEL M PSYD	1/9/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23 MAIN ST	None	WINTERS	CA	95694	1744	57	06113	38.52163272	-121.9695765	Yolo County
106018	Fee-for-Service	1225076516	1225076516	1	1	PARK, PETER H MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67513	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3511 W OLYMPIC BLVD	STE 201	LOS ANGELES	CA	90019	3563	19	06037	34.0525695	-118.3152015	Los Angeles County
106069	Fee-for-Service	1912015462	1912015462	1	1	PALMERI, MARK L MD	8/21/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50942	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
106071	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
106077	Fee-for-Service	1780061150	1780061150	1	1	PATEL VAIL, SELINA S MD	5/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147437	01	General Practice	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
106116	Fee-for-Service	1225635576	1225635576	1	1	PROACTIVE HOSPICE INC	10/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2777 PACIFIC AVE	STE L1	LONG BEACH	CA	90806	2625	19	06037	33.80761478	-118.193744	Los Angeles County
106137	Fee-for-Service	1710992284	1710992284	1	1	PITLICK, PAUL T MD	7/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	21607	40	Pediatrics	0	In state provider	DEPT OF PEDIATRICS	STANFORD UNIV MED CENTER	None	STANFORD	CA	94305	0000	43	06085	37.41407916	-122.1574664	Santa Clara County
106152	Fee-for-Service	1922669548	1922669548	1	1	PATEL, VIRAJ B DO	11/6/2023	207R00000X	NA	Other	026	PHYSICIANS	21726	None	None	0	In state provider	None	5400 W ROSECRANS AVE	STE 100	LAWNDALE	CA	90260	6609	19	06037	33.90173207	-118.3748814	Los Angeles County
106190	Fee-for-Service	1487137139	1487137139	1	1	PIMENTEL, DANIEL LMFT	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
106234	Fee-for-Service	1689200842	1689200842	1	1	PRECISE HOSPICE INC	6/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1720 E WASHINGTON BLVD	STE 224	PASADENA	CA	91104	2784	19	06037	34.16909687	-118.1150986	Los Angeles County
106242	Fee-for-Service	1003874702	1003874702	2	1	PROHEALTH ADVANCED IMAGING M	9/13/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP, INC	10767 RIVERSIDE DRIVE	None	NORTH HOLLYWOOD	CA	91602	2324	19	06037	34.15228949	-118.365732	Los Angeles County
106244	Fee-for-Service	1871623751	1871623751	1	1	PORTER, TERRY LMFT	7/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23110 ATLANTIC CIR	STE F	MORENO VALLEY	CA	92553	5920	33	06065	33.93308206	-117.2597707	Riverside County
106249	Fee-for-Service	1083888515	1083888515	1	1	PEACEHEALTH	8/17/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
106299	Fee-for-Service	1669050266	1669050266	1	1	PHAN, MINH A DO	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22617	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
106312	Fee-for-Service	1700958774	1700958774	1	1	POTASH, ALBERT G LMFT	7/19/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	20300 S VERMONT AVENUE	STE 245	TORRANCE	CA	90502	1355	19	06037	33.84674039	-118.2903826	Los Angeles County
106327	Fee-for-Service	1306289996	1306289996	1	1	PHI HEALTH, LLC	2/21/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	201 CORPORATE RD	HANGAR 18	LONGVIEW	TX	75603	7055	00	None	32.37962663	-94.71973655	Gregg County
106328	Fee-for-Service	1730212432	1730212432	1	1	PROHEALTH PARTNERS	7/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	4201 TORRANCE BLVD	STE 350	TORRANCE	CA	90503	4573	19	06037	33.8375955	-118.358748	Los Angeles County
106352	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
106370	Fee-for-Service	1669069597	1669069597	1	1	PHILLIPS HEALTHCARE A NURSE	1/26/2021	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	PRACTITIONER LED NURSING	331 S H ST	None	BAKERSFIELD	CA	93304	3403	15	06029	35.35053984	-119.0213687	Kern County
106377	Fee-for-Service	1932335783	1932335783	1	1	POON, ALAN K MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125293	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
106382	Fee-for-Service	1962467258	1962467258	1	1	PUNIM, JEFFREY A MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41751	67	Endocrinology	0	In state provider	#410	3010 W ORANGE AVE	None	ANAHEIM	CA	92804	3169	30	06059	33.82472315	-117.994133	Orange County
106407	Fee-for-Service	1386974194	1386974194	1	1	PISHNEY, JESSICA L LP	7/27/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
106426	Fee-for-Service	1588835961	1588835961	1	1	PALMER, LYNNE M LMFT	9/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
106439	Fee-for-Service	1396778965	1396778965	2	1	PHARMERICA DRUG SYSTEMS LLC	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMERICA	873 RICARDO CT	None	SAN LUIS OBISPO	CA	93401	7174	40	06079	35.25707824	-120.6420263	San Luis Obispo County
106485	Fee-for-Service	1770661423	1770661423	1	2	PANTAZIS, KAREN L MD	10/16/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	42898	03	Allergy	0	In state provider	None	817 COURT ST	SUITE 14	JACKSON	CA	95642	2156	03	06005	38.35288237	-120.7662416	Amador County
106516	Fee-for-Service	1427686237	1427686237	1	1	PERESE, JOSHUA K MD	7/16/2023	207P00000X	NA	Other	026	PHYSICIANS	182892	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
106541	Fee-for-Service	1346384195	1346384195	1	1	PIROOZ PHARMACY INC	6/4/1996	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	11701 WILSHIRE BLVD	STE 3	LOS ANGELES	CA	90025	1546	19	06037	34.04921797	-118.4612221	Los Angeles County
106573	Fee-for-Service	1871813097	1871813097	1	1	PIDLAOAN, VICTORIO P MD	6/28/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	150228	10	Gastroenterology (M.D. only)	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
106576	Fee-for-Service	1225277817	1225277817	1	1	PHAN, JACKIE	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109180	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
106615	Fee-for-Service	1730212432	1730212432	1	1	PROHEALTH PARTNERS	7/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL GROUP INC	4201 TORRANCE BLVD	STE 350	TORRANCE	CA	90503	4573	19	06037	33.8375955	-118.358748	Los Angeles County
106639	Fee-for-Service	1699976571	1699976571	1	1	PETERS, RICHARD M JR MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61062	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
106642	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
106663	Fee-for-Service	1235556259	1235556259	1	1	PANNEERSELVAM, AMUDHA R MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138417	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
106669	Fee-for-Service	1093262099	1093262099	1	1	PATEL, NEIL	6/7/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2001 SANTA MONICA BLVD	STE 465W	SANTA MONICA	CA	90404	2178	19	06037	34.02891163	-118.4797466	Los Angeles County
106672	Fee-for-Service	1962467258	1962467258	1	1	PUNIM, JEFFREY A MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41751	41	Internal Medicine	0	In state provider	#410	3010 W ORANGE AVE	None	ANAHEIM	CA	92804	3169	30	06059	33.82472315	-117.994133	Orange County
106676	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	5/19/2017	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
106698	Fee-for-Service	1316063001	1316063001	1	1	PAP, CHARLES A PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	133 FLORIN ST	None	PISMO BEACH	CA	93449	1522	40	06079	35.17226318	-120.6970104	San Luis Obispo County
106774	Fee-for-Service	1770661423	1770661423	1	2	PANTAZIS, KAREN L MD	10/16/2020	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	817 COURT ST	SUITE 14	JACKSON	CA	95642	2156	03	06005	38.35288237	-120.7662416	Amador County
106816	Fee-for-Service	1710356852	1710356852	1	1	PEREZ, ELIZABETH T LCSW	6/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2336 JONATHON CT	None	ESCALON	CA	95320	2073	39	06077	37.79729446	-120.983112	San Joaquin County
106829	Fee-for-Service	1033409644	1033409644	1	1	PATHAK, SWATI MD	3/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	160212	41	Internal Medicine	0	In state provider	None	165 SAINT DOMINICS DR	STE 201	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
106849	Fee-for-Service	1013370469	1013370469	1	1	PHAM, YVONNE MD	8/5/2020	207L00000X	NA	Other	026	PHYSICIANS	153591	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
106864	Fee-for-Service	1285064519	1285064519	1	1	PHUONG, COURTNEY N NP	8/20/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
106903	Fee-for-Service	1609221969	1609221969	1	1	PETRIDES, MICHAEL MD	3/15/2023	2085N0904X	NA	Other	026	PHYSICIANS	181393	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
106933	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
106949	Fee-for-Service	1376676247	1376676247	1	1	PHAM, LAN HONG	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	628 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1902	43	06085	37.34243105	-121.8773044	Santa Clara County
106951	Fee-for-Service	1487605960	1487605960	1	1	PADOVA, PAUL J DO	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7731	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
106961	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
107026	Fee-for-Service	1104146166	1104146166	1	1	PENUELAS, MICHELLE C RN	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1539 W GARVEY AVE	None	WEST COVINA	CA	91790	2138	19	06037	34.07276147	-117.9396	Los Angeles County
107049	Fee-for-Service	1730316100	1730316100	1	1	PICHON, PILAR D MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118211	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
107060	Fee-for-Service	1861663072	1861663072	1	1	PALMA DIAZ, MIGUEL F MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116744	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B-186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
107065	Fee-for-Service	1275755621	1275755621	1	1	PRASAD, GAUTAM MD	4/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103317	30	Radiology	0	In state provider	None	6380 CLARK AVE	None	DUBLIN	CA	94568	3036	01	06001	37.70451998	-121.9205494	Alameda County
107099	Fee-for-Service	1932524105	1932524105	1	1	PECK, ANNA M	12/18/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
107104	Fee-for-Service	1689630550	1689630550	1	1	PINKNEY, LYNNE	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
107129	Fee-for-Service	1952314205	1952314205	1	2	PURAY, MERLA MD	1/5/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	98668	None	None	0	In state provider	None	3175 COLLINS DRIVE	None	MERCED	CA	95348	3133	24	06047	37.32106749	-120.4764781	Merced County
107147	Fee-for-Service	1538731146	1538731146	1	1	PHAM, ANH CNP	1/12/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107155	Fee-for-Service	1942447701	1942447701	1	1	PARK, PETER H MD INC	8/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67513	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3000 W OLYMPIC BLVD	SUITE 203	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
107195	Fee-for-Service	1790700417	1790700417	1	1	PASCUAL, EDUARDO E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3001 E. FLETCHER AVE	None	TAMPA	FL	33613	0000	00	None	28.06907775	-82.42591536	Hillsborough County
107203	Fee-for-Service	1104317460	1104317460	1	1	PARADISE VALLEY ICF DDH INC	6/19/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3313 EL PINOLE WAY	None	FAIRFIELD	CA	94533	7208	48	06095	38.28964863	-122.025928	Solano County
107218	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	6/2/2004	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
107237	Fee-for-Service	1821072505	1821072505	1	1	PATEL, MANDAKINI D MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	41030	40	Pediatrics	0	In state provider	None	175 N JACKSON AVE	STE 210	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
107247	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
107317	Fee-for-Service	1669680351	1669680351	1	1	PIANSAY, MARIA C MD	5/25/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	93785	40	Pediatrics	0	In state provider	None	1635 3RD AVE	STE J	CHULA VISTA	CA	91911	5842	37	06073	32.59663479	-117.064444	San Diego County
107320	Fee-for-Service	1821299926	1821299926	1	1	PEREZ, ARTEMIO A DO	2/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	10726	01	General Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
107332	Fee-for-Service	1487887519	1487887519	1	1	PENA-RICARDO, CAROLINA MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113554	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
107340	Fee-for-Service	1003161795	1003161795	1	1	PEDIATRIC ENDOCRINOLOGY &	3/27/2017	2080P0205X	NA	Endocrinology	026	PHYSICIANS	92055	40	Pediatrics	0	In state provider	None	6001 TRUXTUN AVE	SUITE 130A	BAKERSFIELD	CA	93309	0752	15	06029	35.36252236	-119.072932	Kern County
107359	Fee-for-Service	1649224387	1649224387	1	1	PALAKODETI, VACHASPATHI	6/30/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52484	01	General Practice	0	In state provider	None	612 S J ST	None	IMPERIAL	CA	92251	1826	13	06025	32.84213679	-115.5686993	Imperial County
107371	Fee-for-Service	1316100076	1316100076	1	1	POST, ANNEKE M MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	101591	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8525	01	06001	37.683009	-121.9036935	Alameda County
107415	Fee-for-Service	1720553902	1720553902	1	1	PEDIATRICS FOR ALL INC	8/11/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	4550 PANAMA LN	100	BAKERSFIELD	CA	93313	3436	15	06029	35.29597153	-119.05353	Kern County
107440	Fee-for-Service	1639190044	1639190044	1	1	PHILLIPS, ANTHONY M PT	2/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1450 BESSIE AVE	SUITE A	TRACY	CA	95376	3456	39	06077	37.74417912	-121.4330212	San Joaquin County
107467	Fee-for-Service	1790953040	1790953040	1	1	PINEDA, DON D NP	11/15/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8260 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	2662	37	06073	32.91277002	-117.1459433	San Diego County
107475	Fee-for-Service	1336139708	1336139708	1	1	PALEY, CHRISTINE M NP	9/9/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
107480	Fee-for-Service	1366915175	1366915175	1	1	PINKERTON, RONALD E MD A	1/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64676	01	General Practice	0	In state provider	MEDICAL CORPORATION	8337 TELEGRAPH RD	STE 102	PICO RIVERA	CA	90660	4909	19	06037	33.96454327	-118.1134473	Los Angeles County
107506	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
107514	Fee-for-Service	1730311622	1730311622	1	1	PHAM, HUAN T MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116928	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
107539	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
107555	Fee-for-Service	1144268327	1144268327	2	1	PROGRESSIVE HEALTH AND	9/26/2014	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	74848	36	Psychiatry	0	In state provider	WELLNESS INC	161 E MAIN ST	STE 102	EL CAJON	CA	92020	3993	37	06073	32.79492254	-116.9609805	San Diego County
107625	Fee-for-Service	1699732925	1699732925	1	1	PARKEY, JOE	1/8/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55555	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
107629	Fee-for-Service	1003161795	1003161795	1	1	PEDIATRIC ENDOCRINOLOGY &	3/27/2017	2080P0205X	NA	Endocrinology	026	PHYSICIANS	92055	67	Endocrinology	0	In state provider	None	6001 TRUXTUN AVE	SUITE 130A	BAKERSFIELD	CA	93309	0752	15	06029	35.36252236	-119.072932	Kern County
107630	Fee-for-Service	1447284716	1447284716	1	1	PARK, SAEONG B CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	650 ALAMO PINTADO RD	STE 104	SOLVANG	CA	93463	2266	42	06083	34.600536	-120.128554	Santa Barbara County
107631	Fee-for-Service	1841235066	1841235066	1	1	PILLADO, ERNEST A MD	9/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68623	08	Family Practice	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
107645	Fee-for-Service	1649224387	1649224387	1	1	PALAKODETI, VACHASPATHI	6/30/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52484	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	612 S J ST	None	IMPERIAL	CA	92251	1826	13	06025	32.84213679	-115.5686993	Imperial County
107672	Fee-for-Service	1952348518	1952348518	1	1	PROVIDENCE HEALTH SYSTEM	11/1/2005	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	4320 MARICOPA ST	None	TORRANCE	CA	90503	4314	19	06037	33.83949675	-118.3597243	Los Angeles County
107695	Fee-for-Service	1275039901	1275039901	1	1	PHAN, THAO M DO	5/28/2021	207R00000X	NA	Other	026	PHYSICIANS	17931	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
107701	Fee-for-Service	1689930018	1689930018	1	1	PHUNG, KEVIN G MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128491	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
107771	Fee-for-Service	1003923020	1003923020	1	1	PERKASH, INDER MD	11/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	29629	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107775	Fee-for-Service	1851337356	1851337356	1	1	PEDIATRIC CARE MED GRP	2/28/1986	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	INC	17822 BEACH BLVD	STE 278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
107783	Fee-for-Service	1659756906	1659756906	1	1	POLLACK, MELANIE A DO	2/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15784	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
107784	Fee-for-Service	1851763882	1851763882	2	1	PES-EBS INC	9/23/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	600 W SANTA ANA BLVD	SUITE 107 108 109 110	SANTA ANA	CA	92701	4558	30	06059	33.74804119	-117.874111	Orange County
107794	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	3/15/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
107821	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
107829	Fee-for-Service	1780871160	1780871160	1	1	PETERSEN, MARK A MD	6/6/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97116	None	None	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
107869	Fee-for-Service	1275758591	1275758591	1	1	P AND R MEDICAL, INC	12/5/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7860 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5313	19	06037	34.09077461	-118.3609351	Los Angeles County
107877	Fee-for-Service	1154989812	1154989812	1	1	PEZESHKIAN, SHANT DO	11/22/2022	207P00000X	NA	Other	026	PHYSICIANS	19240	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
107879	Fee-for-Service	1568539385	1568539385	1	1	POLHAMUS, RENEE M MD	2/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65064	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
107928	Fee-for-Service	1346217551	1346217551	1	1	PALIWAL, YOGESH KUMAR MD	1/1/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35011	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 206	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
107930	Fee-for-Service	1326026824	1326026824	1	1	PRUM, ANDRA L DO	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2410 FIRE MESA ST	STE 180	LAS VEGAS	NV	89128	9017	00	None	36.20533596	-115.2575074	Clark County
107971	Fee-for-Service	1124641923	1124641923	1	1	PATEL, NISHA DO	9/10/2024	390200000X	NA	Other	026	PHYSICIANS	22438	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
107997	Fee-for-Service	1073965059	1073965059	1	1	POPPE, MICHAEL MD	8/22/2022	207P00000X	NA	Other	026	PHYSICIANS	170722	None	None	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4304	37	06073	32.63282707	-117.0829101	San Diego County
108004	Fee-for-Service	1053549931	1053549931	1	1	PHAN, HIEU T MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123432	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
108038	Fee-for-Service	1851763783	1851763783	1	1	PUN, STACEY MD	5/1/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	160550	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
108048	Fee-for-Service	1700885977	1700885977	1	1	PUTTLER, JR OLIVER L MD	6/30/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13904	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3798 JANES RD	STE 15	ARCATA	CA	95521	4746	12	06023	40.89649119	-124.0930501	Humboldt County
108083	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
108109	Fee-for-Service	1992761639	1992761639	1	1	PATEL, PARUL P MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78832	08	Family Practice	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
108112	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
108116	Fee-for-Service	1891181640	1891181640	1	1	PELAEZ, RHETT A B JR MD	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151775	01	General Practice	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
108123	Fee-for-Service	1730683145	1730683145	1	1	PANCHAL, PARVITA P DO	9/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20158	None	None	0	In state provider	None	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
108163	Fee-for-Service	1346283629	1346283629	1	1	PICKHARDT,BRADLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MISSOULA SURGICAL	500 W BROADWAY	None	MISSOULA	MT	59802	0000	00	None	46.874889	-114.000444	Missoula County
108165	Fee-for-Service	1568539385	1568539385	1	1	POLHAMUS, RENEE M MD	2/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65064	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
108166	Fee-for-Service	1922749159	1922749159	1	1	PHAI, INC.	5/14/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1516 W BRANCH ST	None	ARROYO GRANDE	CA	93420	1817	40	06079	35.12970393	-120.6035143	San Luis Obispo County
108168	Fee-for-Service	1467547877	1467547877	1	1	PATRICIO, ROSALIE N MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95641	None	None	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
108169	Fee-for-Service	1629507181	1629507181	1	1	PASHA, SHEREEN MD	10/19/2020	207R00000X	NA	Other	026	PHYSICIANS	166472	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
108191	Fee-for-Service	1841687928	1841687928	1	1	PANDYA, PUNITA S MD	4/8/2019	208M00000X	NA	Other	026	PHYSICIANS	156450	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
108194	Fee-for-Service	1548359730	1548359730	1	1	PLANNED PARENTHOOD-LOS	6/21/1995	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES, SOUTH BAY CTR	14623 HAWTHORNE BLVD	STE 300	LAWNDALE	CA	90260	1590	19	06037	33.898572	-118.3527775	Los Angeles County
108195	Fee-for-Service	1528099488	1528099488	1	1	PRONET IMAGING MEDICAL	12/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP, INC	1516 COTNER AVE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
108214	Fee-for-Service	1063636876	1063636876	2	1	PURDOM II, KENNETH R MD INC	10/3/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21180	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11807 E WHITTIER BLVD	None	WHITTIER	CA	90601	3941	19	06037	33.98063769	-118.0503687	Los Angeles County
108256	Fee-for-Service	1982890711	1982890711	1	1	PARENT, RICHARD J JR MD	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99682	02	General Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
108286	Fee-for-Service	1932485182	1932485182	1	1	PATEL, MAULI V MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126719	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
108296	Fee-for-Service	1568510220	1568510220	1	1	PARMAR, PERMINDER S MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115359	04	Otology, Laryngology, Rhinology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1092	37	06073	32.89687721	-117.2418677	San Diego County
108329	Fee-for-Service	1477372613	1477372613	1	1	PENDEKANTI, PAMELA NP	12/10/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
108370	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
108373	Fee-for-Service	1891752952	1891752952	1	1	PATEL, LEKHRAJ MD	4/19/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	128200	13	Neurology (M.D. only)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
108385	Fee-for-Service	1982895108	1982895108	1	1	PANAGOTACOS, JOHN MD	12/27/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	89953	13	Neurology (M.D. only)	0	In state provider	None	1030 SIR FRANCIS DRAKE B	SUITE 130	KENTFIELD	CA	94904	1439	21	06041	37.95718711	-122.5495935	Marin County
108390	Fee-for-Service	1982655833	1982655833	1	1	PRATIK M VAISHNAV M.D.	7/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	799 FARSON ST	None	BELPRE	OH	45714	1044	00	None	39.28226471	-81.61096919	Washington County
108401	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
108469	Fee-for-Service	1932361219	1932361219	1	1	PANDE, VARSHITA MD	1/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118423	40	Pediatrics	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
108492	Fee-for-Service	1548600224	1548600224	1	1	PANDAMOUZ, ALI MD	3/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	136965	66	Emergency Medicine (Urgent Care)	0	In state provider	None	768 MOUNTAIN RANCH ROAD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
108495	Fee-for-Service	1326186289	1326186289	1	1	PULMONARY DISEASE CLINIC	9/27/2002	No Taxonomy Provided	NA	None	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1725 W 17TH ST	None	SANTA ANA	CA	92706	2316	30	06059	33.75999552	-117.892593	Orange County
108515	Fee-for-Service	1528307394	1528307394	1	1	PEARSALL, SHEREESE N LPCC	1/19/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
108602	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
108622	Fee-for-Service	1467654079	1467654079	1	1	PARIKH, RESHMA MD	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115135	01	General Practice	0	In state provider	None	24411 HEALTH CTR DR	STE 300	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
108631	Fee-for-Service	1174843924	1174843924	1	1	POLSKY, KATIE S PHD	4/8/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 CAPITOL AVE	SUITE 206	SACRAMENTO	CA	95816	5755	34	06067	38.573073	-121.4788005	Sacramento County
108643	Fee-for-Service	1346503224	1346503224	1	1	PAYANES, RAELEIGH C MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133896	01	General Practice	0	In state provider	None	830 SCENIC DRIVE	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
108658	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
108669	Fee-for-Service	1700855145	1700855145	1	1	PATEL, AVAN M MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10118	41	Internal Medicine	0	In state provider	None	58 WEST LOOP DRIVE	None	CAMARILLO	CA	93010	2035	56	06111	34.23642208	-119.0416885	Ventura County
108672	Fee-for-Service	1184086993	1184086993	1	1	PLATA-MARTINEZ, CARLOS F MD	3/1/2021	207L00000X	NA	Other	026	PHYSICIANS	168821	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
108685	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
108692	Fee-for-Service	1548271216	1548271216	1	1	POSNER, LARRY S MD	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	52218	40	Pediatrics	0	In state provider	None	1100 PEAR TREE LN	# 100	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
108707	Fee-for-Service	1295838803	1295838803	1	1	PEREIRA, ISABEL J MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60731	38	Geriatrics	0	In state provider	None	440 SILVER SHADOW DR	None	SAN MARCOS	CA	92078	4456	37	06073	33.13312447	-117.1459189	San Diego County
108728	Fee-for-Service	1235470634	1235470634	1	1	PACIFIC SPINE AND PAIN	9/13/2013	208VP0014X	NA	Other	026	PHYSICIANS	124459	25	Physical Medicine and Rehabilitation	0	In state provider	CENTER, INC	805 W ACEQUIA	STE 1D	VISALIA	CA	93291	6163	54	06107	36.32914382	-119.3000697	Tulare County
108730	Fee-for-Service	1235288168	1235288168	1	1	PARKER, KRISTIN A LMFT	6/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2601 E CHAPMAN AVE	STE 101	FULLERTON	CA	92831	3737	30	06059	33.87433432	-117.8837211	Orange County
108733	Fee-for-Service	1104032648	1104032648	1	1	PARTAP, SONIA MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95405	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
108768	Fee-for-Service	1457664583	1457664583	1	1	PATEL, MIRAL MD	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148331	01	General Practice	0	In state provider	None	TWO MEDICAL PLAZA	STE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
108773	Fee-for-Service	1528018223	1528018223	1	1	PLUMB, STEVEN P, MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	50964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
108783	Fee-for-Service	1548600224	1548600224	1	1	PANDAMOUZ, ALI MD	3/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	136965	08	Family Practice	0	In state provider	None	768 MOUNTAIN RANCH ROAD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
108849	Fee-for-Service	1609880947	1609880947	1	2	PREMIER ANESTHESIA	1/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
108881	Fee-for-Service	1578961926	1578961926	1	1	PALLIATIVE CARE PROVIDER	12/20/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SOCAL, INC	13615 VICTORY BLVD	SUITE 120	VAN NUYS	CA	91401	1778	19	06037	34.18671049	-118.429353	Los Angeles County
108889	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
108914	Fee-for-Service	1467654079	1467654079	1	1	PARIKH, RESHMA MD	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115135	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	24411 HEALTH CTR DR	STE 300	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
108922	Fee-for-Service	1942459144	1942459144	1	1	PERIS, TARA S PHD	8/10/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
108939	Fee-for-Service	1104927227	1104927227	1	1	PAVLOVICH, BARBARA J. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	945 N 12TH ST	None	MILWAUKEE	WI	53233	1305	00	None	43.042428	-87.92718546	Milwaukee County
108947	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
108979	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
108996	Fee-for-Service	1295838803	1295838803	1	1	PEREIRA, ISABEL J MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60731	41	Internal Medicine	0	In state provider	None	440 SILVER SHADOW DR	None	SAN MARCOS	CA	92078	4456	37	06073	33.13312447	-117.1459189	San Diego County
109000	Fee-for-Service	1164590204	1164590204	1	1	PICKERT MEDICAL GROUP, P.C.	4/22/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	1	Border provider	F RENO, P.C.	1107 HIGHWAY 395 NORTH	None	GARDNERVILLE	NV	89470	5304	00	None	38.91855037	-119.7196266	Douglas County
109005	Fee-for-Service	1225070345	1225070345	1	1	PATEL, ANAND N MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144194	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109012	Fee-for-Service	1528670114	1528670114	2	1	PEACE AND LOVE HOME HEALTH	3/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2915 W BURBANK BLVD	SUITE A	BURBANK	CA	91505	2310	19	06037	34.17711924	-118.3430525	Los Angeles County
109020	Fee-for-Service	1104032648	1104032648	1	1	PARTAP, SONIA MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95405	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
109022	Fee-for-Service	1407295777	1407295777	1	1	PATEL, KRUNAL S DO	7/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15400	05	Anesthesiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
109035	Fee-for-Service	1508949884	1508949884	1	1	PROVIDENCE HOSPITAL	1/1/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	1111 CRATER LAKE AVE	None	MEDFORD	OR	97504	6225	00	None	42.339654	-122.861086	Jackson County
109043	Fee-for-Service	1255400248	1255400248	1	1	PEREZ-PASILIAO, RAIMEL Y MD	8/27/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	86687	40	Pediatrics	0	In state provider	None	12574 CENTRAL AVE	None	CHINO	CA	91710	3507	36	06071	34.024617	-117.6894775	San Bernardino County
109070	Fee-for-Service	1568540664	1568540664	1	1	PAL, SATINDER MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65493	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
109076	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109097	Fee-for-Service	1245736743	1245736743	1	1	POLITZER, CAREY S MD	7/10/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	164290	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109127	Fee-for-Service	1053410506	1053410506	1	1	PEDIATRIC AFFILIATES MEDICAL	6/30/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	UP INC	7345 MEDICAL CENTER DRIV	SUITE 400	WEST HILLS	CA	91307	1963	19	06037	34.20369349	-118.629837	Los Angeles County
109153	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	4/19/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
109161	Fee-for-Service	1770562910	1770562910	1	1	PARKLAND AMBULANCE SVCS	12/9/2005	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	357 KINGS RD	None	SCHENECTADY	NY	12304	0000	00	None	42.775344	-73.9132875	Schenectady County
109167	Fee-for-Service	1083654834	1083654834	1	1	PALAFOX, MARCOS JR MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80142	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109170	Fee-for-Service	1578961926	1578961926	1	1	PALLIATIVE CARE PROVIDER	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SOCAL, INC	13615 VICTORY BLVD	SUITE 120	VAN NUYS	CA	91401	1778	19	06037	34.18671049	-118.429353	Los Angeles County
109175	Fee-for-Service	1437505559	1437505559	1	1	PATEL, DEVIN N MD	10/15/2019	208800000X	NA	Other	026	PHYSICIANS	144629	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
109177	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109217	Fee-for-Service	1790751055	1790751055	1	1	POCATELLO HOSPITAL LLC	2/12/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	777 HOSPITAL WAY	None	POCATELLO	ID	83201	5175	00	None	42.87385929	-112.4189402	Bannock County
109220	Fee-for-Service	1780986356	1780986356	1	1	PRIME HEALTHCARE	2/9/2015	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BEACH LLC	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
109234	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
109264	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
109277	Fee-for-Service	1043245988	1043245988	1	1	PREM KUMAR NOWLAKHA, M.D.,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3511 TOWN CENTER	BLVD STE 101	SUGARLAND	TX	77479	0000	00	None	29.58753429	-95.62976329	Fort Bend County
109299	Fee-for-Service	1710587670	1710587670	1	4	PHYSICIANS OF SOUTHERN CALIF	3/15/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ORNIA INC	6850 BROCKTON AVE	SUITE 102	RIVERSIDE	CA	92506	3814	33	06065	33.9493261	-117.3967206	Riverside County
109340	Fee-for-Service	1255727749	1255727749	1	1	PATEL, BOSKI MD FAAP	12/5/2019	2084P0805X	NA	Psychiatry	026	PHYSICIANS	160676	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
109362	Fee-for-Service	1326048893	1326048893	1	2	PACIFIC MEDICAL INC	8/29/2008	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 N CHRISMAN RD	None	TRACY	CA	95304	9314	39	06077	37.74886001	-121.3982504	San Joaquin County
109363	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109400	Fee-for-Service	1174578298	1174578298	1	1	PEEK, CORBETT G MD	6/5/1979	207P00000X	NA	Other	026	PHYSICIANS	32939	01	General Practice	0	In state provider	None	2035 BONITA AVE	None	LA VERNE	CA	91750	4442	19	06037	34.10181432	-117.7708168	Los Angeles County
109406	Fee-for-Service	1740392695	1740392695	1	1	PARIKH, MIHIR Y MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
109435	Fee-for-Service	1538344205	1538344205	1	1	PATHAK, BHUVAN MD	2/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99806	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
109440	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	10/3/2022	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
109454	Fee-for-Service	1376669812	1376669812	1	1	PARK, SOO M LCSW	6/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	UNIT 6	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
109465	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	12/20/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109468	Fee-for-Service	1083906556	1083906556	1	1	PEREZ, CECILIA A MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133586	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
109475	Fee-for-Service	1891939252	1891939252	1	1	PATNIYOT, IRENE R MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131569	13	Neurology (M.D. only)	0	In state provider	None	400 PARANASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109476	Fee-for-Service	1407099088	1407099088	1	1	PATEL, DHARMESH A MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125193	30	Radiology	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
109480	Fee-for-Service	1801083902	1801083902	1	1	PEARLMAN, BARRY J MD INC	12/10/2012	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	23387	10	Gastroenterology (M.D. only)	0	In state provider	None	9090 WILSHIRE BLVD	STE 101	BEVERLY HILLS	CA	90211	1849	19	06037	34.06702873	-118.3894057	Los Angeles County
109505	Fee-for-Service	1790751055	1790751055	1	1	POCATELLO HOSPITAL LLC	2/12/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	777 HOSPITAL WAY	None	POCATELLO	ID	83201	5175	00	None	42.87385929	-112.4189402	Bannock County
109523	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
109525	Fee-for-Service	1033286927	1033286927	1	1	PAGE, ROSEMARY C DO	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8666	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109544	Fee-for-Service	1760467005	1760467005	1	1	PENDARVIS, RANIE W MD	7/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87205	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
109550	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
109552	Fee-for-Service	1568757342	1568757342	1	1	PATTERSON, TIERRA M LMFT	4/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	212C	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
109571	Fee-for-Service	1689201972	1689201972	1	1	PHON, TIFFANY MD	8/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187182	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
109599	Fee-for-Service	1295884120	1295884120	1	1	PETERSON, ERICA L MD	8/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91073	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	225 S CABRILLO HWY	STE 100A	HALF MOON BAY	CA	94119	1738	41	06081	37.46542425	-122.4337617	San Mateo County
109608	Fee-for-Service	1982821955	1982821955	1	1	PATEL, SANGITA PT	11/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17815 COUNTRYSIDE CT	None	SALINAS	CA	93907	8804	27	06053	36.79560029	-121.6680603	Monterey County
109621	Fee-for-Service	1245610088	1245610088	2	1	PARSANIAN, LUCINEH C MD	12/21/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159220	None	None	0	In state provider	None	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	19	06037	34.02394552	-118.187748	Los Angeles County
109634	Fee-for-Service	1134763972	1134763972	1	1	PFEUFFER, JENNIFER PSYD	5/23/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
109652	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109675	Fee-for-Service	1619934148	1619934148	1	1	PHILLIPS, MICHAEL E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 BEEKMAN ST	None	PLATTSBURGH	NY	12901	1438	00	None	44.701011	-73.4692635	Clinton County
109678	Fee-for-Service	1609195221	1609195221	1	2	PSB HOMES INCORPORATED	5/23/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8241 DRACAENA DRIVE	None	BUENA PARK	CA	90620	4014	30	06059	33.83618277	-117.9890758	Orange County
109695	Fee-for-Service	1740392695	1740392695	1	1	PARIKH, MIHIR Y MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68508	18	Ophthalmology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
109708	Fee-for-Service	1700938180	1700938180	1	1	PAL, SUMANTA K MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91718	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
109709	Fee-for-Service	1255355616	1255355616	1	1	PRAGLIN, CLAUDIA R NP	3/29/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109711	Fee-for-Service	1407965973	1407965973	2	1	PROCARE PHARMACY LLC	11/17/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8607 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4109	19	06037	34.08805498	-118.3791969	Los Angeles County
109713	Fee-for-Service	1720162795	1720162795	1	1	PIETILA, KAREN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33370	22	Pathology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
109718	Fee-for-Service	1518909464	1518909464	1	1	PLATIA, MARIA P MD	11/27/2017	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151280	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
109728	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	8/8/2024	103TC0700X	NA	Mental Health Outpatient Services	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
109753	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109768	Fee-for-Service	1801083902	1801083902	1	1	PEARLMAN, BARRY J MD INC	12/10/2012	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	23387	41	Internal Medicine	0	In state provider	None	9090 WILSHIRE BLVD	STE 101	BEVERLY HILLS	CA	90211	1849	19	06037	34.06702873	-118.3894057	Los Angeles County
109777	Fee-for-Service	1417035106	1417035106	1	1	PETTY, RAYMOND P DPM	11/30/1989	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
109798	Fee-for-Service	1396143962	1396143962	1	1	PEAR HOLDINGS LLC	5/31/2016	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1609 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4520	41	06081	37.59296295	-122.3848464	San Mateo County
109811	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
109829	Fee-for-Service	1871216820	1871216820	1	1	PURPLE VAN MEDICAL TRANSPORT	6/17/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3947 W HILLSDALE CT	None	VISALIA	CA	93291	5534	54	06107	36.328293	-119.335014	Tulare County
109841	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
109871	Fee-for-Service	1942704168	1942704168	1	1	PATEL, VISHAL S MD	9/1/2023	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	173431	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
109940	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
109999	Fee-for-Service	1528065125	1528065125	1	1	PRAH, MARTY L MD	2/28/1990	208800000X	NA	Other	026	PHYSICIANS	53486	34	Urology and Urological Surgery	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
110014	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	2/10/2023	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
110029	Fee-for-Service	1083304570	1083304570	1	1	PRIMARY & URGENT CARE	8/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2967 DAVISON CT	STE D	COLUSA	CA	95932	3285	06	06011	39.18822138	-121.9974157	Colusa County
110041	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110048	Fee-for-Service	1033345160	1033345160	1	1	PATIL, MUKUL B MD	1/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107954	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
110064	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
110071	Fee-for-Service	1265517817	1265517817	1	1	PATEL, BHARAT G MD	6/30/1993	174400000X	NA	Other	026	PHYSICIANS	40159	41	Internal Medicine	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
110077	Fee-for-Service	1720089329	1720089329	1	1	PATEL, SHEILA A MD	2/1/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55639	08	Family Practice	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	3608	37	06073	33.1857	-117.290538	San Diego County
110101	Fee-for-Service	1841373800	1841373800	1	1	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
110103	Fee-for-Service	1629531868	1629531868	1	1	PHAM, KEVIN MD	7/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176264	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
110131	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
110132	Fee-for-Service	1386818789	1386818789	1	1	PRN MEDICAL SERVICES, LLC	9/20/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	20333 N 19TH AVE	101	PHOENIX	AZ	85027	4167	00	None	33.66834268	-112.0997597	Maricopa County
110164	Fee-for-Service	1134510530	1134510530	1	1	PALMDALE CONGREGATE LIVING,	5/10/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	38702 12TH STREET EAST	None	PALMDALE	CA	93550	3990	19	06037	34.58560232	-118.1075613	Los Angeles County
110180	Fee-for-Service	1093896862	1093896862	1	1	PERFORMANCE HEALTH MEDICAL	12/15/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	25431 CABOT RD	STE 118	LAGUNA HILLS	CA	92653	5527	30	06059	33.59115448	-117.6744575	Orange County
110184	Fee-for-Service	1366601007	1366601007	1	1	PRABAKER, KAVITHA K MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108013	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
110186	Fee-for-Service	1710920079	1710920079	1	1	PENINSULA PHARMACY	7/5/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1294 W 6TH ST	STE 100	SAN PEDRO	CA	90731	2997	19	06037	33.73885348	-118.3056165	Los Angeles County
110228	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110233	Fee-for-Service	1154495471	1154495471	1	1	PAPANICOLAOU, GEORGE MD	6/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43290	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
110252	Fee-for-Service	1497268825	1497268825	1	1	PETERSON, NATALIE PT	6/20/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
110253	Fee-for-Service	1649461179	1649461179	1	1	PRESSER, STEVEN C MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53611	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3484 E 1ST STREET	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
110257	Fee-for-Service	1215987540	1215987540	1	1	PELINO, MARY ANN M MD	9/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	76094	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
110268	Fee-for-Service	1932500410	1932500410	1	1	PETERS, TEMITOPE C NP	9/28/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	732 MOTT ST	STE 100-110	SAN FERNANDO	CA	91340	4240	19	06037	34.27661761	-118.4442372	Los Angeles County
110272	Fee-for-Service	1770183428	1770183428	1	1	PARK, ASHLEY OD	1/22/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	179 MAIN ST	#2	SOLEDAD	CA	93960	3023	27	06053	36.42773071	-121.3284195	Monterey County
110276	Fee-for-Service	1538236419	1538236419	1	1	PATTON, DIANA L MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	58106	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
110287	Fee-for-Service	1154709616	1154709616	1	1	PIERCE, LAURA J DO	1/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15573	01	General Practice	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
110290	Fee-for-Service	1437318326	1437318326	1	1	PATEL, ZAMIP MD	6/5/2024	208800000X	NA	Other	026	PHYSICIANS	147115	34	Urology and Urological Surgery	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
110305	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	10/3/2022	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
110318	Fee-for-Service	1083304570	1083304570	1	1	PRIMARY & URGENT CARE	8/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2967 DAVISON CT	STE D	COLUSA	CA	95932	3285	06	06011	39.18822138	-121.9974157	Colusa County
110327	Fee-for-Service	1801152566	1801152566	1	1	PRIME HEALTHCARE SERVICES	7/10/2012	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	RENO LLC	235 WEST 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
110329	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110334	Fee-for-Service	1063908879	1063908879	1	1	PASHIKOVA, NELI LCSW	11/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15928 VENTURA BLVD	207	ENCINO	CA	91436	4400	19	06037	34.15585301	-118.4801465	Los Angeles County
110350	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
110383	Fee-for-Service	1407268709	1407268709	1	1	PEDIATRIC & FAMILY MEDICAL	11/25/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	3680 E IMPERIAL HIGHWAY	STE 200	LYNWOOD	CA	90262	2659	19	06037	33.93211641	-118.2011728	Los Angeles County
110399	Fee-for-Service	1710946843	1710946843	1	1	PADMANABHA, V M MD	6/1/2001	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	40810	41	Internal Medicine	0	In state provider	None	902 E MAIN ST	None	BARSTOW	CA	92311	2406	36	06071	34.89860886	-117.0148931	San Bernardino County
110423	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
110430	Fee-for-Service	1164590204	1164590204	1	2	PICKERT MEDICAL GROUP, P.C.	4/22/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	1	Border provider	F RENO, P.C.	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
110445	Fee-for-Service	1366601007	1366601007	1	1	PRABAKER, KAVITHA K MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108013	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
110447	Fee-for-Service	1609824895	1609824895	1	1	PRINCESA, GERADO R MD	7/22/2008	207L00000X	NA	Other	026	PHYSICIANS	101856	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
110456	Fee-for-Service	1417451915	1417451915	1	1	PEDRAZA, RUTH MD	5/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166148	None	None	0	In state provider	None	1332 NATIVIDAD RD	C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
110471	Fee-for-Service	1487674636	1487674636	1	1	PECK, MARIANNE LMFT	1/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1101 STANDIFORD AVE	B-2	MODESTO	CA	95350	0981	50	06099	37.68934851	-121.009653	Stanislaus County
110501	Fee-for-Service	1649312240	1649312240	1	1	PAULE, VINCENT E LCSW	4/5/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
110504	Fee-for-Service	1689656886	1689656886	1	1	PATEL MEDICAL CORP	2/1/2003	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	200 JOSE FIGUERES AVE	STE 340	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
110509	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
110515	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110543	Fee-for-Service	1770918658	1770918658	1	1	POULSEN, MONICA LMFT	2/5/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
110545	Fee-for-Service	1649461179	1649461179	1	1	PRESSER, STEVEN C MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53611	01	General Practice	0	In state provider	None	3484 E 1ST STREET	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
110563	Fee-for-Service	1851612303	1851612303	1	1	PATEL, RACHIT H MD	3/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139196	36	Psychiatry	0	In state provider	None	6010 HIDDEN VALLEY ROAD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
110593	Fee-for-Service	1518269372	1518269372	1	1	PSYCHIATRIC ALTERNATIVES AND	6/6/2024	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER PROFESS	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
110595	Fee-for-Service	1568674703	1568674703	1	1	PEPPERMINT RIDGE	11/25/1997	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4045 CASTLE PINES WAY	None	CORONA	CA	92883	0603	33	06065	33.81912206	-117.5274294	Riverside County
110612	Fee-for-Service	1801152566	1801152566	1	1	PRIME HEALTHCARE SERVICES	7/10/2012	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	RENO LLC	235 WEST 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
110615	Fee-for-Service	1740667179	1740667179	1	1	PALO VERDE HEALTHCARE	3/10/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	205 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.613155	-114.595559	Riverside County
110616	Fee-for-Service	1831277599	1831277599	1	1	PEREZ, CARLOS A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81624	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
110618	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110632	Fee-for-Service	1699070508	1699070508	1	2	PEREIRA, GAVIN MD	4/25/2024	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	139199	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
110635	Fee-for-Service	1902995319	1902995319	1	1	PATEL, ANILKUMAR K MD	10/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76952	41	Internal Medicine	0	In state provider	None	1064 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22323556	-119.3375072	Tulare County
110638	Fee-for-Service	1083760482	1083760482	1	1	POON, EILEEN W OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
110639	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
110643	Fee-for-Service	1205924883	1205924883	1	1	PACINI, LILIA M	10/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 N PALM CANYON DR	STE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
110672	Fee-for-Service	1407268709	1407268709	1	1	PEDIATRIC & FAMILY MEDICAL	11/25/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	3680 E IMPERIAL HIGHWAY	STE 200	LYNWOOD	CA	90262	2659	19	06037	33.93211641	-118.2011728	Los Angeles County
110681	Fee-for-Service	1144484999	1144484999	1	1	PARZIALE, NICHOLAS J MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114345	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
110686	Fee-for-Service	1265481295	1265481295	1	1	PRINCENTHAL, ROBERT A MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52310	None	None	0	In state provider	None	415 ROLLING OAKS DR	STE 160	THOUSAND OAKS	CA	91361	1031	56	06111	34.17439717	-118.8691161	Ventura County
110691	Fee-for-Service	1407563661	1407563661	1	1	PAUL KIM, O.D., A PROFESSION	8/15/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	621 S WESTERN AVE	214	LOS ANGELES	CA	90005	3039	19	06037	34.06282163	-118.309122	Los Angeles County
110699	Fee-for-Service	1225282775	1225282775	1	1	PARISE, ERIN E MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	104010	41	Internal Medicine	0	In state provider	None	30281 GOLDEN LANTERN	None	LAGUNA NIGUEL	CA	92677	5979	30	06059	33.52255027	-117.6859055	Orange County
110704	Fee-for-Service	1841373800	1841373800	1	4	PERMANENTE MEDICAL GROUP INC	12/19/2016	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	601 VAN NESS BLVD	None	SAN FRANCISCO	CA	94102	6310	38	06075	37.78149353	-122.4206703	San Francisco County
110719	Fee-for-Service	1801896915	1801896915	1	1	PROVIDENCE MEDICAL CTR	12/27/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8929 PARALLEL PKWY	None	KANSAS CITY	KS	66112	3607	00	None	39.126636	-94.7868255	Wyandotte County
110784	Fee-for-Service	1275659278	1275659278	1	1	PUSHIN, MARK M MD	12/7/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53464	-	NOT APPLICABLE	0	In state provider	None	2550 E FOOTHILL BLVD	2ND FLOOR	PASADENA	CA	91107	3406	19	06037	34.14979153	-118.0979955	Los Angeles County
110785	Fee-for-Service	1093130684	1093130684	1	1	PARK, SEUNG YONG	10/14/2016	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1720 WEST BALL RD	SUITE 3A	ANAHEIM	CA	92804	5551	30	06059	33.8178465	-117.9425115	Orange County
110789	Fee-for-Service	1689656886	1689656886	1	1	PATEL MEDICAL CORP	2/1/2003	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	200 JOSE FIGUERES AVE	STE 340	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
110798	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
110804	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110811	Fee-for-Service	1780834119	1780834119	1	1	PREMA, JATEEN MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105182	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
110816	Fee-for-Service	1275780207	1275780207	1	1	PATEL, PARIN MD	2/22/2024	208600000X	NA	General Surgery	026	PHYSICIANS	104549	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 705	ANAHEIM	CA	92801	2814	30	06059	33.84718298	-117.933758	Orange County
110817	Fee-for-Service	1699746685	1699746685	1	1	PELLETIER, PIERRE A MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72428	30	Radiology	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
110819	Fee-for-Service	1811957327	1811957327	1	1	PACHECO, HECTOR O MD	5/17/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	78489	20	Orthopedic Surgery	0	In state provider	None	25150 HANCOCK AVE	SUITE 200	MURRIETA	CA	92562	5988	33	06065	33.56635084	-117.1823956	Riverside County
110820	Fee-for-Service	1053417212	1053417212	1	1	PEDIATRIC GROUP OF MONTEREY	9/1/1999	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1900 GARDEN ROAD	SUITE 110	MONTEREY	CA	93940	5334	27	06053	36.58681385	-121.8623548	Monterey County
110833	Fee-for-Service	1760720965	1760720965	1	1	PACIFIC MEDICAL, INC.	8/17/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	190 N WIGET LN	STE 109	WALNUT CREEK	CA	94598	2440	07	06013	37.92628945	-122.0245576	Contra Costa County
110837	Fee-for-Service	1245338490	1245338490	1	1	PRATHIPATI, LAKSHMI	4/30/1992	207R00000X	NA	Other	026	PHYSICIANS	47821	41	Internal Medicine	0	In state provider	None	4276 54TH PL	STE B	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
110903	Fee-for-Service	1831277599	1831277599	1	1	PEREZ, CARLOS A MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81624	33	Thoracic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
110905	Fee-for-Service	1740667179	1740667179	1	1	PALO VERDE HEALTHCARE	3/10/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	205 N 1ST ST	None	BLYTHE	CA	92225	1702	33	06065	33.613155	-114.595559	Riverside County
110906	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
110927	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
110928	Fee-for-Service	1154356145	1154356145	1	1	PLANNED PARENTHOOD OF	6/19/1979	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO COUNTY	1685 E MAIN ST	STE 301	EL CAJON	CA	92021	5292	37	06073	32.81132509	-116.9192044	San Diego County
110941	Fee-for-Service	1174265938	1174265938	1	1	PRIDYUK, ROMAN RCP	6/3/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
110952	Fee-for-Service	1366644486	1366644486	1	1	PORAT, SHAROUN S MD	2/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97592	20	Orthopedic Surgery	0	In state provider	None	710 N EUCLID ST	None	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
110988	Fee-for-Service	1225282775	1225282775	1	1	PARISE, ERIN E MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	104010	40	Pediatrics	0	In state provider	None	30281 GOLDEN LANTERN	None	LAGUNA NIGUEL	CA	92677	5979	30	06059	33.52255027	-117.6859055	Orange County
111006	Fee-for-Service	1801896915	1801896915	1	1	PROVIDENCE MEDICAL CTR	12/27/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8929 PARALLEL PKWY	None	KANSAS CITY	KS	66112	3607	00	None	39.126636	-94.7868255	Wyandotte County
111009	Fee-for-Service	1801826904	1801826904	1	1	PARK, JONG C MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
111012	Fee-for-Service	1083081897	1083081897	1	1	PACHECO PAZ, LIGIA E LCSW	4/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
111039	Fee-for-Service	1265455240	1265455240	1	1	POWER, TRACE P PT	7/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25251 PASEO DE ALICIA	SUITE 201	LAGUNA HILLS	CA	92653	4616	30	06059	33.60148289	-117.6894952	Orange County
111047	Fee-for-Service	1437398864	1437398864	1	1	PENG, YUN MD	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105842	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111050	Fee-for-Service	1174515449	1174515449	1	1	PHILLIPS, JEANNE V MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145503	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	30 GARDEN CT	STE B	MONTEREY	CA	93940	5302	27	06053	36.58529309	-121.8551126	Monterey County
111079	Fee-for-Service	1689656886	1689656886	1	1	PATEL MEDICAL CORP	2/1/2003	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	200 JOSE FIGUERES AVE	STE 340	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
111086	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
111091	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111134	Fee-for-Service	1619039005	1619039005	1	1	PARIS-SALB, RANDI PHD	2/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
111193	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111216	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
111242	Fee-for-Service	1710392402	1710392402	1	1	PERPETUAL CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1985 YOSEMITE AVE	SUITE 250	SIMI VALLEY	CA	93063	5234	56	06111	34.27096005	-118.6784091	Ventura County
111250	Fee-for-Service	1013984905	1013984905	1	1	PRZYBYLA, ANNE E	4/13/2005	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8283 GROVE AVE	STE 104	RANCHON CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
111287	Fee-for-Service	1285871137	1285871137	1	1	PINTO, NATASHA J MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106356	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
111294	Fee-for-Service	1588769830	1588769830	1	1	PRUTSOK, LEONARD MD	3/1/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	02	General Surgery	0	In state provider	None	1310 W STEWART DR	STE 214	ORANGE	CA	92868	3837	30	06059	33.78236048	-117.8664975	Orange County
111296	Fee-for-Service	1538207782	1538207782	1	1	PERALTA, WILBUR D MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86749	41	Internal Medicine	0	In state provider	None	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
111307	Fee-for-Service	1265874747	1265874747	1	1	PLEASANT CARE PHARMACY	9/3/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1652 B ST	None	HAYWARD	CA	94541	3020	01	06001	37.67963935	-122.0715674	Alameda County
111310	Fee-for-Service	1437172657	1437172657	1	1	PELEG, NACHEMIA B MD	7/30/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53260	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
111314	Fee-for-Service	1144832718	1144832718	1	1	PRINE, DEREK H RCP	8/30/2020	225B00000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
111339	Fee-for-Service	1003874702	1003874702	2	8	PROHEALTH ADVANCED IMAGING M	11/24/2021	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2560 W OLYMPIC BLVD	100	LOS ANGELES	CA	90006	2972	19	06037	34.05240349	-118.2868875	Los Angeles County
111341	Fee-for-Service	1548515406	1548515406	1	1	PETERSEN, KRISTI A	6/21/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
111344	Fee-for-Service	1992184998	1992184998	1	1	PHAM, DON Q DO	12/14/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	14256	01	General Practice	0	In state provider	None	15888 MAIN STREET	SUITE 112B	HESPERIA	CA	92345	3467	36	06071	34.42375898	-117.3163823	San Bernardino County
111372	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
111380	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111409	Fee-for-Service	1396064093	1396064093	1	1	PREMIER HEALTHCARE SERVICES	11/10/2011	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	333 HEGENBERGER ROAD	SUITE 201	OAKLAND	CA	94621	1452	01	06001	37.7350428	-122.1976624	Alameda County
111467	Fee-for-Service	1750439634	1750439634	1	1	PACHON, JACQUELINE G MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71447	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
111468	Fee-for-Service	1336181858	1336181858	1	1	PUND, ERNEST E MD JR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24202	41	Internal Medicine	0	In state provider	None	9834 GENESEE AVE	STE 300	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
111481	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111488	Fee-for-Service	1326104605	1326104605	1	1	PACIFIC SHORES RADIOLOGY	4/26/2006	174400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
111496	Fee-for-Service	1003046244	1003046244	1	1	PALMER, BARTON W PHD	1/16/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
111500	Fee-for-Service	1194880518	1194880518	1	1	PBD INC	2/21/2018	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	165 PALOS VERDES BLVD	None	REDONDO BEACH	CA	90277	5808	19	06037	33.81693751	-118.3847552	Los Angeles County
111504	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
111509	Fee-for-Service	1093723611	1093723611	1	1	PALITZ, HARVEY F MD APC	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	26307	09	Gynecology (D.O. only)	0	In state provider	None	1524 MCHENRY AVE	STE 405	MODESTO	CA	95350	4568	50	06099	37.666233	-120.993933	Stanislaus County
111521	Fee-for-Service	1255560827	1255560827	1	1	PATEL, DIIXA D MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130144	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
111529	Fee-for-Service	1710392402	1710392402	1	1	PERPETUAL CARE HOSPICE INC	11/24/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1985 YOSEMITE AVE	SUITE 250	SIMI VALLEY	CA	93063	5234	56	06111	34.27096005	-118.6784091	Ventura County
111531	Fee-for-Service	1689189672	1689189672	1	1	PERKINS, OLIVIA R LCSW	12/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
111554	Fee-for-Service	1366630444	1366630444	1	1	PATEL, KAJAL P MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93552	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
111556	Fee-for-Service	1205281193	1205281193	1	1	PONCE, ANIEL PSYD	6/21/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
111577	Fee-for-Service	1215011598	1215011598	1	1	PEARLMAN, JOHN M CRNA	11/28/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
111583	Fee-for-Service	1588769830	1588769830	1	1	PRUTSOK, LEONARD MD	3/1/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	24	Plastic Surgery	0	In state provider	None	1310 W STEWART DR	STE 214	ORANGE	CA	92868	3837	30	06059	33.78236048	-117.8664975	Orange County
111597	Fee-for-Service	1437172657	1437172657	1	1	PELEG, NACHEMIA B MD	7/30/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53260	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
111600	Fee-for-Service	1760504898	1760504898	1	1	PATEL, SHARAD S MD INC	4/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	25839	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	201 S BUENA VISTA ST	STE 440	BURBANK	CA	91505	4577	19	06037	34.15978726	-118.3289164	Los Angeles County
111608	Fee-for-Service	1831346816	1831346816	1	1	PROVENCIO, SANDRA	12/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	201 S MILLER ST	STE 103	SANTA MARIA	CA	93454	5248	42	06083	34.95180214	-120.4315034	Santa Barbara County
111633	Fee-for-Service	1972735991	1972735991	1	1	PETTIT, KATE E MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108961	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
111660	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
111666	Fee-for-Service	1386175230	1386175230	1	1	PALMATIER, LAURENT MD	10/12/2020	207R00000X	NA	Other	026	PHYSICIANS	169783	41	Internal Medicine	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
111667	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111678	Fee-for-Service	1285736694	1285736694	1	2	PHARMACY SERVICE INC	7/6/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y	355 E 21ST ST	None	SAN BERNARDINO	CA	92404	4824	36	06071	34.13404548	-117.2779515	San Bernardino County
111694	Fee-for-Service	1225685910	1225685910	1	1	PALACIOS, ALISON M PT	1/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2525 ERRINGER RD.	None	SIMI VALLEY	CA	93065	2352	56	06111	34.280838	-118.7614975	Ventura County
111713	Fee-for-Service	1578632337	1578632337	1	1	PARKER, PABLO M MD	1/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41819	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
111747	Fee-for-Service	1609880947	1609880947	1	3	PREMIER ANESTHESIA	1/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
111753	Fee-for-Service	1578586806	1578586806	1	1	PIERCE, JOHN J DO	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
111754	Fee-for-Service	1336181858	1336181858	1	1	PUND, ERNEST E MD JR	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24202	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9834 GENESEE AVE	STE 300	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
111758	Fee-for-Service	1831463678	1831463678	2	1	PHARMHEALTH SERVICES INC	10/6/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 W BONITA AVE	STE 110	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
111770	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111772	Fee-for-Service	1740329101	1740329101	1	1	PICO CLINICA MEDICA	2/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LATINA MED GRP INC	1600 W PICO BLVD	None	LOS ANGELES	CA	90015	2410	19	06037	34.04467617	-118.277069	Los Angeles County
111782	Fee-for-Service	1093061970	1093061970	1	1	PARK, HELENA S NP	10/28/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
111786	Fee-for-Service	1447769153	1447769153	1	1	PARK, YOUNG B NP	8/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
111794	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
111798	Fee-for-Service	1093723611	1093723611	1	1	PALITZ, HARVEY F MD APC	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	26307	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	STE 405	MODESTO	CA	95350	4568	50	06099	37.666233	-120.993933	Stanislaus County
111813	Fee-for-Service	1689310955	1689310955	1	1	PEREZ, ALEXIS P LCSW	10/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
111820	Fee-for-Service	1265588933	1265588933	1	1	PRESTI, JOSEPH C JR MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	56934	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
111836	Fee-for-Service	1659513711	1659513711	1	1	PASHA, JUNAID MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119817	78	Neoplastic Diseases/Oncology	0	In state provider	None	18111 BROOKHURST STREET	SUITE LL0300	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
111844	Fee-for-Service	1487040945	1487040945	1	1	POON, ANDREA MD	3/13/2020	207L00000X	NA	Other	026	PHYSICIANS	146506	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
111904	Fee-for-Service	1457445124	1457445124	1	1	PYUNE, EDDIE CHONGHAM MD	8/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44458	08	Family Practice	0	In state provider	None	6301 BEACH BLVD	STE 111	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
111914	Fee-for-Service	1164429643	1164429643	1	1	PATMAS, MICHAEL A MD	10/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88752	41	Internal Medicine	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
111949	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
111951	Fee-for-Service	1821042987	1821042987	1	1	PRADHAN, BHUPENDRA MD	6/1/2010	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	70279	20	Orthopedic Surgery	0	In state provider	None	2627 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16917853	-118.096371	Los Angeles County
111955	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
111964	Fee-for-Service	1578681573	1578681573	1	1	PAYDAR, KEYIANOOSH Z MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74742	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
111976	Fee-for-Service	1770012189	1770012189	1	1	PASTERNAK, RACHEL LCSW	4/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16955 VANOWEN	None	VAN NUYS	CA	91406	4542	19	06037	34.19389751	-118.503342	Los Angeles County
111995	Fee-for-Service	1619977444	1619977444	1	1	PALMORE, DAVID A	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	49263	41	Internal Medicine	0	In state provider	None	110 N VALERIA ST	STE 501	FRESNO	CA	93701	2168	10	06019	36.74388938	-119.7847725	Fresno County
112008	Fee-for-Service	1932525417	1932525417	1	1	PAPPAS, DOMINIC MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185344	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
112028	Fee-for-Service	1235830886	1235830886	1	1	PABAYO, ADRIAN G RCP	12/1/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
112042	Fee-for-Service	1457329674	1457329674	1	1	PRESTON, JOSEPH C MD	12/31/1995	207RC0200X	NA	Other	026	PHYSICIANS	80997	41	Internal Medicine	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
112056	Fee-for-Service	1295870053	1295870053	1	1	PINEDA, JULIO MD	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40352	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
112059	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112066	Fee-for-Service	1831392471	1831392471	1	1	PRECISE COMFORT	12/10/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PRECISE MEDICAL COMFORT	2235 N. LAKE AVE	SUITE 107	ALTADENA	CA	91001	6001	19	06037	34.18412319	-118.1316642	Los Angeles County
112071	Fee-for-Service	1346419348	1346419348	1	1	PARDO, JAIME MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101233	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
112081	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
112085	Fee-for-Service	1093723611	1093723611	1	1	PALITZ, HARVEY F MD APC	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	26307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 MCHENRY AVE	STE 405	MODESTO	CA	95350	4568	50	06099	37.666233	-120.993933	Stanislaus County
112138	Fee-for-Service	1023523990	1023523990	1	1	PACIFIC CENTRAL COAST HEALTH	1/9/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	2271 SOUTH DEPOT STREET	None	SANTA MARIA	CA	93455	1216	42	06083	34.91728273	-120.4435243	Santa Barbara County
112142	Fee-for-Service	1992765036	1992765036	1	1	PORWAY, MARK N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
112146	Fee-for-Service	1255960456	1255960456	1	1	PATEL, TIRTH K MD	5/28/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	189505	13	Neurology (M.D. only)	0	In state provider	None	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
112156	Fee-for-Service	1871673012	1871673012	1	1	PRISLIN, MICHAEL MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55545	08	Family Practice	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
112167	Fee-for-Service	1770692188	1770692188	1	1	PAYLESS DRUG STORE 5933	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	27 ORINDA WAY	None	ORINDA	CA	94563	2538	07	06013	37.88319335	-122.1889277	Contra Costa County
112183	Fee-for-Service	1346447596	1346447596	1	1	PERSWAIN, LORENA Y LMFT	11/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3099 TELEGRAPH AVE	None	BERKELEY	CA	94705	2035	01	06001	37.85389859	-122.2599904	Alameda County
112237	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
112239	Fee-for-Service	1518248152	1518248152	1	1	PFAFF, HEIDI A CNM	10/5/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6650 ALTON PARKWAY	None	IRVINE	CA	92618	2317	30	06059	33.65911992	-117.7737909	Orange County
112243	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112269	Fee-for-Service	1083761852	1083761852	1	1	PICKAR, DANIEL B PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
112275	Fee-for-Service	1235453424	1235453424	1	1	P.E.E.C.E. KEEPERS, INC.	1/11/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	23390 HEMLOCK AVE	None	MORENO VALLEY	CA	92557	8805	33	06065	33.94254348	-117.2538957	Riverside County
112279	Fee-for-Service	1255995544	1255995544	1	1	PENANO, KAREN U NP	9/20/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
112292	Fee-for-Service	1063434850	1063434850	1	1	PARSONS, ROSALEEN B MD	9/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74106	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
112315	Fee-for-Service	1326190521	1326190521	1	1	PETERSON, RICHARD L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76383	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
112340	Fee-for-Service	1447679147	1447679147	1	1	POLITO, CHRISTOPHER J MD	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
112346	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112371	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
112403	Fee-for-Service	1659540599	1659540599	1	1	PATEL, VALLARI S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124784	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
112423	Fee-for-Service	1932497377	1932497377	1	2	PULLINS, JESSICA E PHD	5/19/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	712 D STREET	SUITE N	SAN RAFAEL	CA	94901	3709	21	06041	37.97101704	-122.5323676	Marin County
112454	Fee-for-Service	1861526337	1861526337	1	1	PARTRIDGE, LAURA W LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87918	-	NOT APPLICABLE	0	In state provider	None	1303 W WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
112457	Fee-for-Service	1467600270	1467600270	1	1	PHILLIP DICKINSON MD APC	7/29/2009	208600000X	NA	General Surgery	026	PHYSICIANS	86720	02	General Surgery	0	In state provider	None	8554 LA MESA BLVD	None	LA MESA	CA	91941	3958	37	06073	32.76889956	-117.0129515	San Diego County
112483	Fee-for-Service	1477694081	1477694081	1	1	PETROSYAN, PETROS	12/3/2008	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA AVENUE	# 135	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
112502	Fee-for-Service	1326538513	1326538513	1	1	PANAG, AJIT S MD	8/1/2021	207P00000X	NA	Other	026	PHYSICIANS	173429	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
112512	Fee-for-Service	1134148752	1134148752	1	1	PARKER, JOSHUA M	4/16/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE	140	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
112523	Fee-for-Service	1356571715	1356571715	1	1	PENERA, REBECCA A DPM	4/7/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
112527	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
112532	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112555	Fee-for-Service	1780874313	1780874313	1	1	PUNJABI, VIKAS RAMESH DO	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12352	41	Internal Medicine	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
112601	Fee-for-Service	1184999005	1184999005	1	1	PEDES ORANGE COUNTY INC	8/13/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4501 BIRCH STREET	None	NEWPORT BEACH	CA	92660	1990	30	06059	33.66902484	-117.8655315	Orange County
112632	Fee-for-Service	1992931273	1992931273	1	1	PATEL, HEMALEE K DO	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11619	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
112633	Fee-for-Service	1639252604	1639252604	1	19	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112642	Fee-for-Service	1700968955	1700968955	1	1	POURZAND, HAMIDEH	7/17/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
112645	Fee-for-Service	1871029892	1871029892	1	1	PATTISAPU, NAVEEN MD	10/5/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	177924	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
112654	Fee-for-Service	1750644027	1750644027	1	1	PATEL, SHAUN P MD	9/24/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	155598	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
112668	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
112669	Fee-for-Service	1407103609	1407103609	1	1	PALOS, STEVE LMFT	4/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 VERNON STREET	SUITE B	ROSEVILLE	CA	95678	2600	31	06061	38.74793156	-121.2853565	Placer County
112690	Fee-for-Service	1659540599	1659540599	1	1	PATEL, VALLARI S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124784	77	Infectious Disease	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
112700	Fee-for-Service	1346239704	1346239704	1	1	PENA, CLAUDIA V MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91573	08	Family Practice	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
112814	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
112819	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
112836	Fee-for-Service	1689959116	1689959116	1	1	PATEL, CHIRAG MD	7/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184676	None	None	0	In state provider	None	19111 TOWN CENTER DR	None	APPLE VALLEY	CA	92308	8989	36	06071	34.46573149	-117.2467156	San Bernardino County
112846	Fee-for-Service	1154461754	1154461754	1	1	PAN, MICAH V OD	1/2/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROF CORP	15942 LOS SERRANOS COUNT	None	CHINO HILLS	CA	91709	4531	36	06071	33.9634463	-117.6957708	San Bernardino County
112857	Fee-for-Service	1770902983	1770902983	1	1	PARIKH, FORAM A MD	9/13/2019	207L00000X	NA	Other	026	PHYSICIANS	147034	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
112923	Fee-for-Service	1669969440	1669969440	1	1	PHAM, MAI T CRNA	7/9/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
112942	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	7/14/2017	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
112960	Fee-for-Service	1336526698	1336526698	1	1	PACIFIC MEDICAL PHARMACY INC	3/27/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	808 E CALIFORNIA AVE	None	GLENDALE	CA	91206	3705	19	06037	34.14991951	-118.245213	Los Angeles County
113015	Fee-for-Service	1023166097	1023166097	1	1	PRECIADO, KIMBERLY M MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
113063	Fee-for-Service	1942488747	1942488747	1	1	PATEL, PARUL J MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98531	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
113067	Fee-for-Service	1598989154	1598989154	1	1	PLATCHEK, TERRY S MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113356	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
113100	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
113106	Fee-for-Service	1356876429	1356876429	1	1	PAUL, NICHOLAS A MD	7/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158425	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113109	Fee-for-Service	1639252604	1639252604	1	20	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
113144	Fee-for-Service	1780051441	1780051441	1	1	PEKLO, SARAH LMFT	5/2/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88189	-	NOT APPLICABLE	0	In state provider	None	2307 W 6TH STREET	None	LOS ANGELES	CA	90057	3119	19	06037	34.06056584	-118.2771007	Los Angeles County
113158	Fee-for-Service	1396760443	1396760443	1	1	PETTUS, SONYA D MD	9/1/1996	207L00000X	NA	Other	026	PHYSICIANS	80778	None	None	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
113164	Fee-for-Service	1033572565	1033572565	1	1	PHAM, EDWARD MD	5/31/2022	207R00000X	NA	Other	026	PHYSICIANS	154261	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
113193	Fee-for-Service	1386352466	1386352466	1	1	PACIFICA FOUNDATION LLC	10/6/2023	261QM1300X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	SUITE 407	LOS ANGELES	CA	90027	6086	19	06037	34.0956033	-118.2916918	Los Angeles County
113233	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
113234	Fee-for-Service	1801273461	1801273461	1	1	PENUMARTY, SRAVANI MD	9/21/2020	207RR0500X	NA	Other	026	PHYSICIANS	168301	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
113235	Fee-for-Service	1609862820	1609862820	1	1	PENG, ALBERT MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75807	07	Dermatology	0	In state provider	None	990 SONOMA AVE	STE 9	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
113240	Fee-for-Service	1881898856	1881898856	1	1	PATEL, NARESH A MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105983	68	Hematology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
113275	Fee-for-Service	1073652673	1073652673	1	1	PACIFIC HEARING CLINIC INC	10/1/1993	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 ALAMEDA DE LAS PULG	STE 100	MENLO PARK	CA	94025	6509	41	06081	37.43203515	-122.2019218	San Mateo County
113278	Fee-for-Service	1124042023	1124042023	1	1	PHAM, BANG VU MD	9/15/1989	207R00000X	NA	Other	026	PHYSICIANS	41407	41	Internal Medicine	0	In state provider	None	11801 INGLEWOOD AVE	STE 1	HAWTHORNE	CA	90250	2701	19	06037	33.927039	-118.361338	Los Angeles County
113294	Fee-for-Service	1154326601	1154326601	1	1	POWERS, RICHARD E MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	22262	08	Family Practice	0	In state provider	None	6800 PALM AVE	STE A	SEBASTOPOL	CA	95472	4226	49	06097	38.39602719	-122.8185446	Sonoma County
113358	Fee-for-Service	1255829107	1255829107	1	1	PRIMBAS, ANGELA D MD	7/21/2022	207R00000X	NA	Other	026	PHYSICIANS	173966	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
113360	Fee-for-Service	1982741641	1982741641	1	1	PRICE, JENNIFER C MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121817	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113381	Fee-for-Service	1710498787	1710498787	1	1	PLASCENCIA, KATE LMFT	8/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
113388	Fee-for-Service	1982282851	1982282851	1	1	PALOMARES, VANESSA	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
113389	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	11/28/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
113401	Fee-for-Service	1306083837	1306083837	1	1	PATTERSON, DEBBIE R	4/7/2009	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2961 W MACARTHUR BLVD	STE 127	SANTA ANA	CA	92704	6913	30	06059	33.69994146	-117.908955	Orange County
113402	Fee-for-Service	1881133759	1881133759	1	1	PALLIKIZHAKETHIL, JULIANN T	3/27/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	56463	-	NOT APPLICABLE	0	In state provider	None	4544 SAN FERNANDO ROAD	SUITE 201	GLENDALE	CA	91204	5015	19	06037	34.13475025	-118.2630831	Los Angeles County
113450	Fee-for-Service	1134838352	1134838352	2	1	PAIR TEAM MEDICAL GROUP OF C	4/8/2024	172V00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA, PC	95 3RD ST	STE 293	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
113498	Fee-for-Service	1326365206	1326365206	1	1	PADILLA, OSCAR MD	1/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186959	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
113520	Fee-for-Service	1801273461	1801273461	1	1	PENUMARTY, SRAVANI MD	9/21/2020	207RR0500X	NA	Other	026	PHYSICIANS	168301	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
113521	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
113522	Fee-for-Service	1750458584	1750458584	1	1	PEREZ, DONALD U MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70550	04	Otology, Laryngology, Rhinology	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113525	Fee-for-Service	1881898856	1881898856	1	1	PATEL, NARESH A MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105983	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
113539	Fee-for-Service	1891025573	1891025573	1	1	POLLOCK, MARTHA J LCSW	1/2/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	112 W JONES ST	STE 1	SANTA MARIA	CA	93458	5605	42	06083	34.94583211	-120.436684	Santa Barbara County
113561	Fee-for-Service	1124210497	1124210497	1	1	PACIFIC ADHC	4/12/2010	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	16861 PARTHENIA ST	None	NORTHRIDGE	CA	91343	4539	19	06037	34.22852852	-118.500228	Los Angeles County
113594	Fee-for-Service	1750698924	1750698924	1	1	PELK, JAMES B LCSW	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	16442	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
113622	Fee-for-Service	1568138824	1568138824	1	1	PEREZ, RAMON	3/11/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
113648	Fee-for-Service	1558450684	1558450684	1	1	PERZ, DAVID D DO	6/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8482	None	None	0	In state provider	None	903 E DEVONSHIRE AVE	STE D	HEMET	CA	92543	3097	33	06065	33.75116958	-116.9627485	Riverside County
113649	Fee-for-Service	1982741641	1982741641	1	1	PRICE, JENNIFER C MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121817	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113677	Fee-for-Service	1861875395	1861875395	1	1	PENA, MARLENY S LCSW	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
113678	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
113737	Fee-for-Service	1568088086	1568088086	1	1	PALERMO HOSPICE INC	8/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	229 N CENTRAL AVE	SUITE 201	GLENDALE	CA	91203	3554	19	06037	34.14910181	-118.2579537	Los Angeles County
113739	Fee-for-Service	1134838352	1134838352	2	1	PAIR TEAM MEDICAL GROUP OF C	4/8/2024	172V00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ALIFORNIA, PC	95 3RD ST	STE 293	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
113745	Fee-for-Service	1457125288	1457125288	1	1	PINNACLE HEALTHCARE LLC	5/29/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	1	Border provider	None	101 CIVIC CENTER LN LAKE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
113753	Fee-for-Service	1205321874	1205321874	1	1	PENTAGON RIDES & TRANSPORT,	12/7/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	719 NILES ST	E-1	BAKERSFIELD	CA	93305	4400	15	06029	35.38177957	-118.9901463	Kern County
113773	Fee-for-Service	1114028735	1114028735	1	1	PHILIP A HESS	4/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	334 TOWN CENTER AVE	None	BIG SKY	MT	59716	1713	00	None	45.260424	-111.3007635	Gallatin County
113779	Fee-for-Service	1245611904	1245611904	1	1	POWCH, NICOLE L CRNA	2/9/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
113795	Fee-for-Service	1295827996	1295827996	1	1	PRECISE RADIOLOGICAL	6/20/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ASSOCIATES INC	470 PLUMAS BLVD	STE 101	YUBA CITY	CA	95991	5077	51	06101	39.13270038	-121.6141985	Sutter County
113796	Fee-for-Service	1417301078	1417301078	1	1	PATEL, KRISHNA S MD	11/29/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167501	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113809	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/19/2018	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
113810	Fee-for-Service	1750458584	1750458584	1	1	PEREZ, DONALD U MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70550	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113812	Fee-for-Service	1003849761	1003849761	1	1	PIETUCH, THOMAS J MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	53870	05	Anesthesiology	0	In state provider	None	5469 KEARNY VILLA RD	STE 302	SAN DIEGO	CA	92123	1159	37	06073	32.83298834	-117.1388725	San Diego County
113817	Fee-for-Service	1497914949	1497914949	1	1	PRAKASAM, SOUMIYA MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129051	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
113821	Fee-for-Service	1821297995	1821297995	1	1	PELAYO, CARMEN J MD	7/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94929	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
113864	Fee-for-Service	1235260092	1235260092	1	1	PENUELA-PARKER, CATHERINE M	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
113881	Fee-for-Service	1215962204	1215962204	1	1	PLANNED PARENTHOOD OF THE	5/31/2002	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	4501 MISSION BAY DR	STE 1C&D	SAN DIEGO	CA	92109	4923	37	06073	32.80307971	-117.2166446	San Diego County
113906	Fee-for-Service	1770929143	1770929143	1	1	PATRICK, ROSHNI MD	12/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138990	41	Internal Medicine	0	In state provider	None	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3006	19	06037	34.07803211	-117.74833	Los Angeles County
113908	Fee-for-Service	1023545340	1023545340	1	1	PORTMAN, MARK T MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	158525	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
113934	Fee-for-Service	1144344003	1144344003	1	1	PHILLIPS, DANIEL G K MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111207	22	Pathology (M.D. only)	0	In state provider	None	305 PARK CREEK DRIVE	None	CLOVIS	CA	93611	4426	10	06019	36.84077548	-119.7076545	Fresno County
113948	Fee-for-Service	1265580070	1265580070	1	1	PATEL, NAYANA H MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54490	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
113957	Fee-for-Service	1982838058	1982838058	1	1	PHILLIPS, MARIA V P MD	3/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	114407	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
113963	Fee-for-Service	1376675702	1376675702	1	1	PHAN, VAN V OD	12/6/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
113966	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
113969	Fee-for-Service	1124272695	1124272695	1	1	PINATANFERANI, SHERRI A PHD	10/11/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
113987	Fee-for-Service	1205869872	1205869872	2	1	PHARMACY CORPORATION OF	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AMERICA	4910 E ASHLAN AVE	STE 111	FRESNO	CA	93726	3021	10	06019	36.79411387	-119.7309194	Fresno County
114012	Fee-for-Service	1649203910	1649203910	1	1	PHUNG, LANH M MD INC	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48978	05	Anesthesiology	0	In state provider	None	10130 WARNER AVE	STE B	FOUNTAIN VALLEY	CA	92708	1619	30	06059	33.7161915	-117.95238	Orange County
114024	Fee-for-Service	1568088086	1568088086	1	1	PALERMO HOSPICE INC	8/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	229 N CENTRAL AVE	SUITE 201	GLENDALE	CA	91203	3554	19	06037	34.14910181	-118.2579537	Los Angeles County
114026	Fee-for-Service	1144287707	1144287707	1	1	PETERSON, KENNETH P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50553	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
114029	Fee-for-Service	1285814921	1285814921	1	1	PATIENT ASSISTANCE	12/22/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	2351 CLAY ST	STE. 141	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
114033	Fee-for-Service	1134279912	1134279912	1	1	PETRYNIAK, MAGDALENA MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84189	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
114035	Fee-for-Service	1740560903	1740560903	1	1	PANA, EDMUNDRAY H MD	1/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	151378	41	Internal Medicine	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
114094	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	3/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
114102	Fee-for-Service	1457642332	1457642332	1	1	PEDIATRIC HOSPITAL CARE ASSO	6/24/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CIATES	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
114124	Fee-for-Service	1457442063	1457442063	1	1	PEZNER, RICHARD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39182	30	Radiology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
114129	Fee-for-Service	1558866426	1558866426	1	1	PILGRAM, LAURA MD	9/26/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	176844	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
114157	Fee-for-Service	1376625004	1376625004	1	1	PETYN, RICHARD MD	4/28/1999	207R00000X	NA	Other	026	PHYSICIANS	51659	41	Internal Medicine	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
114238	Fee-for-Service	1285625509	1285625509	1	1	PLEASANTON EMERGENCY	2/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
114254	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
114329	Fee-for-Service	1679180863	1679180863	1	1	PANGANIBAN, JANNELYN M NP	12/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
114341	Fee-for-Service	1225396583	1225396583	1	1	PETERSON, KIMBERLY	3/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	814 BROADWAY	None	SONOMA	CA	95476	7584	49	06097	38.28627132	-122.4586519	Sonoma County
114365	Fee-for-Service	1093135469	1093135469	1	1	PHELPS, KENNETH S LAC	1/11/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
114384	Fee-for-Service	1841373800	1841373800	1	12	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
114404	Fee-for-Service	1356699649	1356699649	1	1	PYUN, DAISY LCSW	4/9/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
114439	Fee-for-Service	1427170513	1427170513	1	1	PARAMOUNT HOME HEALTH	4/3/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	9420 TOPANGA CANYON BLVD	STE 202	CHATSWORTH	CA	91311	5759	19	06037	34.24129936	-118.6061277	Los Angeles County
114446	Fee-for-Service	1003874702	1003874702	2	2	PROHEALTH ADVANCED IMAGING M	8/5/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	145 S DOHENY DR	None	BEVERLY HILLS	CA	90211	2509	19	06037	34.065855	-118.3897585	Los Angeles County
114451	Fee-for-Service	1457338154	1457338154	1	1	PHAM, HEIDI T OD	9/1/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1689 ARDEN WAY	STE 1091	SACRAMENTO	CA	95815	4096	34	06067	38.601549	-121.4274825	Sacramento County
114454	Fee-for-Service	1568607653	1568607653	1	1	PHILLIPS, TYCEL J MD	5/5/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	178254	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
114467	Fee-for-Service	1811693948	1811693948	1	1	PAGES, SOPHIA LMFT	10/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	214 E WALNUT ST	None	SANTA ANA	CA	92701	5896	30	06059	33.74436237	-117.8656067	Orange County
114487	Fee-for-Service	1699702456	1699702456	1	1	PIEN-WONG, JENNIFER H MD	8/5/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80003	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114493	Fee-for-Service	1740228576	1740228576	1	1	PLATT, TIMOTHY B MD	12/31/1988	207L00000X	NA	Other	026	PHYSICIANS	59355	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
114525	Fee-for-Service	1225177223	1225177223	1	1	PHAM, TIENANH N DO	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10798	08	Family Practice	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
114541	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
114545	Fee-for-Service	1629182704	1629182704	1	1	PATEL, SATISH M MD	12/27/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	92343	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
114555	Fee-for-Service	1508980566	1508980566	1	1	PRASAD, SUDEEPTHI MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99807	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	SUITE 3-A	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
114570	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	10/31/2014	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
114627	Fee-for-Service	1982075107	1982075107	1	1	PEDIATRIC AND FAMILY MEDICAL	6/30/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	15477 VENTURA BLVD	SUITE 300	SHERMAN OAKS	CA	91403	3006	19	06037	34.15468022	-118.4712272	Los Angeles County
114644	Fee-for-Service	1023395894	1023395894	1	1	PAULSEN, DANA M CRNA	4/5/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
114693	Fee-for-Service	1467032185	1467032185	1	1	PLASCENCIA, MAYRA LMFT	12/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
114695	Fee-for-Service	1386625721	1386625721	1	1	POULAIN, FRANCIS R	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45812	40	Pediatrics	0	In state provider	None	533 PARNASSUS AVE	STE U503	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
114719	Fee-for-Service	1124105754	1124105754	1	1	PALEY, WILLIAM DO	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	4932	08	Family Practice	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
114730	Fee-for-Service	1093953721	1093953721	1	1	PECK, DIANA G LCSW	9/27/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
114736	Fee-for-Service	1790471498	1790471498	1	1	PENG, RICHARD LCSW	7/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
114746	Fee-for-Service	1790289908	1790289908	1	1	PANG, RAN MD	6/22/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164259	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
114755	Fee-for-Service	1467497958	1467497958	1	1	PALENCHAR, B C MD	10/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30732	30	Radiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
114811	Fee-for-Service	1093953721	1093953721	1	2	PECK, DIANA G LCSW	4/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14204 MAIN STREET	SUITE 14A	AMADOR CITY	CA	95601	8024	03	06005	38.41922733	-120.824844	Amador County
114819	Fee-for-Service	1679589691	1679589691	1	1	PATTERSON, SCOTT W MD	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65905	02	General Surgery	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
114828	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
114830	Fee-for-Service	1649867243	1649867243	1	1	PINNACLE PALLIATIVE SERVICES	5/19/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	19737 VENTURA BLVD	STE 202	WOODLAND HILLS	CA	91364	2605	19	06037	34.17249119	-118.5635388	Los Angeles County
114837	Fee-for-Service	1225690233	1225690233	1	1	PACHECO, FABIOLA MSW LCSW	7/22/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
114858	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	10/20/2016	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
114863	Fee-for-Service	1508859323	1508859323	1	1	PIH HEALTH GOOD SAMARITAN	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
114873	Fee-for-Service	1548808553	1548808553	1	1	PIECE BY PEACE, COUNSELING &	12/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CONSULTING	3067 FREEPORT BLVD	SUITE 8	SACRAMENTO	CA	95818	4347	34	06067	38.54850759	-121.4894843	Sacramento County
114875	Fee-for-Service	1700203171	1700203171	1	1	PRIETO, EDNA C MD	3/14/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139228	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
114914	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
114918	Fee-for-Service	1982075107	1982075107	1	1	PEDIATRIC AND FAMILY MEDICAL	6/30/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	15477 VENTURA BLVD	SUITE 300	SHERMAN OAKS	CA	91403	3006	19	06037	34.15468022	-118.4712272	Los Angeles County
114981	Fee-for-Service	1750468682	1750468682	1	1	PATEL, MANJARI K MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60158	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
115005	Fee-for-Service	1124105754	1124105754	1	1	PALEY, WILLIAM DO	1/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	4932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
115037	Fee-for-Service	1699821199	1699821199	1	1	PAULSON, ANTON PHD	11/15/2024	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
115048	Fee-for-Service	1861526337	1861526337	1	2	PARTRIDGE, LAURA W LMFT	6/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
115055	Fee-for-Service	1528207461	1528207461	1	1	PREMIER EMERGENCY PHYSICIANS	3/1/2009	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	3800 JANES ROAD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
115070	Fee-for-Service	1396758306	1396758306	1	1	PETRAS, WILLIAM D MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8158	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
115078	Fee-for-Service	1801013768	1801013768	1	1	PALMDALE WOMEN AND	5/25/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CHILDRENS CENTER INC	3005 E PALMDALE BLVD	STE 4	PALMDALE	CA	93550	1833	19	06037	34.58024946	-118.0755315	Los Angeles County
115104	Fee-for-Service	1063015162	1063015162	1	1	PANINGBATAN, ANNA SABRINA N	7/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	33	06065	33.95782448	-117.3904065	Riverside County
115117	Fee-for-Service	1639252604	1639252604	1	14	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
115118	Fee-for-Service	1649867243	1649867243	1	1	PINNACLE PALLIATIVE SERVICES	5/19/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	19737 VENTURA BLVD	STE 202	WOODLAND HILLS	CA	91364	2605	19	06037	34.17249119	-118.5635388	Los Angeles County
115147	Fee-for-Service	1932103520	1932103520	1	1	PARSONS, GIBBE MD	1/27/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	17728	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
115148	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
115151	Fee-for-Service	1508859323	1508859323	1	1	PIH HEALTH GOOD SAMARITAN	12/1/1979	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
115156	Fee-for-Service	1568969335	1568969335	1	1	PICKERING, ANNALICIA M MD	8/13/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	173617	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
115193	Fee-for-Service	1215319140	1215319140	1	1	PIERRE, GRITZ MD	10/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167492	08	Family Practice	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
115194	Fee-for-Service	1922019397	1922019397	1	1	PLANNED PARENTHOOD	12/1/1977	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	GOLDEN GATE	2211 PALM AVE	None	SAN MATEO	CA	94403	1814	41	06081	37.54653566	-122.3064343	San Mateo County
115201	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
115203	Fee-for-Service	1982075107	1982075107	1	1	PEDIATRIC AND FAMILY MEDICAL	3/12/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	15477 VENTURA BLVD	SUITE 300	SHERMAN OAKS	CA	91403	3006	19	06037	34.15468022	-118.4712272	Los Angeles County
115242	Fee-for-Service	1215948740	1215948740	1	1	PIKE, LEAH M MD	10/16/2007	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	83814	40	Pediatrics	0	In state provider	None	1760 TERMINO AVE	SUITE 308	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
115255	Fee-for-Service	1659691970	1659691970	1	1	PANMED ANESTHESIA SERVICES	7/14/2010	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
115272	Fee-for-Service	1235627167	1235627167	1	1	PRIMARY HOME CARE INC	10/8/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	STE 201	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
115275	Fee-for-Service	1841210044	1841210044	1	1	PIETRAS, RICHARD J MD	4/11/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	61562	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA #365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
115291	Fee-for-Service	1235493669	1235493669	1	1	PORTER, JOANN LMFT	12/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
115296	Fee-for-Service	1346699667	1346699667	1	1	PIRZAD, ARMAN MD	10/1/2021	207K00000X	NA	Other	026	PHYSICIANS	174425	None	None	0	In state provider	None	2504 HARRISON AVE	STE B & C	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
115304	Fee-for-Service	1043368988	1043368988	1	1	PURCELL, LESLIE J OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.80766827	-116.9222044	San Diego County
115306	Fee-for-Service	1366084063	1366084063	3	1	PONTUS HEALTHCARE INC	12/3/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1203 N. AVALON BLVD.	SUITE A	WILMINGTON	CA	90744	2646	19	06037	33.78702155	-118.2630145	Los Angeles County
115311	Fee-for-Service	1992957237	1992957237	1	1	PATEL, ANISH A MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117372	41	Internal Medicine	0	In state provider	None	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
115347	Fee-for-Service	1083807440	1083807440	1	1	PHILLIPS, LAUREEN A LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
115356	Fee-for-Service	1396758306	1396758306	1	1	PETRAS, WILLIAM D MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8158	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
115368	Fee-for-Service	1740427673	1740427673	1	1	PARISA REFAAT PHYSICAL	6/12/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	4028 E BROADWAY	None	LONG BEACH	CA	90803	1502	19	06037	33.76442452	-118.1451465	Los Angeles County
115369	Fee-for-Service	1801013768	1801013768	1	1	PALMDALE WOMEN AND	5/25/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CHILDRENS CENTER INC	3005 E PALMDALE BLVD	STE 4	PALMDALE	CA	93550	1833	19	06037	34.58024946	-118.0755315	Los Angeles County
115397	Fee-for-Service	1427480524	1427480524	1	1	PATEL, SAMISH A MD	1/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142858	41	Internal Medicine	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
115435	Fee-for-Service	1932103520	1932103520	1	1	PARSONS, GIBBE MD	1/27/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	17728	01	General Practice	0	In state provider	None	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
115436	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
115441	Fee-for-Service	1891864559	1891864559	1	1	PAIGE, THOMAS N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32212	07	Dermatology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
115491	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	3/9/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
115531	Fee-for-Service	1215948740	1215948740	1	1	PIKE, LEAH M MD	10/16/2007	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	83814	20	Orthopedic Surgery	0	In state provider	None	1760 TERMINO AVE	SUITE 308	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
115552	Fee-for-Service	1699718270	1699718270	1	1	PIERCE, SAMUEL L MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06593048	-118.2708351	Los Angeles County
115560	Fee-for-Service	1104371806	1104371806	1	1	PASILABAN, KLAR F NP	2/3/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95004610	-	NOT APPLICABLE	0	In state provider	None	4544 SAN FERNANDO ROAD	SUITE 201	GLENDALE	CA	91204	5015	19	06037	34.13475025	-118.2630831	Los Angeles County
115563	Fee-for-Service	1841210044	1841210044	1	1	PIETRAS, RICHARD J MD	4/11/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	61562	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA #365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
115581	Fee-for-Service	1669147625	1669147625	1	1	PHYSICIAN PARTNERS MEDICAL G	7/10/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ROUP	15571 BROOKHURST STREET	None	WESTMINSTER	CA	92683	7554	30	06059	33.73633159	-117.9548222	Orange County
115661	Fee-for-Service	1801013768	1801013768	1	1	PALMDALE WOMEN AND	5/25/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CHILDRENS CENTER INC	3005 E PALMDALE BLVD	STE 4	PALMDALE	CA	93550	1833	19	06037	34.58024946	-118.0755315	Los Angeles County
115685	Fee-for-Service	1255911053	1255911053	1	1	PELAYO, BRENDA	8/17/2023	207R00000X	NA	Other	026	PHYSICIANS	21280	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
115692	Fee-for-Service	1447269667	1447269667	1	1	PRESSMAN, JEFFREY H MD	10/6/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45990	10	Gastroenterology (M.D. only)	0	In state provider	None	8008 FROST ST	STE 305	SAN DIEGO	CA	92123	4230	37	06073	32.80027859	-117.1524832	San Diego County
115716	Fee-for-Service	1528588795	1528588795	1	1	PREMIER DIAGNOSTICS LLC	2/17/2019	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	LLC	8222 DOUGLAS AVE	820	DALLAS	TX	75225	5936	00	None	32.862879	-96.80855303	Dallas County
115725	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
115727	Fee-for-Service	1255725644	1255725644	1	1	PENNY, BRIAN MD	3/30/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151377	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
115730	Fee-for-Service	1477671386	1477671386	1	1	PHILIPOSE, JAYA A MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83146	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
115758	Fee-for-Service	1437141520	1437141520	1	1	PLUM, MARIA CLARA MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70008	40	Pediatrics	0	In state provider	None	17692 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	6810	30	06059	33.705462	-117.9890701	Orange County
115776	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
115777	Fee-for-Service	1124213301	1124213301	1	1	PERERA, JENNIFER L MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	102627	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
115782	Fee-for-Service	1255175964	1255175964	1	1	PALOS, CESAR	4/8/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9065 HAVEN AVE	STE 110	RANCHO CUCAMONGA	CA	91730	5429	36	06071	34.089012	-117.5756625	San Bernardino County
115795	Fee-for-Service	1629203971	1629203971	1	1	PALANCA, ARIEL A MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114257	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115844	Fee-for-Service	1699718270	1699718270	1	1	PIERCE, SAMUEL L MD	7/5/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	70056	-	NOT APPLICABLE	0	In state provider	None	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06593048	-118.2708351	Los Angeles County
115863	Fee-for-Service	1881142438	1881142438	1	1	PAN, SUWEN CNP	3/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	660 BAKER STREET	STE A-102	COSTA MESA	CA	92626	4407	30	06059	33.68014263	-117.8842009	Orange County
115887	Fee-for-Service	1669704235	1669704235	1	1	PASSANANTE, GIOVANNI J MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113115	30	Radiology	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
115898	Fee-for-Service	1902981665	1902981665	1	1	PIRZADA, NUDRAT MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86688	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
115901	Fee-for-Service	1205951126	1205951126	1	1	PATEL, NEHA J MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100359	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	MS #54	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
115948	Fee-for-Service	1245859040	1245859040	1	1	PUENTE, GABRIELLA C MD	8/15/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185489	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
115971	Fee-for-Service	1790213247	1790213247	1	5	PASADENA CLINICAL GROUP, A P	2/1/2023	103TA0400X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SYCHOLOGY CORPORATION	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
115998	Fee-for-Service	1649644220	1649644220	1	1	PHAM, JESSICA OT	11/3/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 NORTH COLLEGE DR	SUITE 203	SANTA MARIA	CA	93454	4614	42	06083	34.954461	-120.424836	Santa Barbara County
116003	Fee-for-Service	1609195221	1609195221	1	1	PSB HOMES INCORPORATED	8/12/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4742 VIA DEL RANCHO	None	YORBA LINDA	CA	92886	2927	30	06059	33.89143299	-117.784324	Orange County
116011	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
116038	Fee-for-Service	1649262239	1649262239	1	1	PRESIDIO HEALTH ASSOCIATES	10/1/2017	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	2	Out of state provider	LLC	2611 N WARREN AVE	None	TUCSON	AZ	85719	3160	00	None	32.254722	-110.9472525	Pima County
116064	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
116068	Fee-for-Service	1174568489	1174568489	1	1	PENG, STANFORD L MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92894	83	Rheumatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116147	Fee-for-Service	1144205790	1144205790	1	1	PARK, JU HUI PHD	9/27/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
116156	Fee-for-Service	1366643363	1366643363	1	1	PATEL, ASHISH K MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94801	41	Internal Medicine	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
116189	Fee-for-Service	1205951126	1205951126	1	1	PATEL, NEHA J MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100359	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	MS #54	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
116202	Fee-for-Service	1962428912	1962428912	1	1	PATEL, VARSHA H MD	2/17/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	50538	None	None	0	In state provider	None	127 N MCKINLEY ST	SUITE# 101	CORONA	CA	92879	6563	33	06065	33.88276394	-117.5149214	Riverside County
116209	Fee-for-Service	1942528286	1942528286	1	1	PATEL, VEENA MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117454	13	Neurology (M.D. only)	0	In state provider	None	15963 QUANTICO ROAD	SUITE C	APPLE VALLEY	CA	92307	0840	36	06071	34.54122514	-117.2706519	San Bernardino County
116236	Fee-for-Service	1578065199	1578065199	1	1	PATEL, KAVITA S	11/9/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
116246	Fee-for-Service	1932210382	1932210382	1	1	PREISS-FARZANEGAN, SARAH	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104365	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116247	Fee-for-Service	1841722485	1841722485	1	1	PINSON, KELSEY A MD	7/12/2021	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158192	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
116257	Fee-for-Service	1144647512	1144647512	1	1	P & J HOMES LLC	4/24/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7683 HEATHER CIR	None	BUENA PARK	CA	90621	1724	30	06059	33.85128776	-117.9954711	Orange County
116259	Fee-for-Service	1790213247	1790213247	1	5	PASADENA CLINICAL GROUP, A P	2/1/2023	103TA0400X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SYCHOLOGY CORPORATION	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
116299	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	10/31/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
116320	Fee-for-Service	1184247470	1184247470	1	1	PARKER, HANNAH J CRNA	8/15/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
116352	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
116394	Fee-for-Service	1710035035	1710035035	1	1	PLASTIC SURGERY ASSOC OF	3/1/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	REDDING, A MED CORP	2439 SONOMA ST	None	REDDING	CA	96001	3026	45	06089	40.57313392	-122.4026033	Shasta County
116415	Fee-for-Service	1588018741	1588018741	1	1	PHAM, NHAN DO	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	17378	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
116420	Fee-for-Service	1386747442	1386747442	1	1	PATTEE, JOHN R MD	3/31/1981	174400000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2865 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
116423	Fee-for-Service	1144713215	1144713215	1	1	PICCOLI, CARA T MD	7/5/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	189884	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116434	Fee-for-Service	1588175988	1588175988	1	1	PRICE-GIBSON, TAJ	10/11/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116478	Fee-for-Service	1205951126	1205951126	1	1	PATEL, NEHA J MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100359	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	MS #54	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
116483	Fee-for-Service	1851798417	1851798417	1	1	POTHURI, PALLAVI MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149719	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
116508	Fee-for-Service	1568744647	1568744647	1	1	PLATINUM PHARMACY, INC.	10/21/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1377 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	4940	19	06037	34.05564158	-118.4420038	Los Angeles County
116530	Fee-for-Service	1366928525	1366928525	1	1	PERRY, TIFFANAY M LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
116542	Fee-for-Service	1144766064	1144766064	1	2	PERFORMANCE PLUS PHYSICAL TH	2/5/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY, INC.	600 PALM AVE	126	IMPERIAL BEACH	CA	91932	1246	37	06073	32.5839813	-117.1207525	San Diego County
116547	Fee-for-Service	1790213247	1790213247	1	5	PASADENA CLINICAL GROUP, A P	7/8/2024	103TA0400X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SYCHOLOGY CORPORATION	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
116557	Fee-for-Service	1407190515	1407190515	1	1	PANG, JUDY	4/23/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
116576	Fee-for-Service	1083177943	1083177943	1	1	PATEL, SHIV U	12/9/2022	208M00000X	NA	Other	026	PHYSICIANS	180223	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
116586	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	10/20/2016	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
116614	Fee-for-Service	1689739732	1689739732	1	1	PILCH, BORIS I MD	6/21/2000	174400000X	NA	Other	026	PHYSICIANS	68397	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
116642	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
116649	Fee-for-Service	1316429384	1316429384	1	1	PALACIOS, JUAN C RCP	11/26/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
116660	Fee-for-Service	1245659457	1245659457	1	2	PUNATAR, RUCHI MD	9/11/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140033	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
116719	Fee-for-Service	1982075107	1982075107	1	7	PEDIATRIC AND FAMILY MEDICAL	4/24/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1500 SOUTH OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
116774	Fee-for-Service	1861080996	1861080996	1	1	PACIFIC HEARTS HOSPICE INC	10/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	SUITE 281	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
116787	Fee-for-Service	1912996638	1912996638	1	1	PENNY L. KRICH, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6644 E BAYWOOD AVE	None	MESA	AZ	85206	1747	00	None	33.411159	-111.688686	Maricopa County
116838	Fee-for-Service	1396926549	1396926549	1	2	PARSONS, KAREN	2/13/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	81407	-	NOT APPLICABLE	0	In state provider	None	1750 S WHITE RD	None	SAN JOSE	CA	95127	4760	43	06085	37.347282	-121.8062115	Santa Clara County
116851	Fee-for-Service	1811350861	1811350861	1	1	PEREZ, EDGAR L MD	6/16/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173150	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116854	Fee-for-Service	1942489356	1942489356	1	1	PIROUZ, ASHKAN MD	7/1/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	97183	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
116875	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	10/20/2016	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
116890	Fee-for-Service	1932255189	1932255189	1	1	PATEL, MAITRAYA K MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85031	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
116930	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
116932	Fee-for-Service	1710516364	1710516364	1	1	PINEHURST HOSPITALIST MEDICA	4/10/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	L GROUP, INC.	75 NEILSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
116950	Fee-for-Service	1063686376	1063686376	1	1	PERRY, RACHEL A MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131371	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
117009	Fee-for-Service	1982075107	1982075107	1	7	PEDIATRIC AND FAMILY MEDICAL	4/24/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1500 SOUTH OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
117013	Fee-for-Service	1255973947	1255973947	1	1	PARSLEY, MICHAEL NP	6/6/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117062	Fee-for-Service	1861080996	1861080996	1	1	PACIFIC HEARTS HOSPICE INC	10/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	SUITE 281	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
117069	Fee-for-Service	1093777252	1093777252	1	1	PATRICIA CELINE BERGEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5223 HARRY HINES BLVD	None	DALLAS	TX	75235	7708	00	None	32.81151975	-96.83708934	Dallas County
117074	Fee-for-Service	1942239926	1942239926	1	3	PAIR & MAROTTA PHYSICAL THER	10/3/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	3400 PANAMA LANE	SUITE R	BAKERSFIELD	CA	93313	3996	15	06029	35.29601148	-119.040507	Kern County
117100	Fee-for-Service	1386746931	1386746931	1	1	PATEL, ANIL A MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66576	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
117126	Fee-for-Service	1386897130	1386897130	1	1	PARUNGAO, JOANNE P OD	9/20/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2845 COCHRAN ST	STE D	SIMI VALLEY	CA	93065	7902	56	06111	34.280973	-118.742589	Ventura County
117128	Fee-for-Service	1265596373	1265596373	1	1	PETALUMA ICF/DDH	6/25/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	805 PETALUMA AVE	None	SONOMA	CA	95476	6320	49	06097	38.29192968	-122.4848419	Sonoma County
117130	Fee-for-Service	1639120934	1639120934	1	1	PAQUETTE, JANET MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	6255	00	None	45.20010494	-123.1656951	Yamhill County
117137	Fee-for-Service	1154961837	1154961837	1	1	PHARMEDQUEST PHARMACY SERVIC	4/15/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	45104 10TH ST W	A	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
117144	Fee-for-Service	1801139514	1801139514	1	1	PE, MARYBELLE A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5401	34	06067	38.463381	-121.416183	Sacramento County
117157	Fee-for-Service	1578816070	1578816070	1	1	PITTS, RESHONA LMFT	7/13/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132542	-	NOT APPLICABLE	0	In state provider	None	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	19	06037	34.00134941	-118.4039837	Los Angeles County
117158	Fee-for-Service	1528178936	1528178936	1	1	PODOLSKY, ANATOL MD INC	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71630	20	Orthopedic Surgery	0	In state provider	None	400 NEWPORT CENTER DRIVE	SUITE 601	NEWPORT BEACH	CA	92660	7685	30	06059	33.6142606	-117.8726808	Orange County
117162	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
117218	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
117219	Fee-for-Service	1780630087	1780630087	1	3	PETROLEUM HELICOPTER INC	1/1/2005	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	PHI AIR MED/MERCY AIR	3775 FLIGHT AVE	None	REDDING	CA	96002	9376	45	06089	40.50938893	-122.3003916	Shasta County
117248	Fee-for-Service	1437385010	1437385010	1	1	PREMIER HEALTHCARE SERVICES	4/13/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	2020 CAMINO DEL RIO N	STE 600	SAN DIEGO	CA	92108	1545	37	06073	32.77020579	-117.1423463	San Diego County
117250	Fee-for-Service	1881793743	1881793743	1	1	PORRAL, AZUCENA A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25493	40	Pediatrics	0	In state provider	None	5546 ROSEMEAD BLVD	STE 102	TEMPLE CITY	CA	91780	1855	19	06037	34.10036598	-118.0734184	Los Angeles County
117251	Fee-for-Service	1689745648	1689745648	1	1	PHAM, RONALD A MD	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77172	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
117276	Fee-for-Service	1689849986	1689849986	1	1	PAYKAR, ABRAHAM MD INC	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54392	41	Internal Medicine	0	In state provider	None	1601 W AVENUE J	SUITE 203	LANCASTER	CA	93534	2824	19	06037	34.68946047	-118.158849	Los Angeles County
117295	Fee-for-Service	1841333226	1841333226	1	1	PEREZ, ELIBETT LVN	3/29/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21340 E FLORAL AVE	None	REEDLEY	CA	93654	8904	10	06019	36.57505534	-119.4064793	Fresno County
117323	Fee-for-Service	1922176924	1922176924	1	1	PATEL, RICHARD M MD	12/8/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	79939	None	None	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
117325	Fee-for-Service	1740830850	1740830850	1	1	PRESPECTIVE HOME HEALTH INC	1/1/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1864 E WASHINGTON BLVD	SUITE 205	PASADENA	CA	91104	1667	19	06037	34.16910848	-118.112022	Los Angeles County
117341	Fee-for-Service	1982210126	1982210126	1	1	PEGASUS IMAGING, LLC	9/26/2024	207RM1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4300 LONG BEACH BLVD	STE 170	LONG BEACH	CA	90807	2015	19	06037	33.83662572	-118.1900605	Los Angeles County
117357	Fee-for-Service	1942239926	1942239926	1	1	PAIR & MAROTTA PHYSICAL THER	4/4/2006	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	5337 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	2807	15	06029	35.36721148	-119.0622416	Kern County
117360	Fee-for-Service	1205089026	1205089026	1	2	PRIME HEALTHCARE SERVICES	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SHASTA, LLC	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
117366	Fee-for-Service	1942239926	1942239926	1	3	PAIR & MAROTTA PHYSICAL THER	4/29/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	3400 PANAMA LANE	SUITE R	BAKERSFIELD	CA	93313	3996	15	06029	35.29601148	-119.040507	Kern County
117387	Fee-for-Service	1568462364	1568462364	1	1	PAK, FIROOZ MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73904	45	Nephrology (Renal-Kidney)	0	In state provider	None	1061 EAST VERNON AVE	STE F	LOS ANGELES	CA	90011	3778	19	06037	34.0039535	-118.256877	Los Angeles County
117404	Fee-for-Service	1609991116	1609991116	1	1	PALLAY, GERALD D MD	6/24/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55039	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
117431	Fee-for-Service	1659536795	1659536795	1	1	PEELA, BHASKARI MD	8/21/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103623	40	Pediatrics	0	In state provider	None	39500 FREMONT BLVD	SUITE 100	FREMONT	CA	94538	1621	01	06001	37.5448266	-121.9802588	Alameda County
117441	Fee-for-Service	1104525633	1104525633	1	1	PACKARD, DENITA LCSW	9/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
117449	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
117468	Fee-for-Service	1386711075	1386711075	1	1	POHLOT, NANCY E	6/18/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3982	30	06059	33.78142951	-117.866583	Orange County
117473	Fee-for-Service	1134516545	1134516545	1	1	PURVIEW HOSPICE AND PAL	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	440 W COLORADO ST	SUITE 208	GLENDALE	CA	91204	4564	19	06037	34.14249549	-118.2628035	Los Angeles County
117495	Fee-for-Service	1710516364	1710516364	1	2	PINEHURST HOSPITALIST MEDICA	4/10/2020	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	L GROUP, INC.	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
117506	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
117582	Fee-for-Service	1841333226	1841333226	1	1	PEREZ, ELIBETT LVN	11/16/2006	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21340 E FLORAL AVE	None	REEDLEY	CA	93654	8904	10	06019	36.57505534	-119.4064793	Fresno County
117594	Fee-for-Service	1043280605	1043280605	1	1	POTTER, DANIEL A MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74758	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
117614	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
117638	Fee-for-Service	1942239926	1942239926	1	1	PAIR & MAROTTA PHYSICAL THER	6/27/2018	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	5337 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	2807	15	06029	35.36721148	-119.0622416	Kern County
117644	Fee-for-Service	1629181524	1629181524	1	1	PEACOCK, CHRISTA M NP	10/19/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117648	Fee-for-Service	1205089026	1205089026	1	2	PRIME HEALTHCARE SERVICES	2/18/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SHASTA, LLC	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
117667	Fee-for-Service	1538121470	1538121470	1	1	PALADUGU, GEETHA K MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70692	36	Psychiatry	0	In state provider	None	710 BROOKSIDE AVE	STE 7	REDLANDS	CA	92373	5181	36	06071	34.05189799	-117.1920987	San Bernardino County
117673	Fee-for-Service	1992264840	1992264840	1	1	PEDICINI, ROBERT L MD	11/9/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	178837	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
117689	Fee-for-Service	1326284258	1326284258	1	1	PATEL, BHAIRAVI D MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99465	41	Internal Medicine	0	In state provider	None	18031 US HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
117739	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
117762	Fee-for-Service	1134516545	1134516545	1	1	PURVIEW HOSPICE AND PAL	8/6/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	440 W COLORADO ST	SUITE 208	GLENDALE	CA	91204	4564	19	06037	34.14249549	-118.2628035	Los Angeles County
117794	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
117825	Fee-for-Service	1053306381	1053306381	1	1	PALMER, JAMES D MD	11/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78219	18	Ophthalmology	0	In state provider	None	50 S SAN MATEO DR	STE 125	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
117826	Fee-for-Service	1124643960	1124643960	1	1	PETERSON, TYLER A DO	9/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19747	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
117869	Fee-for-Service	1205525821	1205525821	1	1	PALMDALE WOMEN'S HEALTH PHYS	11/27/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ICIAN GROUP, INC.	41250 12TH ST W	SUITE B	PALMDALE	CA	93551	1444	19	06037	34.63265063	-118.1517391	Los Angeles County
117902	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	7/25/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
117911	Fee-for-Service	1659342723	1659342723	1	1	PATEL, NIKUNJ K MD	3/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83760	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
117935	Fee-for-Service	1861441594	1861441594	1	1	PUMERANTZ, ANDREW S DO	2/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9786	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
117954	Fee-for-Service	1689939431	1689939431	1	1	PASECHNIK, VIKTORIYA V CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
117969	Fee-for-Service	1275863193	1275863193	1	1	PIPPITT, KAYLA R LMFT	6/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22 WILLIAMSBURG LN	STE H	CHICO	CA	95926	2238	04	06007	39.75264856	-121.8548871	Butte County
117978	Fee-for-Service	1326284258	1326284258	1	1	PATEL, BHAIRAVI D MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99465	38	Geriatrics	0	In state provider	None	18031 US HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
117986	Fee-for-Service	1003254202	1003254202	1	1	PATEL, PRACHI T DO	7/16/2021	207R00000X	NA	Other	026	PHYSICIANS	18778	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
118014	Fee-for-Service	1477659001	1477659001	1	1	PHAM, TRI MINH MD	5/1/1983	207R00000X	NA	Other	026	PHYSICIANS	35619	41	Internal Medicine	0	In state provider	None	1130 COFFEE RD	STE 2A	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
118015	Fee-for-Service	1639348204	1639348204	1	1	PRASAD, PRADEEP S MD	5/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99979	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
118025	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
118028	Fee-for-Service	1114157351	1114157351	1	1	PANDEY, PARITOSH MD	12/10/2009	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118044	Fee-for-Service	1497892178	1497892178	1	1	PRIEBE, DANA A PSYD	8/9/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
118053	Fee-for-Service	1932577632	1932577632	1	1	PERETS, ERICA NP	7/8/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
118068	Fee-for-Service	1922200054	1922200054	1	1	PLANINIC, PETAR MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3006 S MARYLAND PARKWAY	# 315	LAS VEGAS	NV	89109	2313	00	None	36.135288	-115.1368705	Clark County
118071	Fee-for-Service	1396926549	1396926549	1	1	PARSONS, KAREN R	3/23/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118081	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
118090	Fee-for-Service	1982801718	1982801718	1	1	PATEL, SANJIV M MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102972	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11190 WARNER AVE	STE 408	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
118103	Fee-for-Service	1134368053	1134368053	1	1	PRONOY ROY	6/30/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
118120	Fee-for-Service	1407930209	1407930209	1	1	PARDOE, MARK B MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78580	24	Plastic Surgery	0	In state provider	None	2324 23RD ST	None	EUREKA	CA	95501	3231	12	06023	40.78684447	-124.143066	Humboldt County
118134	Fee-for-Service	1245414614	1245414614	1	1	PAINE, DAVID A MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111750	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
118166	Fee-for-Service	1386268738	1386268738	1	1	PLOTNER, ELISABETH MD	4/4/2024	261QU0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
118189	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
118220	Fee-for-Service	1073669040	1073669040	1	1	PLANNED PARENTHOOD PASADENA	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	19	06037	34.16394511	-118.1324885	Los Angeles County
118245	Fee-for-Service	1235184219	1235184219	1	1	PADUA, NARCIS0 MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45172	40	Pediatrics	0	In state provider	None	2030 FOREST AVE	STE 110	SAN JOSE	CA	95128	4833	43	06085	37.32706467	-121.9341193	Santa Clara County
118253	Fee-for-Service	1740389063	1740389063	1	1	PEASE,BARBARA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV PHYS HOSPITAL KINO	2800 E AJO WAY	None	TUCSON	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
118274	Fee-for-Service	1841933934	1841933934	1	1	PHAM, ANH N OT	10/30/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
118289	Fee-for-Service	1942239926	1942239926	1	6	PAIR & MAROTTA PHYSICAL THER	5/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	4605 BUENA VISTA RD	SUITE 690	BAKERSFIELD	CA	93311	8793	15	06029	35.31350802	-119.1281378	Kern County
118315	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
118333	Fee-for-Service	1982775938	1982775938	1	1	PLATZ, BRIAN E MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75602	22	Pathology (M.D. only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
118356	Fee-for-Service	1285214718	1285214718	1	1	PERCELAY, RACHEL MD	10/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
118369	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
118374	Fee-for-Service	1598883159	1598883159	1	1	POPAT, NITA P	5/13/1995	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2195 CLUB CENTER DR	STE G	SAN BERNARDINO	CA	92408	4162	36	06071	34.06055692	-117.2814193	San Bernardino County
118384	Fee-for-Service	1053679472	1053679472	1	1	PERRINO, SABRINA K MD	6/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129805	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
118386	Fee-for-Service	1699934497	1699934497	1	1	PEVERIERI, SONJA S	9/29/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
118397	Fee-for-Service	1073693123	1073693123	1	1	PCSC 15 INC	6/16/2023	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	NTURA	3805 TELEGRAPH RD	None	VENTURA	CA	93003	3422	56	06111	34.2737362	-119.2436316	Ventura County
118427	Fee-for-Service	1669543583	1669543583	1	1	PRUSA, BORIS MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63074	34	Urology and Urological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
118429	Fee-for-Service	1427270180	1427270180	1	2	POKALA, SATHYA P MD INC	12/9/2014	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51070	01	General Practice	0	In state provider	None	8860 CENTER DRIVE	SUITE 240	LA MESA	CA	91942	7000	37	06073	32.78189749	-117.0075062	San Diego County
118430	Fee-for-Service	1730529959	1730529959	1	1	PRIMA PHARMACY INC	7/20/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12643 SHERMAN WAY	UNIT C	NORTH HOLLYWOOD	CA	91605	5270	19	06037	34.20123149	-118.408464	Los Angeles County
118479	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
118496	Fee-for-Service	1508902487	1508902487	1	1	PAOLETTI, ROBERT DPM	12/1/1995	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4477 W 118TH ST	STE 105	HAWTHORNE	CA	90250	2256	19	06037	33.92734752	-118.354221	Los Angeles County
118520	Fee-for-Service	1912350273	1912350273	1	1	PINA, CHRISTINE LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
118526	Fee-for-Service	1770802852	1770802852	1	1	PASHALIDES, THOMAS A MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118166	34	Urology and Urological Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
118537	Fee-for-Service	1184702938	1184702938	1	1	PLATA, ARMANDO L MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68431	34	Urology and Urological Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
118582	Fee-for-Service	1023317781	1023317781	1	1	PHAMATECH INCORPORATED	12/26/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	15175 INNOVATION DRIVE	None	SAN DIEGO	CA	92128	3401	37	06073	32.99182353	-117.0769651	San Diego County
118583	Fee-for-Service	1942239926	1942239926	1	6	PAIR & MAROTTA PHYSICAL THER	10/3/2024	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	4605 BUENA VISTA RD	SUITE 690	BAKERSFIELD	CA	93311	8793	15	06029	35.31350802	-119.1281378	Kern County
118603	Fee-for-Service	1639252604	1639252604	1	22	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
118618	Fee-for-Service	1013108794	1013108794	1	1	PHAN, HUY MD	8/12/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99726	08	Family Practice	0	In state provider	None	6226 E SPRING ST	STE 100	LONG BEACH	CA	90815	1442	19	06037	33.81040053	-118.1102715	Los Angeles County
118658	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
118675	Fee-for-Service	1982667911	1982667911	1	1	POMONA VALLEY IMAGING	4/13/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP, INC	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
118678	Fee-for-Service	1497242556	1497242556	1	1	PRUSSAK, NATALIE R MD	9/20/2021	207R00000X	NA	Other	026	PHYSICIANS	163898	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118689	Fee-for-Service	1073006375	1073006375	1	1	PUCHALA, GRZEGORZ DO	10/17/2024	207R00000X	NA	Other	026	PHYSICIANS	23057	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
118736	Fee-for-Service	1487072278	1487072278	1	1	PUCCINELLI, ALAYNA M DPM	8/1/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	345 F STREET	SUITE 100	CHULA VISTA	CA	91910	2632	37	06073	32.64088085	-117.081699	San Diego County
118768	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	8/26/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
118794	Fee-for-Service	1417467192	1417467192	1	1	PASCUA, JOSEPH F LCSW	2/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
118824	Fee-for-Service	1487889598	1487889598	1	1	PHAN, HANNAH J MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107645	40	Pediatrics	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
118841	Fee-for-Service	1679592281	1679592281	1	1	PRATT, GARRY M MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	41306	41	Internal Medicine	0	In state provider	None	1237 E MAIN ST	None	ALHAMBRA	CA	91801	4114	19	06037	34.10129883	-118.1140327	Los Angeles County
118887	Fee-for-Service	1003891516	1003891516	1	1	PACIFICA LINDA MAR, INC	6/1/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LINDA MAR CARE CENTER	751 SAN PEDRO TERRACE RD	None	PACIFICA	CA	94044	4101	41	06081	37.58922864	-122.5018256	San Mateo County
118921	Fee-for-Service	1760678932	1760678932	1	1	PEARL, MICHELLE S	8/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
118922	Fee-for-Service	1669456174	1669456174	1	1	PAIVA, TOBIAS A DO	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9775	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
118934	Fee-for-Service	1902118631	1902118631	1	1	PERAZA, JOE S MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
118945	Fee-for-Service	1841373800	1841373800	1	3	PERMANENTE MEDICAL GROUP INC	1/18/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
118969	Fee-for-Service	1912371188	1912371188	1	1	PHELPS, BRANDON J PT	12/2/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	411 W. MAIN ST.	None	BRAWLEY	CA	92227	2244	13	06025	32.97866153	-115.5481515	Imperial County
119053	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	1/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
119108	Fee-for-Service	1972569838	1972569838	1	1	PUZA, SCOTT MD	6/5/2024	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84336	15	Obstetrics (D.O. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
119118	Fee-for-Service	1336270529	1336270529	1	1	PRICE-HARPER, CHERIE A LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
119202	Fee-for-Service	1346698834	1346698834	1	1	PALEJWALA, ALI MD	4/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119225	Fee-for-Service	1376067611	1376067611	1	1	PERRET, CASSANDRA M H MD	8/22/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119238	Fee-for-Service	1285165498	1285165498	1	1	PATEL, RICHA D MD	6/6/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176041	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119258	Fee-for-Service	1194294900	1194294900	1	1	PANIAGUA, HENRY RCP	6/12/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
119259	Fee-for-Service	1437180692	1437180692	1	1	PRESTON, ELIZABETH A PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 FRANKLIN ST	STE 410	OAKLAND	CA	94612	3223	01	06001	37.80339088	-122.2702731	Alameda County
119295	Fee-for-Service	1932561933	1932561933	1	1	PARK, KRISTINE MD	12/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168285	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
119307	Fee-for-Service	1932497377	1932497377	1	1	PULLINS, JESSICA E PHD	6/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119322	Fee-for-Service	1134208283	1134208283	1	1	PATEL, RAMESHCHANDRA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
119341	Fee-for-Service	1538244314	1538244314	1	1	PASCUZZO, JOSEPH M DO	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8935	68	Hematology	0	In state provider	None	6121 N THESTA ST	STE 204	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
119342	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
119370	Fee-for-Service	1194898569	1194898569	1	1	PATEL, AMI T OD	5/29/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2771 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	3513	19	06037	33.97449155	-117.8375299	Los Angeles County
119383	Fee-for-Service	1962834812	1962834812	1	1	POULSEN, RAUL J MD	8/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	173593	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
119387	Fee-for-Service	1629628243	1629628243	1	1	POSADAS, CHRISTIAN RAE CPO	5/19/2020	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	19845 LAKE CHABOT	STE 302	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
119427	Fee-for-Service	1821436882	1821436882	1	1	PRASAD, AMITHA	8/15/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158657	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
119437	Fee-for-Service	1285954578	1285954578	1	1	PARK, CHANWANG MD	12/22/2020	207L00000X	NA	Other	026	PHYSICIANS	170507	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
119456	Fee-for-Service	1235572298	1235572298	1	1	PATIDAR, VINAY J MD	12/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	5825 KANAN RD	B	AGOURA HILLS	CA	91301	1651	19	06037	34.15592291	-118.7563824	Los Angeles County
119462	Fee-for-Service	1801580006	1801580006	1	1	PARKHILL HEALTH INC	2/7/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2455 SAND CREEK RD	STE 144	BRENTWOOD	CA	94513	7176	07	06013	37.94689155	-121.7370896	Contra Costa County
119533	Fee-for-Service	1346546157	1346546157	1	1	PASIMIO, STACIE A LMFT	6/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 GUASTI RD	STE 178B	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
119542	Fee-for-Service	1427021583	1427021583	1	1	PAHLAVAN, PANTEA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77685	None	None	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 300A	FAIRFIELD	CA	94533	3550	48	06095	38.261952	-122.0498745	Solano County
119576	Fee-for-Service	1174537104	1174537104	1	1	PELTZ, MATTHEW J DO	1/12/2012	207R00000X	NA	Other	026	PHYSICIANS	6384	41	Internal Medicine	0	In state provider	None	1832 BUENAVENTURA BLVD	STE C	REDDING	CA	96001	3700	45	06089	40.55644085	-122.3971882	Shasta County
119587	Fee-for-Service	1235181850	1235181850	1	1	POH, MICHAEL EUGENE MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60583	30	Radiology	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
119601	Fee-for-Service	1730272063	1730272063	1	1	PARUCHURI, PHANI K MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	64174	None	None	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
119617	Fee-for-Service	1134310006	1134310006	1	1	POWELL, CHRISTIAN H MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108605	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
119619	Fee-for-Service	1417957374	1417957374	1	1	PERSONIUS, BRADLEY E MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
119624	Fee-for-Service	1538244314	1538244314	1	1	PASCUZZO, JOSEPH M DO	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8935	78	Neoplastic Diseases/Oncology	0	In state provider	None	6121 N THESTA ST	STE 204	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
119625	Fee-for-Service	1932555976	1932555976	1	1	PREMIERE REHABILITATION &	9/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER OF LANCA	43830 10TH STREET WEST	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
119631	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
119656	Fee-for-Service	1114003399	1114003399	1	1	PAESCHKE, TRACY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COLORADO HEART CLINIC	850 E HARVARD AVE	STE 365	DENVER	CO	80210	5076	00	None	39.6712499	-104.9777413	Denver County
119666	Fee-for-Service	1093868663	1093868663	1	1	PETERSON, BRADLEY S MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130737	36	Psychiatry	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
119672	Fee-for-Service	1518131671	1518131671	1	1	PARCERO, AUGUSTO F MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113553	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
119719	Fee-for-Service	1821232505	1821232505	1	1	PHILLIPS, SHERESE M MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114977	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
119724	Fee-for-Service	1336332980	1336332980	1	1	PHAM, VU T MD	10/28/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101304	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
119735	Fee-for-Service	1457318073	1457318073	1	1	PANTILAT, STEVEN Z MD	11/30/1990	207R00000X	NA	Other	026	PHYSICIANS	69877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
119741	Fee-for-Service	1215287933	1215287933	1	1	PREPARING PEOPLE FOR SUCCESS	3/3/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1513 SPORTS DRIVE	SUITE 100	SACRAMENTO	CA	95834	1904	34	06067	38.648673	-121.496283	Sacramento County
119746	Fee-for-Service	1659413284	1659413284	1	1	PHAM, TIFFANY, THUY DO	1/11/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13192 HARBOR BLVD	None	GARDEN GROVE	CA	92843	1740	30	06059	33.77163713	-117.9202936	Orange County
119765	Fee-for-Service	1285216010	1285216010	1	1	PATEL, SHREYA B OT	5/13/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
119775	Fee-for-Service	1275262248	1275262248	1	1	PENINSULA NON EMERGENCY MEDI	7/14/2022	2278P4000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CAL TRANSPORTATION LLC	400 CAMINO AGUAJITO	104	MONTEREY	CA	93940	3532	27	06053	36.59661347	-121.8826851	Monterey County
119781	Fee-for-Service	1023317682	1023317682	1	1	PAULIK, AMY M MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139224	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
119845	Fee-for-Service	1467699553	1467699553	1	1	PINDER, JOSHUA W	5/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
119857	Fee-for-Service	1154568350	1154568350	1	1	PATTATHU, ROSHNY A MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106185	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DRIVE	STE 409	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
119865	Fee-for-Service	1174537104	1174537104	1	1	PELTZ, MATTHEW J DO	1/12/2012	207R00000X	NA	Other	026	PHYSICIANS	6384	01	General Practice	0	In state provider	None	1832 BUENAVENTURA BLVD	STE C	REDDING	CA	96001	3700	45	06089	40.55644085	-122.3971882	Shasta County
119866	Fee-for-Service	1104881507	1104881507	1	1	PARKVIEW MEDICAL CENTER	3/19/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 W 16TH ST	None	PUEBLO	CO	81003	2745	00	None	38.28171999	-104.6119963	Pueblo County
119871	Fee-for-Service	1073857439	1073857439	1	1	PAINE, ALLISON C MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122387	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
119880	Fee-for-Service	1972545275	1972545275	1	1	PACKMAN, SEYMOUR MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33787	40	Pediatrics	0	In state provider	UC MEDICAL CENTER	650 MOFFITT HOSP	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.73743268	-122.4331132	San Francisco County
119906	Fee-for-Service	1417957374	1417957374	1	1	PERSONIUS, BRADLEY E MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	520 MEDICAL CENTER DR	STE 100	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
119917	Fee-for-Service	1538302930	1538302930	1	1	POSTON, ROBERT W PHD	7/13/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
119918	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
119937	Fee-for-Service	1114076601	1114076601	1	1	PILGRIM PLACE HEALTH	12/15/1970	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SERVICES CENTER	721 HARRISON AVE	None	CLAREMONT	CA	91711	4539	19	06037	34.0986453	-117.7265413	Los Angeles County
119955	Fee-for-Service	1770816266	1770816266	1	1	PUNSALAN, GABRIEL T CRNA	5/28/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
119961	Fee-for-Service	1518131671	1518131671	1	1	PARCERO, AUGUSTO F MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113553	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
119988	Fee-for-Service	1750578761	1750578761	1	1	PARK, SUNG UN JUSTIN MD INC	12/1/1998	2084N0400X	NA	Neurology	026	PHYSICIANS	48704	None	None	0	In state provider	None	3055 W ORANGE AVE	STE 101	ANAHEIM	CA	92804	3152	30	06059	33.8247435	-117.99621	Orange County
119993	Fee-for-Service	1568659977	1568659977	1	1	POWAY ADULT DAY HEALTH	6/19/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	12250 CROSTHWAITE CIRCLE	None	POWAY	CA	92064	6882	37	06073	32.93989156	-117.0339634	San Diego County
120037	Fee-for-Service	1487278065	1487278065	1	1	PACIFIC PALLIATIVE SERVICES	7/1/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	10523 BURBANK BLVD	SUITE 107	NORTH HOLLYWOOD	CA	91601	2235	19	06037	34.17216449	-118.36017	Los Angeles County
120043	Fee-for-Service	1922298520	1922298520	1	1	PENG, YU-HUNG P MD	11/2/2017	207P00000X	NA	Other	026	PHYSICIANS	78615	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
120070	Fee-for-Service	1467678391	1467678391	1	1	PARADIGM HEALTHCARE SOLUTION	10/27/2021	363LP2300X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	S, INC	4929 VAN NUYS	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
120085	Fee-for-Service	1225041676	1225041676	1	1	PADILLA, PATRICK J MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	79160	20	Orthopedic Surgery	0	In state provider	None	26730 CROWN VALLEY PKWY	STE 200	MISSION VIEJO	CA	92691	8001	30	06059	33.56365057	-117.6649048	Orange County
120135	Fee-for-Service	1265562615	1265562615	1	1	POZO-BREEN, ALMA LPCC	10/25/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
120153	Fee-for-Service	1104881507	1104881507	1	1	PARKVIEW MEDICAL CENTER	3/19/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 W 16TH ST	None	PUEBLO	CO	81003	2745	00	None	38.28171999	-104.6119963	Pueblo County
120170	Fee-for-Service	1730576646	1730576646	1	1	PATHAK, SAUMYA MD	8/18/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	155555	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
120198	Fee-for-Service	1184602518	1184602518	1	1	PRENTKE ROMICH COMPANY	8/1/1997	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1022 HEYL RD	None	WOOSTER	OH	44691	9744	00	None	40.78462958	-81.9624949	Wayne County
120206	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
120272	Fee-for-Service	1841516390	1841516390	1	1	POZOS-BREWER, RANDOLFO R	7/21/2010	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	260 MAIN ST	STE F	REDWOOD CITY	CA	94063	1733	41	06081	37.49317192	-122.2281925	San Mateo County
120285	Fee-for-Service	1871102954	1871102954	1	1	PAUL, NINA B PHD	12/26/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120287	Fee-for-Service	1942239926	1942239926	1	5	PAIR & MAROTTA PHYSICAL THER	10/3/2024	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	APY, INC.	2601 OSWELL STREET	SUITE 105	BAKERSFIELD	CA	93306	3101	15	06029	35.39259632	-118.9496489	Kern County
120326	Fee-for-Service	1487278065	1487278065	1	1	PACIFIC PALLIATIVE SERVICES	7/1/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	10523 BURBANK BLVD	SUITE 107	NORTH HOLLYWOOD	CA	91601	2235	19	06037	34.17216449	-118.36017	Los Angeles County
120338	Fee-for-Service	1598184186	1598184186	1	1	PHILLIPS, LYNETTA M MD	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142006	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
120354	Fee-for-Service	1326471905	1326471905	1	1	POE, CELESTE PHD	11/7/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
120368	Fee-for-Service	1467656397	1467656397	1	1	PRESBYTERIAN HEALTHCARE	12/6/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	8300 CONSTITUTION AVE NE	None	ALBUQUERQUE	NM	87110	7613	00	None	35.0924715	-106.5540422	Bernalillo County
120395	Fee-for-Service	1669776175	1669776175	1	1	PRENATAL CLINIC JONATHAN	3/8/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AZIZZADEH MD INC	1300 N VERMONT AVENUE	STE 304	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
120413	Fee-for-Service	1083686612	1083686612	1	1	PASSANANTE, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1441 N BECKLEY AVE	None	DALLAS	TX	75203	1201	00	None	32.76063	-96.8257485	Dallas County
120415	Fee-for-Service	1649692328	1649692328	1	1	PETSCHE, JULIE CRNA	2/11/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
120428	Fee-for-Service	1912196056	1912196056	1	1	PARK, BURN MD	9/13/2012	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	32222	01	General Practice	0	In state provider	None	19085 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2953	19	06037	33.98742081	-117.8873248	Los Angeles County
120431	Fee-for-Service	1831504760	1831504760	2	1	PHALAROPE INPATIENT SERVICES	1/18/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AMC	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90295	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
120486	Fee-for-Service	1851534051	1851534051	1	1	PITTMON, MANDISA G LMFT	6/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3960 INDUSTRIAL BLVD	STE 200	WEST SACRAMENTO	CA	95691	5024	34	06067	38.57029234	-121.5767941	Yolo County
120494	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
120517	Fee-for-Service	1215472428	1215472428	1	1	PARISH HEALTH AND WELLNESS	6/12/2019	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
120518	Fee-for-Service	1205845807	1205845807	1	1	POLLACK, JAMES A MD	6/24/2011	208600000X	NA	General Surgery	026	PHYSICIANS	88748	02	General Surgery	0	In state provider	None	1594 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.7798	-115.5697791	Imperial County
120572	Fee-for-Service	1942239926	1942239926	1	5	PAIR & MAROTTA PHYSICAL THER	5/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	APY, INC.	2601 OSWELL STREET	SUITE 105	BAKERSFIELD	CA	93306	3101	15	06029	35.39259632	-118.9496489	Kern County
120585	Fee-for-Service	1033748819	1033748819	1	1	PATEL, DARSHNA N MD	9/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189750	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
120598	Fee-for-Service	1245746023	1245746023	1	1	PAZ, JOHANNA P LMFT	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
120621	Fee-for-Service	1609326024	1609326024	1	1	PETTINGER, DENISE C CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
120638	Fee-for-Service	1144649476	1144649476	1	1	PHAM, ANH T N MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139226	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
120654	Fee-for-Service	1467656397	1467656397	1	1	PRESBYTERIAN HEALTHCARE	12/14/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	8300 CONSTITUTION AVE NE	None	ALBUQUERQUE	NM	87110	7613	00	None	35.0924715	-106.5540422	Bernalillo County
120666	Fee-for-Service	1013316652	1013316652	1	1	PATEL, SUMIT S MD	12/31/2019	207R00000X	NA	Other	026	PHYSICIANS	162788	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
120668	Fee-for-Service	1346893872	1346893872	1	1	PAVONE, FRANK J LCSW	9/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
120686	Fee-for-Service	1154428621	1154428621	1	1	PICKELL, GARFIELD C MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	41759	01	General Practice	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
120740	Fee-for-Service	1376526392	1376526392	1	1	PUZDRAKIEWICZ, MICHELLE	7/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67302	None	None	0	In state provider	None	2000 O ST	STE 210	SACRAMENTO	CA	95814	5286	34	06067	38.57106572	-121.4822412	Sacramento County
120776	Fee-for-Service	1982075107	1982075107	1	8	PEDIATRIC AND FAMILY MEDICAL	4/15/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
120781	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	6/12/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
120792	Fee-for-Service	1205685377	1205685377	1	1	PISHAY, MARIAN	6/6/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	82227 US HWY 111	STE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
120804	Fee-for-Service	1215472428	1215472428	1	1	PARISH HEALTH AND WELLNESS	10/15/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	22425 SUNBRIGHT AVE	None	RED BLUFF	CA	96080	9237	52	06103	40.11839058	-122.2038466	Tehama County
120857	Fee-for-Service	1447372487	1447372487	1	1	PURUSHOTHAM AND	4/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AKTHER J KOTHA MD INC	5555 RESERVOIR DR	STE 309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
120868	Fee-for-Service	1801403985	1801403985	1	1	PRINCIPLE HOME HEALTH, INC	5/13/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9608 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	1043	19	06037	34.24485892	-118.4502135	Los Angeles County
120873	Fee-for-Service	1871646414	1871646414	1	1	PACIFIC HILLS NEUROSURGICAL	3/1/2001	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC.	630 S RAYMOND AVE.	SUITE 301	PASADENA	CA	91105	3278	19	06037	34.13505223	-118.1487761	Los Angeles County
120904	Fee-for-Service	1427106095	1427106095	1	1	PALIWAL, AMIT R MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95984	08	Family Practice	0	In state provider	MPH INC	1818 N ORANGE GROVE AVE	STE 206	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
120913	Fee-for-Service	1700120631	1700120631	1	1	PRADO, FRANCES T NP	9/30/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
120991	Fee-for-Service	1073187464	1073187464	1	1	PYLES, ALEXI LPCC	6/21/2024	1041C0700X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
121006	Fee-for-Service	1881014983	1881014983	1	1	PATBERG, ELIZABETH MD	6/19/2018	390200000X	NA	Other	026	PHYSICIANS	155025	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
121008	Fee-for-Service	1093164519	1093164519	1	1	PEJUHESH, VALENTINA A LMFT	10/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
121062	Fee-for-Service	1982075107	1982075107	1	8	PEDIATRIC AND FAMILY MEDICAL	4/15/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
121065	Fee-for-Service	1477550838	1477550838	1	1	PAP, ANGELA MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77249	41	Internal Medicine	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
121068	Fee-for-Service	1639252604	1639252604	1	2	PERMANENTE MEDICAL GROUP INC	10/16/2012	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
121082	Fee-for-Service	1285847301	1285847301	1	1	PEPPERMINT RIDGE	12/10/1982	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	EVERGREEN ESTATE	825 MAGNOLIA AVE	None	CORONA	CA	92879	3129	33	06065	33.86004536	-117.5526662	Riverside County
121108	Fee-for-Service	1184639650	1184639650	1	1	PARK, JOO-HEE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
121119	Fee-for-Service	1306392477	1306392477	1	1	PSZ INC	5/23/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1271 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	4811	19	06037	34.05736928	-118.4430479	Los Angeles County
121132	Fee-for-Service	1821029869	1821029869	1	1	PETER G LARCOM MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
121144	Fee-for-Service	1447372487	1447372487	1	1	PURUSHOTHAM AND	4/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	AKTHER J KOTHA MD INC	5555 RESERVOIR DR	STE 309	SAN DIEGO	CA	92120	5193	37	06073	32.77628471	-117.0563688	San Diego County
121148	Fee-for-Service	1952908782	1952908782	1	1	PAN, YING	10/6/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10515 GIFFIN WAY	None	SAN DIEGO	CA	92126	3049	37	06073	32.90781345	-117.1588604	San Diego County
121209	Fee-for-Service	1093001737	1093001737	1	1	PARK, ANNE E MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137068	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
121210	Fee-for-Service	1881894368	1881894368	1	1	PECK, TRACY S	8/1/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1234 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3911	38	06075	37.781144	-122.4390035	San Francisco County
121220	Fee-for-Service	1972624591	1972624591	1	1	PATRIKYAN, ARTASHES MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75827	66	Emergency Medicine (Urgent Care)	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
121228	Fee-for-Service	1952460859	1952460859	1	1	PASHINIAN, NOUNE MD	11/5/2003	207RR0500X	NA	Other	026	PHYSICIANS	56473	83	Rheumatology	0	In state provider	None	1300 S CENTRAL AVE	None	GLENDALE	CA	91204	2506	19	06037	34.12963988	-118.2577897	Los Angeles County
121235	Fee-for-Service	1295802437	1295802437	1	1	PEREZ, GINA A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
121247	Fee-for-Service	1649887779	1649887779	1	1	PACIFIC COAST HEARING AID CE	11/3/2021	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	NTER, INC.	103 CYPRESS STREET	None	FORT BRAGG	CA	95437	5401	23	06045	39.43269788	-123.8061328	Mendocino County
121254	Fee-for-Service	1629268750	1629268750	1	1	PARK, GRACE E MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129985	41	Internal Medicine	0	In state provider	None	317 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
121258	Fee-for-Service	1205120375	1205120375	1	1	PACIFIC RHEUMATOLOGY MEDICAL	11/17/2014	207RR0500X	NA	Other	026	PHYSICIANS	54349	83	Rheumatology	0	In state provider	CENTER INC	805 WEST LA VETA AVE	SUITE 105	ORANGE	CA	92868	3928	30	06059	33.78064152	-117.8606475	Orange County
121303	Fee-for-Service	1558454595	1558454595	1	1	PASCUAL, PRODE P MD	1/1/1979	193200000X	NA	Other	026	PHYSICIANS	30986	08	Family Practice	0	In state provider	None	11360 183RD ST	None	CERRITOS	CA	90703	5419	19	06037	33.86558889	-118.0918958	Los Angeles County
121312	Fee-for-Service	1508828658	1508828658	1	1	PREMIER PATHOLO LAB INC	11/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
121324	Fee-for-Service	1285669085	1285669085	1	1	PARK, TARI YOUNG MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74537	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
121347	Fee-for-Service	1417252867	1417252867	1	1	PLAINE DIALYSIS LLC	3/3/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1525 PLUMAS CT	STE A	YUBA CITY	CA	95991	2971	51	06101	39.15274768	-121.6184473	Sutter County
121348	Fee-for-Service	1235366626	1235366626	1	2	PIGGOTT, KURT D	6/30/2023	2080P0203X	NA	Other	026	PHYSICIANS	187084	None	None	0	In state provider	None	3828 SCHAUFELE AVE	STE 340	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
121355	Fee-for-Service	1750487021	1750487021	2	1	PATEL, KIRITKUMAR B MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35277	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1400 FLORIDA AVE	#102	MODESTO	CA	95350	4446	50	06099	37.66410995	-120.996159	Stanislaus County
121360	Fee-for-Service	1770667768	1770667768	1	1	POURMEHR, KEYVAN MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77720	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
121416	Fee-for-Service	1366578957	1366578957	1	1	PAMIROYAN, BONNIE R NP	11/8/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121435	Fee-for-Service	1952908782	1952908782	1	1	PAN, YING	10/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10515 GIFFIN WAY	None	SAN DIEGO	CA	92126	3049	37	06073	32.90781345	-117.1588604	San Diego County
121506	Fee-for-Service	1972624591	1972624591	1	1	PATRIKYAN, ARTASHES MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75827	41	Internal Medicine	0	In state provider	None	888 S HILL RD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
121509	Fee-for-Service	1477766152	1477766152	1	1	PATEL, JIJIBHOY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38717	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2320 N CALIFORNIA ST	STE 1	STOCKTON	CA	95204	5509	39	06077	37.97483792	-121.2907554	San Joaquin County
121517	Fee-for-Service	1952460859	1952460859	1	1	PASHINIAN, NOUNE MD	11/5/2003	207RR0500X	NA	Other	026	PHYSICIANS	56473	41	Internal Medicine	0	In state provider	None	1300 S CENTRAL AVE	None	GLENDALE	CA	91204	2506	19	06037	34.12963988	-118.2577897	Los Angeles County
121526	Fee-for-Service	1366472185	1366472185	1	1	PISKOVA, RAYNA MD	9/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52376	18	Ophthalmology	0	In state provider	None	1816 HOWARD RD	STE 4	MADERA	CA	93637	5157	20	06039	36.9526935	-120.0797955	Madera County
121556	Fee-for-Service	1700135688	1700135688	1	1	PLOTZKER, ALICIA M CRNA	3/15/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
121589	Fee-for-Service	1588152417	1588152417	1	1	PATTERSON, SHADA M LMFT	6/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
121632	Fee-for-Service	1861771370	1861771370	1	1	PAPANI, RAVIKANTH MD	12/14/2020	207RC0200X	NA	Other	026	PHYSICIANS	166936	None	None	0	In state provider	None	555 E HARDY ST	IRA KAUFMAN PAVILION	INGLEWOOD	CA	90301	4106	19	06037	33.94909549	-118.3481595	Los Angeles County
121658	Fee-for-Service	1972824696	1972824696	1	1	PROSS, SETH E MD	12/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118940	04	Otology, Laryngology, Rhinology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
121741	Fee-for-Service	1932128626	1932128626	1	1	PINTO, KATHLEEN M	7/25/2006	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
121763	Fee-for-Service	1982285698	1982285698	1	1	PATEL, NEEDHEE N MD	9/20/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
121785	Fee-for-Service	1407187412	1407187412	1	1	PHARMACY FOR LESS INC	8/15/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16600 SHERMAN WAY	STE 290	VAN NUYS	CA	91406	3794	19	06037	34.20107495	-118.4951343	Los Angeles County
121807	Fee-for-Service	1538280284	1538280284	1	1	PHYSICIANS SURGERY CTR	1/27/2009	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF MODESTO	609 E ORANGEBURG AVE	BLDG B	MODESTO	CA	95350	5580	50	06099	37.66364947	-120.9857985	Stanislaus County
121838	Fee-for-Service	1275604209	1275604209	1	1	PATWARDHAN, JAYASHREE MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	29378	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
121895	Fee-for-Service	1992008999	1992008999	1	1	PHAN, STEPHANIE T MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114260	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
121898	Fee-for-Service	1457374274	1457374274	1	1	PAUKER, KENNETH Y MD	10/10/1995	207L00000X	NA	Other	026	PHYSICIANS	44782	05	Anesthesiology	0	In state provider	SO COAST MED CENTER	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
121922	Fee-for-Service	1134189970	1134189970	1	1	POLO CHEN, M.D.	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N SMITH AVENUE	None	ST. PAUL	MN	55102	2387	00	None	44.94164123	-93.10866966	Ramsey County
121944	Fee-for-Service	1790939049	1790939049	1	1	POBLACION, ROSEMARY PT	8/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
121984	Fee-for-Service	1871586065	1871586065	1	1	PRAKASAM, GNANAGURUDASAN	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65908	40	Pediatrics	0	In state provider	MD	5301 F ST	STE 209	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
121994	Fee-for-Service	1598901308	1598901308	1	1	PARAMOUNT ANESTHESIA	1/8/2009	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES INC	450 GREENFIELD AVENUE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
122142	Fee-for-Service	1063554798	1063554798	1	1	PROVIDENT ANESTHESIA MEDICAL	3/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	46241	05	Anesthesiology	0	In state provider	GROUP INC	7300 MEDICAL DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
122154	Fee-for-Service	1194291245	1194291245	1	1	PHAM, VANNESSA D	10/24/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	802 MAGNOLIA AVE	STE 208	CORONA	CA	92879	3157	33	06065	33.8596449	-117.5529774	Riverside County
122158	Fee-for-Service	1326183583	1326183583	1	1	PETTIT, CHARLES R MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	23559	84	Surgery-Head and Neck	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
122173	Fee-for-Service	1104364546	1104364546	1	1	PAUSELIUS, HOLLAND LPCC	4/4/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
122192	Fee-for-Service	1831114479	1831114479	1	1	PATEL, TARANG B MD	6/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95267	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
122193	Fee-for-Service	1447214937	1447214937	1	1	PETER T BUMP M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3960 W ROYAL DR	None	TRAVERSE CITY	MI	49684	9200	00	None	44.762634	-85.6521045	Grand Traverse County
122211	Fee-for-Service	1255348496	1255348496	1	1	PAGE, DEBORAH E MD	8/1/1988	207L00000X	NA	Other	026	PHYSICIANS	32894	05	Anesthesiology	0	In state provider	None	4295 GESNER ST	STE 3C	SAN DIEGO	CA	92117	6663	37	06073	32.79163081	-117.2034465	San Diego County
122251	Fee-for-Service	1659096410	1659096410	1	1	PROVIDENCE MEDICAL SUPPLY LL	2/2/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	C	1125 N MOUNTAIN AVE	None	ONTARIO	CA	91762	1739	36	06071	34.078689	-117.670653	San Bernardino County
122265	Fee-for-Service	1245216779	1245216779	1	1	PRAKASH, NAGAPPA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3815 E BELL RD	STE 3400	PHOENIX	AZ	85032	2164	00	None	33.638571	-111.9990015	Maricopa County
122267	Fee-for-Service	1306928098	1306928098	1	1	PURI, RAHUL D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96964	01	General Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
122270	Fee-for-Service	1407190937	1407190937	1	1	PRATT, LUCAS E PT	8/6/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
122271	Fee-for-Service	1093054132	1093054132	1	1	PLESHCHUK KOWALSKI, RENATA	7/21/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
122272	Fee-for-Service	1871586065	1871586065	1	1	PRAKASAM, GNANAGURUDASAN	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65908	67	Endocrinology	0	In state provider	MD	5301 F ST	STE 209	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
122282	Fee-for-Service	1487725032	1487725032	1	1	PERKINS, BRETT W OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
122319	Fee-for-Service	1922497510	1922497510	1	1	PACIFIC CENTRAL COAST HEALTH	8/3/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	2238 BAYVIEW HEIGHTS	SUITE G	LOS OSOS	CA	93402	3921	40	06079	35.31038553	-120.8334714	San Luis Obispo County
122338	Fee-for-Service	1437653698	1437653698	1	1	PATEL, LISA MD	9/29/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	167358	40	Pediatrics	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
122343	Fee-for-Service	1164590204	1164590204	1	5	PICKERT MEDICAL GROUP, P.C.	11/2/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	F RENO, P.C.	2375 PRATER	None	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
122346	Fee-for-Service	1609088707	1609088707	1	1	PEGASUS MEDICAL GROUP	4/23/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	19	06037	34.58013142	-118.0898273	Los Angeles County
122375	Fee-for-Service	1376542811	1376542811	1	1	PATEL, ASHIQ V MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66156	41	Internal Medicine	0	In state provider	ANTELOPE VALLEY ENDOCRIN	1331 W AVENUE J	STE 206	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
122386	Fee-for-Service	1962642736	1962642736	1	1	PARLET, KATHRYN LMFT	10/17/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
122411	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
122427	Fee-for-Service	1467586537	1467586537	1	1	PHAGUDA, GURPAL S MD	5/25/1995	207R00000X	NA	Other	026	PHYSICIANS	71819	08	Family Practice	0	In state provider	None	15462 MAIN ST	None	HESPERIA	CA	92345	3318	36	06071	34.42553716	-117.3261813	San Bernardino County
122449	Fee-for-Service	1770849820	1770849820	1	1	PHILLIPS, ANDREW W MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
122454	Fee-for-Service	1144795253	1144795253	1	1	PIER VISION OPTOMETRY	9/13/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2525 EL CAMINO REAL	SUITE 125	CARLSBAD	CA	92008	1261	37	06073	33.178248	-117.332028	San Diego County
122468	Fee-for-Service	1659707586	1659707586	1	1	PENSANTI, HELEN MD	2/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	41177	01	General Practice	0	In state provider	None	5350 MADISON AVENUE	None	SACRAMENTO	CA	95841	3169	34	06067	38.66031	-121.339125	Sacramento County
122480	Fee-for-Service	1992069413	1992069413	1	1	PLUMLEY, KEVIN V MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136069	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
122488	Fee-for-Service	1427268747	1427268747	1	3	PHILIP D. SZOLD, MD, INC	6/7/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8881 FLETCHER PARKWAY	205	LA MESA	CA	91942	3135	37	06073	32.78442148	-117.0073814	San Diego County
122492	Fee-for-Service	1871039487	1871039487	1	1	PURE CARE HOSPICE INC	3/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11911 ARTESIA BLVD	SUITE 208	CERRITOS	CA	90701	4061	19	06037	33.87314847	-118.079649	Los Angeles County
122512	Fee-for-Service	1962424457	1962424457	1	1	PAUL J LINDQUIST	10/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5225 23RD AVE S	None	FARGO	ND	58104	7927	00	None	46.845468	-96.8753655	Cass County
122519	Fee-for-Service	1699201764	1699201764	1	1	PONTE, SARAH A MD	7/13/2020	390200000X	NA	Other	026	PHYSICIANS	157261	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
122555	Fee-for-Service	1831277680	1831277680	1	1	PINSKY, LISA Y MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68862	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
122560	Fee-for-Service	1710180336	1710180336	1	1	PIGGOTT, CAROLINE DS MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106289	07	Dermatology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
122563	Fee-for-Service	1497386155	1497386155	1	1	PINCKNEY, MICHELLE NP	2/3/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
122578	Fee-for-Service	1043226756	1043226756	1	1	PATEL, VINOD D MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56460	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	STE 204	DOWNEY	CA	90241	5026	19	06037	33.93622932	-118.1311752	Los Angeles County
122592	Fee-for-Service	1487892352	1487892352	1	1	PATEL, ARUSH A MD	3/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105982	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
122610	Fee-for-Service	1033739933	1033739933	1	1	PARRA, JONATHAN A MD	8/17/2023	207P00000X	NA	Other	026	PHYSICIANS	186773	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
122635	Fee-for-Service	1417175423	1417175423	1	1	PEDIATRIC SUBSPECIALTY	11/20/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	NETWORK INC	5350 HOLLISTER AVE	SUITE F	SANTA BARBARA	CA	93111	2326	42	06083	34.4351156	-119.8109023	Santa Barbara County
122642	Fee-for-Service	1871887588	1871887588	1	1	POLLOCK, RICHARD A MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148245	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
122643	Fee-for-Service	1861846446	1861846446	1	1	PHAM, LY-ELAINE MD	9/22/2020	207R00000X	NA	Other	026	PHYSICIANS	168989	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
122653	Fee-for-Service	1679187835	1679187835	1	1	PEACEFUL HEART HEALTHCARE	10/1/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	391 N MAIN STREET	STE 303	CORONA	CA	92878	4006	33	06065	33.88547338	-117.5647471	Riverside County
122665	Fee-for-Service	1376542811	1376542811	1	1	PATEL, ASHIQ V MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66156	67	Endocrinology	0	In state provider	ANTELOPE VALLEY ENDOCRIN	1331 W AVENUE J	STE 206	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
122674	Fee-for-Service	1699739318	1699739318	1	1	PATHRIA, MINI	12/31/1989	2085R0203X	NA	Other	026	PHYSICIANS	43771	30	Radiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
122698	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
122716	Fee-for-Service	1467586537	1467586537	1	1	PHAGUDA, GURPAL S MD	5/25/1995	207R00000X	NA	Other	026	PHYSICIANS	71819	41	Internal Medicine	0	In state provider	None	15462 MAIN ST	None	HESPERIA	CA	92345	3318	36	06071	34.42553716	-117.3261813	San Bernardino County
122720	Fee-for-Service	1205851649	1205851649	1	1	POIRIER, BRIAN F MD	1/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96683	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
122724	Fee-for-Service	1114352903	1114352903	1	1	PROGRESS HOME HEALTH INC	3/23/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	919 1/2 E BROADWAY	SUITE 206	GLENDALE	CA	91205	1252	19	06037	34.14629477	-118.2434113	Los Angeles County
122729	Fee-for-Service	1669670592	1669670592	1	1	PARIKH, SACHIN S MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96960	84	Surgery-Head and Neck	0	In state provider	None	1800 HARRISON ST	7TH FLR	OAKLAND	CA	94612	3429	01	06001	37.80593773	-122.2656714	Alameda County
122775	Fee-for-Service	1427268747	1427268747	1	3	PHILIP D. SZOLD, MD, INC	6/7/2019	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8881 FLETCHER PARKWAY	205	LA MESA	CA	91942	3135	37	06073	32.78442148	-117.0073814	San Diego County
122781	Fee-for-Service	1871039487	1871039487	1	1	PURE CARE HOSPICE INC	3/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11911 ARTESIA BLVD	SUITE 208	CERRITOS	CA	90701	4061	19	06037	33.87314847	-118.079649	Los Angeles County
122811	Fee-for-Service	1639266026	1639266026	1	1	PATEL, BIJAL V MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74638	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
122812	Fee-for-Service	1558062265	1558062265	1	1	PROGENY TMS CORPORATION	6/11/2024	261QM0850X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	17782 COWAN	STE D	IRVINE	CA	92614	6030	30	06059	33.69590054	-117.862371	Orange County
122835	Fee-for-Service	1346654613	1346654613	1	1	PACIFIQUE, MIKALA MD	1/28/2019	207P00000X	NA	Other	026	PHYSICIANS	153966	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
122851	Fee-for-Service	1902877236	1902877236	1	1	PRENTICE, ANNE M MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60257	02	General Surgery	0	In state provider	None	1648 E HERNDON AVE	STE 102C	FRESNO	CA	93720	3381	10	06019	36.83757677	-119.7568043	Fresno County
122859	Fee-for-Service	1164506234	1164506234	1	1	PETRAS, ADAM F MD	8/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	38194	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
122861	Fee-for-Service	1508264128	1508264128	1	1	PASCH, JACLYN M LMFT	3/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
122895	Fee-for-Service	1043211147	1043211147	1	1	PACIFIC PAIN TREATMENT	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CENTER	2000 VAN NESS AVE	STE 402	SAN FRANCISCO	CA	94109	3019	38	06075	37.79415339	-122.422986	San Francisco County
122903	Fee-for-Service	1649201898	1649201898	1	1	PETALUMA EMERGENCY	6/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
122924	Fee-for-Service	1417175423	1417175423	1	1	PEDIATRIC SUBSPECIALTY	11/20/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	NETWORK INC	5350 HOLLISTER AVE	SUITE F	SANTA BARBARA	CA	93111	2326	42	06083	34.4351156	-119.8109023	Santa Barbara County
122934	Fee-for-Service	1386935914	1386935914	1	1	PIEROS, JANELLE J DO	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13225	01	General Practice	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91911	5736	37	06073	32.62870793	-117.0750108	San Diego County
122942	Fee-for-Service	1679187835	1679187835	1	1	PEACEFUL HEART HEALTHCARE	10/1/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	391 N MAIN STREET	STE 303	CORONA	CA	92878	4006	33	06065	33.88547338	-117.5647471	Riverside County
122973	Fee-for-Service	1922677038	1922677038	1	1	PATEL, JAY MD	7/26/2024	208M00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
122988	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
123011	Fee-for-Service	1770240459	1770240459	1	1	PRIMUS HOME HEALTH CARE, INC	7/14/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1607 N EL CENTRO AVE	SUITE 19	LOS ANGELES	CA	90028	6430	19	06037	34.10011093	-118.32378	Los Angeles County
123019	Fee-for-Service	1386121853	1386121853	1	1	PAZ, LUISA F	8/10/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1660 DREW CIRCLE	39	DAVIS	CA	95618	6356	57	06113	38.53756061	-121.7266523	Yolo County
123029	Fee-for-Service	1619986577	1619986577	1	1	PRACTICE HOLDINGS LP	7/5/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL ASSOCIATES	41511 STATE HIGHWAY 74	None	HEMET	CA	92544	5802	33	06065	33.747165	-116.936613	Riverside County
123087	Fee-for-Service	1629059977	1629059977	1	1	PARSONS, COLIN M MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85815	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
123095	Fee-for-Service	1255911244	1255911244	1	1	POSEY, ELIZABETH LMFT	4/22/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
123101	Fee-for-Service	1558062265	1558062265	1	1	PROGENY TMS CORPORATION	6/11/2024	261QM0850X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	17782 COWAN	STE D	IRVINE	CA	92614	6030	30	06059	33.69590054	-117.862371	Orange County
123107	Fee-for-Service	1285946277	1285946277	1	1	POON, YIUKEI DO	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11218	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
123109	Fee-for-Service	1942408166	1942408166	1	1	PUN, JOSAIAH CNP	6/21/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
123111	Fee-for-Service	1932294253	1932294253	1	1	PUNNAM, SUJEETH R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54250	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE A170	STOCKTON	CA	95210	6673	39	06077	38.00315652	-121.2868715	San Joaquin County
123138	Fee-for-Service	1992768519	1992768519	1	1	PATEL, RAKESH R MD	10/9/2008	2085R0001X	NA	Other	026	PHYSICIANS	105289	30	Radiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
123141	Fee-for-Service	1205089026	1205089026	1	3	PRIME HEALTHCARE SERVICES	11/1/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SHASTA, LLC	1355 E ST	None	REDDING	CA	96001	0801	45	06089	40.553244	-122.3601303	Shasta County
123149	Fee-for-Service	1841913548	1841913548	1	1	PILE, MARTHACLAIRE OD	10/16/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
123151	Fee-for-Service	1811579667	1811579667	1	1	PHAM, HALLEN MD	9/25/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
123156	Fee-for-Service	1275567059	1275567059	1	1	PRUNES, FERNANDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40476	01	General Practice	0	In state provider	None	1830 FLOWER ST	# 217	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
123163	Fee-for-Service	1215063094	1215063094	1	1	PARTHASARATHY, ANAND MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87745	78	Neoplastic Diseases/Oncology	0	In state provider	None	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
123168	Fee-for-Service	1831548197	1831548197	1	1	POOM MEDICAL CLINIC INC	7/12/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2055 N PERRIS BLVD	E6	PERRIS	CA	92571	2517	33	06065	33.80930628	-117.2260719	Riverside County
123181	Fee-for-Service	1790308179	1790308179	1	1	PALO DIALYSIS LLC	5/7/2021	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	10211 LONG BEACH BLVD	None	LYNWOOD	CA	90262	1508	19	06037	33.94281053	-118.2154924	Los Angeles County
123197	Fee-for-Service	1215088182	1215088182	1	1	PASCUAL, RAMON O MD	8/31/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36839	30	Radiology	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
123209	Fee-for-Service	1538626866	1538626866	1	1	PURE HOME HEALTH	9/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	315 W VERDUGO AVE	STE B	BURBANK	CA	91502	2469	19	06037	34.17082135	-118.314366	Los Angeles County
123215	Fee-for-Service	1396786976	1396786976	1	1	PICHE, JAMES BENNETT	10/31/1988	207P00000X	NA	Other	026	PHYSICIANS	60730	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
123233	Fee-for-Service	1083814800	1083814800	1	1	PHELPS, MOLLY A MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91767	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
123270	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	5/14/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
123276	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	6/9/2017	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
123294	Fee-for-Service	1700309762	1700309762	1	1	PAX THERAPY AND FAMILY SERVI	1/17/2024	101Y00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	CES	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
123307	Fee-for-Service	1386121853	1386121853	1	1	PAZ, LUISA F	8/10/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1660 DREW CIRCLE	39	DAVIS	CA	95618	6356	57	06113	38.53756061	-121.7266523	Yolo County
123335	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	7/25/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
123347	Fee-for-Service	1093849697	1093849697	1	1	PETRELLA, REGINA M LMFT	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	STE 109	SAN FERNANDO	CA	91340	3615	19	06037	34.28449525	-118.4396137	Los Angeles County
123348	Fee-for-Service	1225437973	1225437973	1	1	PORRAS, SARAH A LCSW	11/29/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
123371	Fee-for-Service	1790378784	1790378784	1	1	PROVIDE HOME HEALTH INC	3/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2829 N SAN FERNANDO RD	STE 206	LOS ANGELES	CA	90065	1342	19	06037	34.11119067	-118.2434149	Los Angeles County
123374	Fee-for-Service	1437327046	1437327046	1	1	POULTSIDES, GEORGE MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109564	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123385	Fee-for-Service	1467723098	1467723098	2	1	PECHERSKIY, VIACHESLAV MD	5/31/2022	207R00000X	NA	Other	026	PHYSICIANS	125441	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
123391	Fee-for-Service	1427314947	1427314947	1	1	POLYNICE, PAMELA B DO	9/11/2020	207P00000X	NA	Other	026	PHYSICIANS	17360	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
123399	Fee-for-Service	1932294253	1932294253	1	1	PUNNAM, SUJEETH R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54250	41	Internal Medicine	0	In state provider	None	1801 E MARCH LN	STE A170	STOCKTON	CA	95210	6673	39	06077	38.00315652	-121.2868715	San Joaquin County
123410	Fee-for-Service	1215072293	1215072293	1	1	PROGRESS HOUSE, INC	4/18/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2844 COLOMA STREET	None	PLACERVILLE	CA	95667	4406	09	06017	38.73241271	-120.8065775	El Dorado County
123428	Fee-for-Service	1992768519	1992768519	1	1	PATEL, RAKESH R MD	10/9/2008	2085R0001X	NA	Other	026	PHYSICIANS	105289	78	Neoplastic Diseases/Oncology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
123437	Fee-for-Service	1396031068	1396031068	1	1	PARK, CAROLINE MD	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142236	02	General Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
123441	Fee-for-Service	1730840059	1730840059	1	1	PROCARE FIRST HOME HEALTH,	10/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	18269 PARTHENIA ST	None	NORTHRIDGE	CA	91325	3303	19	06037	34.22871451	-118.532034	Los Angeles County
123442	Fee-for-Service	1912491499	1912491499	1	1	PICO, MICHAEL MD	9/15/2023	208VP0000X	NA	Other	026	PHYSICIANS	185532	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
123444	Fee-for-Service	1225193964	1225193964	1	1	PAN, ZHAOYANG MD INC	10/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55081	08	Family Practice	0	In state provider	None	652 N BROADWAY	STE A	LOS ANGELES	CA	90012	2802	19	06037	34.06003557	-118.2394613	Los Angeles County
123447	Fee-for-Service	1013011048	1013011048	1	3	PERSONAL HEARING SOLUTIONS I	2/23/2023	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	190 EL CERRITO PLAZA	None	EL CERRITO	CA	94530	4002	07	06013	37.89933405	-122.2977101	Contra Costa County
123449	Fee-for-Service	1215063094	1215063094	1	1	PARTHASARATHY, ANAND MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87745	30	Radiology	0	In state provider	None	301 PROFESSIONAL CENTER	None	ROHNERT PARK	CA	94928	2152	49	06097	38.35471913	-122.7076253	Sonoma County
123478	Fee-for-Service	1154364347	1154364347	1	1	PAYNE, MICHAEL S MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102144	30	Radiology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
123480	Fee-for-Service	1891961835	1891961835	1	1	PETTIGREW, HOWARD D MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104136	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
123509	Fee-for-Service	1396708913	1396708913	1	1	PATRICK GILBRETH M.D.	9/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1423 N JEFFERSON AVE	None	SPRINGFIELD	MO	65802	1917	00	None	37.22492991	-93.28917587	Greene County
123514	Fee-for-Service	1619351129	1619351129	1	1	POUST, GAIL LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
123521	Fee-for-Service	1114005691	1114005691	1	1	PATIL, RAJITA G MD	4/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86533	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
123524	Fee-for-Service	1447319108	1447319108	1	1	POWELL, WILLYE B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26351	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
123535	Fee-for-Service	1811330160	1811330160	1	1	PANDEY, SHIVLAL MD	12/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
123542	Fee-for-Service	1467816074	1467816074	1	1	PERRONE, KENNETH H MD	6/16/2023	208600000X	NA	General Surgery	026	PHYSICIANS	150987	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123558	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	3/7/2022	207L00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
123562	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
123565	Fee-for-Service	1467584441	1467584441	1	1	PROHEALTH PARTNERS,	10/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3772 KATELLA AVE	STE 101	LOS ALAMITOS	CA	90720	6420	30	06059	33.8029895	-118.0670445	Orange County
123584	Fee-for-Service	1700309762	1700309762	1	1	PAX THERAPY AND FAMILY SERVI	1/17/2024	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CES	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
123610	Fee-for-Service	1144775263	1144775263	1	1	PRODIGY HEALTHCARE INC	9/15/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2801 W ADAMS AVENUE	None	FRESNO	CA	93706	9601	10	06019	36.63408048	-119.842434	Fresno County
123624	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
123640	Fee-for-Service	1972879427	1972879427	1	2	PHAM, KHOA D MD	10/16/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	142496	18	Ophthalmology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
123661	Fee-for-Service	1306946793	1306946793	1	1	PAW, PATRICK T MD	8/31/1995	208G00000X	NA	General Surgery	026	PHYSICIANS	68451	33	Thoracic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123694	Fee-for-Service	1376076885	1376076885	1	1	PATEL, PAAVAN MD	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123731	Fee-for-Service	1225193964	1225193964	1	1	PAN, ZHAOYANG MD INC	10/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55081	01	General Practice	0	In state provider	None	652 N BROADWAY	STE A	LOS ANGELES	CA	90012	2802	19	06037	34.06003557	-118.2394613	Los Angeles County
123766	Fee-for-Service	1154364347	1154364347	1	1	PAYNE, MICHAEL S MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102144	78	Neoplastic Diseases/Oncology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
123794	Fee-for-Service	1699239905	1699239905	1	1	PIETERS, COSSETTE RCP	9/15/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
123810	Fee-for-Service	1164928917	1164928917	1	1	PARDIKAR, RICHA S MD	5/13/2022	207L00000X	NA	Other	026	PHYSICIANS	167558	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
123827	Fee-for-Service	1649509647	1649509647	1	1	PEDIATRIC GASTROENTEROLOGY	2/26/2010	2080P0206X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	CONSULTANTS	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
123829	Fee-for-Service	1306182175	1306182175	1	2	PHARMACY ALTERNATIVES CALIFO	6/28/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RNIA, LLC	2940 E LA PALMA AVE	SUITE A	ANAHEIM	CA	92806	2619	30	06059	33.84978318	-117.8625179	Orange County
123844	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	1/7/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
123851	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
123908	Fee-for-Service	1679769558	1679769558	1	1	PATEL, HARISHCHANDRA	2/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41341	None	None	0	In state provider	MD INC	3400 W BALL RD	STE 203	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
123911	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
123912	Fee-for-Service	1902984628	1902984628	1	1	POPLAWSKI, DONNA MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56118	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
123917	Fee-for-Service	1942613021	1942613021	1	1	PLUYM, GARRETT DO MD	7/30/2018	207P00000X	NA	Other	026	PHYSICIANS	16190	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
123921	Fee-for-Service	1679869515	1679869515	1	1	PORTER, ANTHONY J MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145413	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO ROAD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
123949	Fee-for-Service	1306946793	1306946793	1	1	PAW, PATRICK T MD	8/31/1995	208G00000X	NA	General Surgery	026	PHYSICIANS	68451	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
123953	Fee-for-Service	1174212542	1174212542	1	1	PACIFIC COAST SPEECH THERAPY	12/1/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18837 BROOKHURST ST	SUITE 108 AND 109	FOUNTAIN VALLEY	CA	92708	7301	30	06059	33.68919119	-117.9542204	Orange County
123980	Fee-for-Service	1306892906	1306892906	1	1	PUTNOKY, GILBERT J MD	6/30/1988	207RR0500X	NA	Other	026	PHYSICIANS	27563	83	Rheumatology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
123991	Fee-for-Service	1720256647	1720256647	1	1	PLANNED PARENTHOOD EAST	3/28/2008	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES CENTER	5068 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3128	19	06037	34.02101146	-118.1603463	Los Angeles County
123996	Fee-for-Service	1407233240	1407233240	1	1	PRAIRIE DIALYSIS LLC	1/20/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	721 W 1ST STREET	None	TUSTIN	CA	92780	2903	30	06059	33.74577605	-117.8317754	Orange County
123997	Fee-for-Service	1073559191	1073559191	1	1	PAK, JAMES H MD	2/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72313	05	Anesthesiology	0	In state provider	None	5176 HILL RD	SUITE E	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
124001	Fee-for-Service	1477660116	1477660116	1	1	PHILIP, SUSAN S MD	4/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80537	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
124010	Fee-for-Service	1629540596	1629540596	1	1	POWER, GRACE D RCP	2/15/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
124042	Fee-for-Service	1750491247	1750491247	1	1	PRIME HEALTHCARE SVS II	7/1/2010	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	SHERMAN OAKS HOSP	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
124064	Fee-for-Service	1356399760	1356399760	1	1	PAGE, GREGORY T MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	64911	None	None	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
124067	Fee-for-Service	1831213156	1831213156	1	1	PEREZ DE JANERO, ELENA MD	4/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
124095	Fee-for-Service	1912941808	1912941808	1	1	PARSA, SHAHRAM MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79497	08	Family Practice	0	In state provider	None	3200 LONG BEACH BLVD	None	LONG BEACH	CA	90807	5062	19	06037	33.815637	-118.1892215	Los Angeles County
124102	Fee-for-Service	1447291851	1447291851	1	1	PARSI, KAY HOOSHMAND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1838 FRANKLIN ST	None	DENVER	CO	80218	1126	00	None	39.7455458	-104.9683475	City and County of Denver
124114	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
124122	Fee-for-Service	1396988226	1396988226	1	1	PENDER, ROSS A MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111504	13	Neurology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
124134	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	8/2/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
124142	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	3/14/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
124153	Fee-for-Service	1043877327	1043877327	1	1	PRIMIANI, CHRISTOPHER T MD	4/23/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	187439	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124201	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	6/12/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
124222	Fee-for-Service	1366734618	1366734618	1	1	PRIMUS, FRANK MD	7/30/2024	208600000X	NA	General Surgery	026	PHYSICIANS	114110	02	General Surgery	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
124224	Fee-for-Service	1427251396	1427251396	1	1	POULSEN, CHRISTOFFER E. DO	6/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
124229	Fee-for-Service	1912644196	1912644196	1	1	POUR, SCHYNA LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124258	Fee-for-Service	1922398908	1922398908	1	1	PATEL, VEENA DO MD	4/9/2018	208M00000X	NA	Other	026	PHYSICIANS	16104	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
124295	Fee-for-Service	1538121967	1538121967	1	1	PANNU, SUKHBIR S MD	8/31/2012	207R00000X	NA	Other	026	PHYSICIANS	56442	41	Internal Medicine	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
124299	Fee-for-Service	1427501154	1427501154	1	1	PATEL, MEHUL K MD	7/1/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	158299	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
124302	Fee-for-Service	1750669628	1750669628	1	1	PARKER, ALICIA	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
124330	Fee-for-Service	1750491247	1750491247	1	1	PRIME HEALTHCARE SVS II	3/1/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SHERMAN OAKS HOSP	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
124336	Fee-for-Service	1518424902	1518424902	1	1	PRIOLO, JESSE B CRNA	7/5/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
124338	Fee-for-Service	1891842480	1891842480	1	1	PRICHARD, GAIL A MD	11/30/1990	207R00000X	NA	Other	026	PHYSICIANS	54724	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
124341	Fee-for-Service	1245329440	1245329440	1	1	PLANNED PARENTHOOD LOS	1/20/1996	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES JONES CENTER	7655 GREENLEAF AVE	None	WHITTIER	CA	90602	1626	19	06037	33.9719973	-118.0374206	Los Angeles County
124388	Fee-for-Service	1265407225	1265407225	1	1	PREM SOMAN MD	1/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	None	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
124393	Fee-for-Service	1689799199	1689799199	1	1	PHUNG, CHI-BAO L MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77048	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
124399	Fee-for-Service	1275059040	1275059040	1	1	POSNICK, NICOLE PT	9/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2222 FRANCISCO DR	STE 120	EL DORADO HILLS	CA	95762	3762	09	06017	38.71039358	-121.08565	El Dorado County
124402	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
124420	Fee-for-Service	1750791364	1750791364	1	1	PEARSON, CATHERINE MD	9/9/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	146638	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124423	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	6/13/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
124429	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
124443	Fee-for-Service	1538488580	1538488580	1	1	PASTRANA, MARIEL M MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127358	None	None	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
124450	Fee-for-Service	1497182026	1497182026	1	1	PEARSON, HEATHER PSYD	3/13/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2701 COTTAGE WAY	16	SACRAMENTO	CA	95825	1225	34	06067	38.604078	-121.3996365	Sacramento County
124478	Fee-for-Service	1417294455	1417294455	1	1	PACIFIC CENTRAL COAST HEALTH	4/4/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	217 WEST CENTRAL AVENUE	SUITE F & G	LOMPOC	CA	93436	2830	42	06083	34.66084049	-120.460302	Santa Barbara County
124479	Fee-for-Service	1275751174	1275751174	1	1	PHAM, THAO T MD	8/13/2007	207R00000X	NA	Other	026	PHYSICIANS	99358	41	Internal Medicine	0	In state provider	None	777 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43375205	-121.8931721	Santa Clara County
124489	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
124510	Fee-for-Service	1558756882	1558756882	1	1	PANAHIPOUR, SAMAN MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	165969	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
124526	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	1/6/2017	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
124532	Fee-for-Service	1891377487	1891377487	1	1	PATREGNANI, MICHELLE A MD	9/3/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
124552	Fee-for-Service	1669497921	1669497921	1	1	PITZELE, HENRY Z MD	9/23/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1299 BERTHA HOWE	None	MESQUITE	NV	89027	7500	00	None	36.80863769	-114.1155175	Clark County
124554	Fee-for-Service	1376272138	1376272138	1	1	PAULSON, TAYLOR LMFT	1/13/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
124571	Fee-for-Service	1013497213	1013497213	1	1	PETRIKOVETS, ANDREY MD APC	8/28/2018	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	127810	None	None	0	In state provider	None	1513 S GRAND AVE	STE 400	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
124601	Fee-for-Service	1962542274	1962542274	1	1	PRINCIPLES INC	5/31/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1680 N FAIR OAKS AVENUE	None	PASADENA	CA	91103	1642	19	06037	34.17483072	-118.150706	Los Angeles County
124603	Fee-for-Service	1558772368	1558772368	1	1	PULST-KORENBERG, JOHANNES B	7/13/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	166240	13	Neurology (M.D. only)	0	In state provider	MD	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
124634	Fee-for-Service	1508925199	1508925199	1	1	PARK, SUE MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61447	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
124640	Fee-for-Service	1326796632	1326796632	1	1	PEAK MENTAL HEALTH - LICENSE	3/21/2024	261QM0801X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
124647	Fee-for-Service	1871739136	1871739136	1	1	PERA, TASHA LMFT	2/16/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2711 TULARE AVE	None	EL CERRITO	CA	94530	1438	07	06013	37.93820476	-122.3150292	Contra Costa County
124686	Fee-for-Service	1164473757	1164473757	1	1	PATHWAY MEDICAL GRP, INC	7/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
124692	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
124696	Fee-for-Service	1811378987	1811378987	1	1	PLUSHCARE OF CALIFORNIA INC	2/27/2017	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	A PROFESSIONAL CORP	650 5TH STREET	STE 311	SAN FRANCISCO	CA	94107	1542	38	06075	37.77575268	-122.3977845	San Francisco County
124708	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	2/11/2022	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
124715	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
124755	Fee-for-Service	1518664408	1518664408	1	1	PETERSON, SOPHIE R LCSW	3/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124761	Fee-for-Service	1114901105	1114901105	1	1	PATEL, ATULKUMAR N MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	83624	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
124767	Fee-for-Service	1740708098	1740708098	1	1	PACIFICO, NICOLLE A PHD	10/29/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
124775	Fee-for-Service	1912613795	1912613795	1	1	PEPPER, SYDNEY DOULA	2/11/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	04	06007	0	0	None
124776	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	6/11/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	27	Psychiatry Neurology (D.O. only)	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
124809	Fee-for-Service	1760557912	1760557912	1	1	PASCHAL, JOHN F MD	6/30/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	62369	18	Ophthalmology	0	In state provider	None	3401 FOLSOM BLVD	STE A	SACRAMENTO	CA	95816	5354	34	06067	38.566926	-121.4630865	Sacramento County
124812	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
124850	Fee-for-Service	1841280740	1841280740	1	1	PREEMYER, BYRON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 MADISON OAK DR	None	SAN ANTONIO	TX	78258	3913	00	None	29.62127927	-98.49119067	Bexar County
124856	Fee-for-Service	1235162959	1235162959	1	1	PANIK, BRIAN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N KAUKINI STREET	None	HONOLULU	HI	96817	2336	00	None	21.32247447	-157.8564644	Honolulu County
124894	Fee-for-Service	1093262354	1093262354	1	1	PAYNE, CHRISTI A NP	8/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1990 FRUITDALE AVE	None	SAN JOSE	CA	95128	2709	43	06085	37.31065241	-121.9285256	Santa Clara County
124928	Fee-for-Service	1326796632	1326796632	1	1	PEAK MENTAL HEALTH - LICENSE	3/21/2024	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
124945	Fee-for-Service	1992739049	1992739049	1	1	PAZ, LORNA T MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54823	40	Pediatrics	0	In state provider	None	1120 2ND ST	STE A	BRENTWOOD	CA	94513	2234	07	06013	37.93716122	-121.6978484	Contra Costa County
124979	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
124996	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	8/2/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
125001	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
125005	Fee-for-Service	1518071174	1518071174	1	1	PETTIT, ROBERT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3430 WASHINGTON PKWY	None	IDAHO FALLS	ID	83404	7579	00	None	43.46676369	-111.9933057	Bonneville County
125063	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2016	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
125081	Fee-for-Service	1194776591	1194776591	1	1	POLLOCK,AVRUM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	614 BALLYTORE RD CTR	None	WYNNEWOOD	PA	19096	0000	00	None	40.00038509	-75.27957855	Montgomery County
125089	Fee-for-Service	1013084870	1013084870	1	1	PLEHN, CYNTHIA L CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
125096	Fee-for-Service	1700240066	1700240066	1	1	PATEL, NEHA B MD	12/17/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	152788	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125102	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
125114	Fee-for-Service	1881820876	1881820876	1	1	PHAN, CHINH T DO	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11954	41	Internal Medicine	0	In state provider	None	2825 J STREET	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
125125	Fee-for-Service	1932166865	1932166865	1	1	PELTZ RONALD HD	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4225 TWEEDY BLVD	STE B	SOUTH GATE	CA	90280	6296	19	06037	33.94330446	-118.1970199	Los Angeles County
125139	Fee-for-Service	1730519927	1730519927	1	1	PROHEALTH PARTNERS A MEDICAL	8/25/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP	12321 CARSON ST	SUITE 1-2	HAWAIIAN GARDENS	CA	90716	1846	19	06037	33.83157953	-118.0689075	Los Angeles County
125157	Fee-for-Service	1770720427	1770720427	1	1	POWELL, SEAN T MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102975	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
125186	Fee-for-Service	1326068990	1326068990	1	1	PHAM, ANTHONY T MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	87649	41	Internal Medicine	0	In state provider	None	1310 W STEWART DRIVE	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
125192	Fee-for-Service	1467549774	1467549774	1	1	POWERS, ELLEN A PSYD	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 LONG BEACH BLVD	STE 340	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
125193	Fee-for-Service	1689667651	1689667651	1	1	PASCHALL, PAUL MD	1/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D ALENE	ID	83814	2611	00	None	47.69465937	-116.7917936	Kootenai County
125211	Fee-for-Service	1326363557	1326363557	1	1	PATTON, DANIEL J MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143495	01	General Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
125213	Fee-for-Service	1881921781	1881921781	1	1	PEREZ, DENISE R NP	1/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
125214	Fee-for-Service	1326796632	1326796632	1	1	PEAK MENTAL HEALTH - LICENSE	4/24/2024	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
125267	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	1/9/2017	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
125282	Fee-for-Service	1427784982	1427784982	1	1	PRIORITY SCIENCE LABS	4/23/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	14340 BOLSA CHICA RD	SUITE D	WESTMINSTER	CA	92683	4868	30	06059	33.75373245	-118.0425384	Orange County
125284	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
125290	Fee-for-Service	1841373800	1841373800	1	6	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
125296	Fee-for-Service	1760246441	1760246441	1	1	PHARMAHEALTH RX SOLUTIONS IN	6/4/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	341 1/2 N LA BREA AVE	None	LOS ANGELES	CA	90036	2517	19	06037	34.07731425	-118.3441214	Los Angeles County
125300	Fee-for-Service	1689427601	1689427601	1	1	PIERRA, CONNER PT	2/4/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2170 BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795324	-118.122705	Los Angeles County
125305	Fee-for-Service	1962573105	1962573105	1	1	PONCE, ANNA MARIE CNP	9/23/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
125328	Fee-for-Service	1255792172	1255792172	1	1	PATEL, JAY P MD	9/18/2018	207KA0200X	NA	Other	026	PHYSICIANS	134930	03	Allergy	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
125352	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
125374	Fee-for-Service	1447625553	1447625553	1	1	PLOSZYNSKI, MATEUSZ LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94989	-	NOT APPLICABLE	0	In state provider	None	1200 N MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3630	30	06059	33.755175	-117.8676195	Orange County
125390	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
125394	Fee-for-Service	1336237080	1336237080	1	1	PALMER, HIRAM S MD INC	4/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	LOMA LINDA CARDIOLOGY	1701 E CESAR CHAVEZ AVE	STE 403	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
125404	Fee-for-Service	1881820876	1881820876	1	1	PHAN, CHINH T DO	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11954	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J STREET	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
125447	Fee-for-Service	1992851265	1992851265	1	1	PELAYO, FRANCIS C PT	4/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
125504	Fee-for-Service	1326796632	1326796632	1	1	PEAK MENTAL HEALTH - LICENSE	8/28/2023	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
125507	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
125525	Fee-for-Service	1417486176	1417486176	1	1	POUDEL, ROSINA MD	5/11/2021	208M00000X	NA	Other	026	PHYSICIANS	170241	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
125552	Fee-for-Service	1003874702	1003874702	2	6	PROHEALTH ADVANCED IMAGING M	12/19/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	14915 BURBANK BOULEVARD	None	VAN NUYS	CA	91411	3610	19	06037	34.17213345	-118.4582475	Los Angeles County
125555	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	11/18/2016	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
125574	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	9/2/2022	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
125582	Fee-for-Service	1891872743	1891872743	1	1	PEREDY, GEORGE S MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43635	41	Internal Medicine	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
125587	Fee-for-Service	1588030951	1588030951	1	1	PROHEALTH PARTNERS A MEDICAL	10/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	5750 DOWNEY AVE	STE 206	LAKEWOOD	CA	90712	1474	19	06037	33.859611	-118.1511435	Los Angeles County
125610	Fee-for-Service	1366612848	1366612848	1	1	PATEL, BEENA H MD	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98529	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
125626	Fee-for-Service	1154490506	1154490506	1	1	PASLEY, JASON D DO	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
125639	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	8/2/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
125678	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
125685	Fee-for-Service	1336237080	1336237080	1	1	PALMER, HIRAM S MD INC	4/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	LOMA LINDA CARDIOLOGY	1701 E CESAR CHAVEZ AVE	STE 403	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
125688	Fee-for-Service	1437492733	1437492733	1	1	PROEHL, SARAH C MD	8/9/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	132922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
125709	Fee-for-Service	1972665644	1972665644	1	1	PFEIFFER, JENNIFER	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
125721	Fee-for-Service	1477663722	1477663722	1	1	PINTO, ANITA MD	8/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75968	None	None	0	In state provider	None	860 JAMACHA RD	SUITE 203	EL CAJON	CA	92019	3224	37	06073	32.78430676	-116.9279962	San Diego County
125722	Fee-for-Service	1497449094	1497449094	1	1	PETERSON, SHERRI	5/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11879 KEMPER RD.	SUITE 4	AUBURN	CA	95603	9021	31	06061	38.93136899	-121.0916266	Placer County
125754	Fee-for-Service	1538120886	1538120886	1	1	PICKETT, ANTHONY J MD	4/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
125795	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	6/12/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
125802	Fee-for-Service	1467586099	1467586099	1	1	PALLICCIA, TORI LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
125838	Fee-for-Service	1841721784	1841721784	1	1	PORTERA, ARIEL M DO	9/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16832	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125844	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
125863	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	5/17/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
125868	Fee-for-Service	1891872743	1891872743	1	1	PEREDY, GEORGE S MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43635	66	Emergency Medicine (Urgent Care)	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
125875	Fee-for-Service	1588030951	1588030951	1	1	PROHEALTH PARTNERS A MEDICAL	10/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	5750 DOWNEY AVE	STE 206	LAKEWOOD	CA	90712	1474	19	06037	33.859611	-118.1511435	Los Angeles County
125888	Fee-for-Service	1962618884	1962618884	1	1	PHO, CUONG N	7/20/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE RD	None	SUNNYVALE	CA	94086	6215	43	06085	37.36886669	-122.0316101	Santa Clara County
125894	Fee-for-Service	1780240135	1780240135	1	1	PERSONAL TOUCH HOME HEALTH	11/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	16909 PARTHENIA ST	STE 104 A	NORTHRIDGE	CA	91343	4551	19	06037	34.22852346	-118.500687	Los Angeles County
125899	Fee-for-Service	1366612848	1366612848	1	1	PATEL, BEENA H MD	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98529	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
125916	Fee-for-Service	1083774897	1083774897	1	1	PETERSON, STEVEN H MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43320	20	Orthopedic Surgery	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
125917	Fee-for-Service	1255793725	1255793725	1	1	PATEL, KUNAL S MD	3/7/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	151579	None	None	0	In state provider	None	300 STEIN PLZ	420	LOS ANGELES	CA	90095	0001	19	06037	34.06482846	-118.4443432	Los Angeles County
125926	Fee-for-Service	1063698223	1063698223	2	1	POST, STEPHEN E MD A	5/16/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	PROFESSIONAL CORPORATION	2149 CENTRAL AVENUE	None	ALAMEDA	CA	94501	2894	01	06001	37.76643361	-122.2479293	Alameda County
125927	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	8/26/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
125930	Fee-for-Service	1629378534	1629378534	1	1	PASCARZI, CHRISTINA M PHD	2/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
125933	Fee-for-Service	1104985787	1104985787	1	1	PHILLIPS, GREGORY L MD	5/30/1988	207R00000X	NA	Other	026	PHYSICIANS	63577	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
125937	Fee-for-Service	1174604292	1174604292	1	1	PATEL, VIVEK R MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96366	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO STREET	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
125939	Fee-for-Service	1144690694	1144690694	1	1	PINEDA, MINETTE M NP	5/4/2017	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125944	Fee-for-Service	1831284900	1831284900	1	1	PULLOS, TAKE G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5201 YELLOWSTONE RD	None	CHEYENNE	WY	82009	4741	00	None	41.16619244	-104.8286429	Laramie County
125955	Fee-for-Service	1326094020	1326094020	1	7	PHI HEALTH, LLC	3/3/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1304 S 105TH PLACE	1002	MESA	AZ	85209	3819	00	None	33.391584	-111.6028665	Maricopa County
125965	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	4/27/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
125985	Fee-for-Service	1386614121	1386614121	1	1	PESCO, SALLY A	10/31/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
125999	Fee-for-Service	1447427018	1447427018	1	1	POLARIS MEDICAL GROUP LLC	9/1/2009	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
126006	Fee-for-Service	1295763878	1295763878	1	1	PEREZ-SILVA, RENE D MD	8/24/2004	207R00000X	NA	Other	026	PHYSICIANS	34707	41	Internal Medicine	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
126025	Fee-for-Service	1457913196	1457913196	1	1	PARVEZ MEMON MD, INC	12/18/2023	207RG0300X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7702 MEANY AVE	STE 101	BAKERSFIELD	CA	93308	5199	15	06029	35.3942865	-119.087946	Kern County
126076	Fee-for-Service	1972590602	1972590602	1	1	PALO PINTO GENERAL HOSPITAL	5/12/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 SW 25TH AVE	None	MINERAL WELLS	TX	76067	8246	00	None	32.79953355	-98.144991	Palo Pinto County
126080	Fee-for-Service	1962550798	1962550798	1	1	PERES DA SILVA, EDWIN J	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53374	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
126081	Fee-for-Service	1275722381	1275722381	1	1	PANTALEONI, JULIE L MD	6/8/2010	390200000X	NA	Other	026	PHYSICIANS	105352	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
126085	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
126092	Fee-for-Service	1326282476	1326282476	1	1	PACKARD, LISA K MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113818	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
126108	Fee-for-Service	1760643779	1760643779	1	1	PHAM, PHUONG M MD	5/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126343	24	Plastic Surgery	0	In state provider	None	95 SCRIPPS DRIVE	None	SACRAMENTO	CA	95825	6320	34	06067	38.571831	-121.409604	Sacramento County
126122	Fee-for-Service	1407299225	1407299225	1	1	PANNELL, STEPHANIE MD	6/25/2019	208800000X	NA	Other	026	PHYSICIANS	132591	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
126125	Fee-for-Service	1851683650	1851683650	1	1	PAYABVASH, SEYEDMEHDI MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141742	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126132	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
126148	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	5/10/2021	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
126171	Fee-for-Service	1477922391	1477922391	1	1	PASION, NESTOR DOMINIC D PT	2/5/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
126173	Fee-for-Service	1194754002	1194754002	1	1	PENG, HONGQI Q MD	4/21/2022	207ZP0101X	NA	Other	026	PHYSICIANS	169287	None	None	0	In state provider	None	6125 N FRESNO STREET	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
126179	Fee-for-Service	1912956053	1912956053	1	1	PANAHI, GHAROON MD	12/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34894	01	General Practice	0	In state provider	None	11180 WARNER AVE	STE 157	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
126181	Fee-for-Service	1306995287	1306995287	1	1	POWELL, CATHERINE B	11/30/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59583	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
126213	Fee-for-Service	1821466756	1821466756	1	1	PATEL, SHAILJA J PT	3/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
126215	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
126237	Fee-for-Service	1588655823	1588655823	1	1	PEPPERCORN, ROBERT M MD	8/14/1990	207N00000X	NA	Dermatology	026	PHYSICIANS	38720	07	Dermatology	0	In state provider	INC	350 DEL NORTE AVE	None	YUBA CITY	CA	95991	4123	51	06101	39.14502655	-121.615685	Sutter County
126254	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	10/16/2012	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
126285	Fee-for-Service	1750574604	1750574604	1	1	PAULSEN, JEREMY D MD	8/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97394	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
126309	Fee-for-Service	1568641520	1568641520	1	1	PEDIATRIC PLAY THERAPY	1/31/2023	261Q00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
126314	Fee-for-Service	1457913196	1457913196	1	1	PARVEZ MEMON MD, INC	12/18/2023	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7702 MEANY AVE	STE 101	BAKERSFIELD	CA	93308	5199	15	06029	35.3942865	-119.087946	Kern County
126316	Fee-for-Service	1932520863	1932520863	1	1	PATHWAY PHARMACEUTICALS INC	2/10/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43875 WASHINGTON ST	STE A	PALM DESERT	CA	92211	8249	33	06065	33.730155	-116.303978	Riverside County
126331	Fee-for-Service	1396968376	1396968376	1	1	PITCHON, HOWARD MD	11/25/2014	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	25655	77	Infectious Disease	0	In state provider	None	8920 WILSHIRE BLVD	SUITE 330	BEVERLY HILLS	CA	90211	2011	19	06037	34.06703599	-118.3863456	Los Angeles County
126372	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
126419	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
126438	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	1/17/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
126478	Fee-for-Service	1316243546	1316243546	1	1	PRODIGY HEALTHCARE, INC	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1976 MORRIS KYLE DR	101-102,301-306,814	FIREBAUGH	CA	93622	9711	10	06019	36.84447	-120.4446915	Fresno County
126480	Fee-for-Service	1942567854	1942567854	1	1	PROS MEDICAL CLINIC INC	6/18/2012	261QP2300X	NA	Other	026	PHYSICIANS	34068	08	Family Practice	0	In state provider	None	4959 PALO VERDE STREET	SUITE #101A	MONTCLAIR	CA	91763	2340	36	06071	34.08129954	-117.6966135	San Bernardino County
126485	Fee-for-Service	1245424738	1245424738	1	1	PRASAD-AGUILERA, ANITA M	10/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 SHAW	SUITE 109	FRESNO	CA	93710	7917	10	06019	36.80872147	-119.765979	Fresno County
126502	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
126505	Fee-for-Service	1477533586	1477533586	1	1	PETERSON, TODD R DO	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	7104	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
126518	Fee-for-Service	1053346379	1053346379	1	1	PEREZ, JOSE A JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45328	41	Internal Medicine	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
126541	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
126549	Fee-for-Service	1467410134	1467410134	1	1	PRIMARY CRITICAL CARE	7/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	LIMITED PARTNERSHIP	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
126556	Fee-for-Service	1255674537	1255674537	1	1	PHI HEALTH, LLC	8/3/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2400 UNSER BLVD SE	None	RIO RANCHO	NM	87124	4740	00	None	35.219403	-106.6930515	Sandoval County
126594	Fee-for-Service	1568641520	1568641520	1	1	PEDIATRIC PLAY THERAPY	8/17/2021	261Q00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
126659	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
126689	Fee-for-Service	1518061563	1518061563	1	1	PABBY, VIKAS K MD	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88755	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
126707	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
126710	Fee-for-Service	1598820110	1598820110	1	1	PETERSON, AMANDA L MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94082	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
126727	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	1/27/2023	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
126751	Fee-for-Service	1326497520	1326497520	1	1	POE, AMANDA L MD	10/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169984	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
126762	Fee-for-Service	1245370899	1245370899	1	1	PETROS, GEORGE DC	5/28/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC CLINIC	2724 ABORN RD	None	SAN JOSE	CA	95121	1204	43	06085	37.31364749	-121.7928998	Santa Clara County
126791	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
126795	Fee-for-Service	1609880947	1609880947	1	1	PREMIER ANESTHESIA	1/1/1999	174400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
126806	Fee-for-Service	1467641134	1467641134	1	1	POWERS, COLE B LMFT	5/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
126815	Fee-for-Service	1164505962	1164505962	1	1	PARSONS, ANN M	9/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
126829	Fee-for-Service	1851463244	1851463244	1	1	PRUITT, MICHAEL W DO	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12351	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN ROAD	None	BIG BEAR LAKE	CA	92315	9999	36	06071	34.24602097	-116.8885243	San Bernardino County
126830	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
126851	Fee-for-Service	1346551819	1346551819	1	1	PHAM, HOANG H MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120294	41	Internal Medicine	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
126862	Fee-for-Service	1003178138	1003178138	1	1	PATEL, KUMKUM S MD	10/16/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	163386	10	Gastroenterology (M.D. only)	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
126883	Fee-for-Service	1952768988	1952768988	1	1	PASADENA SENIOR LIVING	1/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	1415 N GARFIELD AVE	None	PASADENA	CA	91104	2106	19	06037	34.16989584	-118.1439365	Los Angeles County
126903	Fee-for-Service	1083065338	1083065338	1	1	PRIMARY CARE INTERNIST INC	4/12/2016	207R00000X	NA	Other	026	PHYSICIANS	40921	41	Internal Medicine	0	In state provider	None	6700 N FIRST STREET	STE 111	FRESNO	CA	93710	3947	10	06019	36.83586697	-119.7721176	Fresno County
126906	Fee-for-Service	1881651222	1881651222	1	1	PRICCO, MARTIN F MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54161	25	Physical Medicine and Rehabilitation	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
126916	Fee-for-Service	1497770481	1497770481	1	1	PRYSTASH, SEAN M MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136903	36	Psychiatry	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BLD C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
126919	Fee-for-Service	1215257639	1215257639	1	1	PAINTER, CHRISTOPHER J MD	7/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117837	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126922	Fee-for-Service	1538371844	1538371844	1	1	PARK, DANIEL MD	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99433	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
126936	Fee-for-Service	1659577492	1659577492	1	1	PURI, POONAM MD	2/14/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	92644	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
126948	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
126964	Fee-for-Service	1821118084	1821118084	1	1	PLEASANT VALLEY SD	5/21/2002	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	600 TEMPLE AVE	None	CAMARILLO	CA	93010	4835	56	06111	34.2234843	-119.0302317	Ventura County
126973	Fee-for-Service	1154765436	1154765436	1	1	PLAISTED, SHERI R MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133330	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
126978	Fee-for-Service	1841498730	1841498730	1	1	PALMER, BARRON M MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86685	02	General Surgery	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
126994	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	7/14/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
127008	Fee-for-Service	1477726933	1477726933	1	1	PRITISH PAWAR	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4530 E MUIRWOOD DR	STE 111	PHOENIX	AZ	85048	7693	00	None	33.303006	-111.9855375	Maricopa County
127013	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	6/18/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
127021	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
127023	Fee-for-Service	1376836155	1376836155	1	1	PATELVENKETSAMY, NISHA K	10/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
127065	Fee-for-Service	1962666156	1962666156	1	1	PANG, ARNOLD T DO INC	9/16/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9712	08	Family Practice	0	In state provider	None	15572 E GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1513	19	06037	34.0120345	-117.9671884	Los Angeles County
127080	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	6/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
127096	Fee-for-Service	1487278008	1487278008	1	1	PSYCHOTHERAPY WELLNESS AND H	8/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	EALING CENTER INC	123 W PADRE ST	STE A	SANTA BARBARA	CA	93105	3960	42	06083	34.43007785	-119.7177802	Santa Barbara County
127101	Fee-for-Service	1114347986	1114347986	1	1	PEREZ, JUSTIN MD	12/29/2020	208200000X	NA	General Surgery	026	PHYSICIANS	167469	None	None	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
127119	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
127136	Fee-for-Service	MSS00054F	None	1	1	PARTNERS IN CARE FOUNDATION	1/1/2016	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INC	5951 ENCINA ROAD	STE 200	GOLETA	CA	93117	6252	42	06083	34.44293979	-119.829107	Santa Barbara County
127139	Fee-for-Service	1275228223	1275228223	1	1	PLANNED PARENTHOOD OF THE	7/1/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	25130 HANCOCK AVENUE	STE 100	MURRIETA	CA	92562	5969	33	06065	33.56839325	-117.1824289	Riverside County
127143	Fee-for-Service	1750573648	1750573648	1	1	PAULS SHOE REPAIR AND SALES	7/16/2020	335E00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC.	1102 S GLENDALE AVE	None	GLENDALE	CA	91205	3203	19	06037	34.13330842	-118.2519938	Los Angeles County
127148	Fee-for-Service	1932441425	1932441425	1	1	PARK, ESTHER S MD	8/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143191	None	None	0	In state provider	None	8940 RESEDA BLVD	STE 101	NORTHRIDGE	CA	91324	5833	19	06037	34.233084	-118.5360505	Los Angeles County
127155	Fee-for-Service	1356441752	1356441752	1	1	PENINSULA WOMEN'S HEALTH	7/31/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1828 EL CAMINO REAL	STE 805	BURLINGAME	CA	94010	3124	41	06081	37.59552262	-122.3838771	San Mateo County
127164	Fee-for-Service	1316393747	1316393747	1	1	PONG, TERRENCE MD	9/3/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	154290	33	Thoracic Surgery	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
127170	Fee-for-Service	1821176686	1821176686	1	1	PHANEUF, JOSEPH G MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43104	07	Dermatology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
127201	Fee-for-Service	1427543511	1427543511	1	1	PINJALA, ANUSHA BHARGAVI MD	9/10/2021	207R00000X	NA	Other	026	PHYSICIANS	174608	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
127209	Fee-for-Service	1538371844	1538371844	1	1	PARK, DANIEL MD	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99433	77	Infectious Disease	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
127218	Fee-for-Service	1902984081	1902984081	1	1	PACHTMAN, CORI MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82857	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
127236	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
127238	Fee-for-Service	1720599103	1720599103	1	1	PARK, SARAH I AU	9/14/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
127280	Fee-for-Service	1083984074	1083984074	1	1	PRINGLE, LAUREN C MD	7/2/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153077	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
127283	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
127290	Fee-for-Service	1932251550	1932251550	1	1	PROGRESSIVE MED SPECIALISTS	3/15/2006	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	SPECIALISTS, LLC	4974 EL CAJON BLVD	STE A	SAN DIEGO	CA	92115	4677	37	06073	32.75676923	-117.0872161	San Diego County
127303	Fee-for-Service	1841373800	1841373800	1	14	PERMANENTE MEDICAL GROUP INC	1/21/2022	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 CALIFORNIA ST	400	SAN FRANCISCO	CA	94109	0429	38	06075	37.79030099	-122.4230289	San Francisco County
127309	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
127324	Fee-for-Service	1053420844	1053420844	2	2	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	65 3RD STREET	SUITE 13	POINT REYES STATI	CA	94956	0910	21	06041	38.06766892	-122.8068687	Marin County
127351	Fee-for-Service	1366047516	1366047516	1	1	PRESTIGE HOME CARE INC	7/29/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNY	STE 101B	SANTA CLARITA	CA	91355	1256	19	06037	34.43517857	-118.5722781	Los Angeles County
127370	Fee-for-Service	1639252604	1639252604	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
127389	Fee-for-Service	1346350394	1346350394	1	1	PYRKOVA-COROTAN, IRINA A MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51927	41	Internal Medicine	0	In state provider	None	1450 TREAT BLVD	SUITE 120	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
127407	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
127416	Fee-for-Service	1144842212	1144842212	1	1	PENTZIEN, CASSANDRA PHD	12/1/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
127478	Fee-for-Service	1881713469	1881713469	1	1	PAULIN, EUGENE H PHD	5/21/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	540 N FAIRVIEW STREET	None	BURBANK	CA	91505	3247	19	06037	34.16460784	-118.3378561	Los Angeles County
127512	Fee-for-Service	1700959483	1700959483	1	1	PATEL, GRISHMA J MD	4/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	53486	41	Internal Medicine	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
127525	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
127551	Fee-for-Service	1083719207	1083719207	1	1	PUN, KWAN C MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79942	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
127566	Fee-for-Service	1396799672	1396799672	1	1	PHAN, TUAN V MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70808	08	Family Practice	0	In state provider	None	10362 BOLSA AVE	None	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
127572	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
127579	Fee-for-Service	1861577736	1861577736	1	1	PRAZICH, JULIE A MD	11/22/1994	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	28985	41	Internal Medicine	0	In state provider	None	3560 CLAIREMONT DR	STE 8	SAN DIEGO	CA	92117	5939	37	06073	32.80561282	-117.2009029	San Diego County
127607	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
127611	Fee-for-Service	1053420844	1053420844	2	2	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	65 3RD STREET	SUITE 13	POINT REYES STATI	CA	94956	0910	21	06041	38.06766892	-122.8068687	Marin County
127646	Fee-for-Service	1275526980	1275526980	1	1	PETERSON, MICHELE L	11/2/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41690 ENTERPRISE CIRCLE	SUITE 206	TEMECULA	CA	92590	5627	33	06065	33.51949343	-117.1693521	Riverside County
127666	Fee-for-Service	1306981683	1306981683	1	1	PASCUAL, JOSE M JR MD	12/14/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	25729	-	NOT APPLICABLE	0	In state provider	None	44900 NORTH 60TH ST WEST	None	LANCASTER	CA	93536	7618	19	06037	34.6976943	-118.2365888	Los Angeles County
127674	Fee-for-Service	1184120354	1184120354	1	1	PHAM, STEVEN C MD	10/16/2021	390200000X	NA	Other	026	PHYSICIANS	165146	None	None	0	In state provider	None	320 SANTA FE DRIVE	107-B	ENCINITAS	CA	92024	1334	37	06073	33.038847	-117.285579	San Diego County
127693	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
127714	Fee-for-Service	1316069503	1316069503	1	1	PACELLA, SALVATORE J MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98071	24	Plastic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
127718	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
127725	Fee-for-Service	1992183479	1992183479	1	1	PRZYBYLOWICZ, RYLE W MD	1/29/2025	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	10123 SE MARKET STREET	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
127754	Fee-for-Service	1417135096	1417135096	1	1	PALMER, SHAYNE MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5212 S COTTONWOOD ST	None	MURRAY	UT	84107	0000	00	None	40.65819735	-111.8949111	Salt Lake County
127766	Fee-for-Service	1578767273	1578767273	1	1	PACIFIC NEPHROLOGY	12/6/2007	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
127773	Fee-for-Service	1215404017	1215404017	1	1	PHUNG, ANDY OT	12/10/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE STE 114	None	TUSTIN	CA	92780	7247	30	06059	33.70954889	-117.8043627	Orange County
127796	Fee-for-Service	1073694980	1073694980	1	1	POLSINELLI JR, ELIO OD	1/23/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	340 WEST PORTAL AVENUE	None	SAN FRANCISCO	CA	94127	1412	38	06075	37.73744363	-122.4697471	San Francisco County
127811	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
127841	Fee-for-Service	1083719207	1083719207	1	1	PUN, KWAN C MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79942	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
127858	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
127863	Fee-for-Service	1538468285	1538468285	1	1	PASTRANO, ALMA V LCSW	8/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
127869	Fee-for-Service	1811004799	1811004799	1	1	PETERSEN, JOHN L MD INC	9/12/2006	207R00000X	NA	Other	026	PHYSICIANS	74917	41	Internal Medicine	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
127881	Fee-for-Service	1356545529	1356545529	1	1	PUREZA, ANTHONY R MD	8/5/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	95874	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
127882	Fee-for-Service	1912373226	1912373226	1	1	PHINO, EMILY J CRNA	11/18/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
127884	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
127908	Fee-for-Service	1285936757	1285936757	1	1	PATEL, USHIR V MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114259	45	Nephrology (Renal-Kidney)	0	In state provider	None	8120 TIMBERLAKE WAY	None	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
127940	Fee-for-Service	1750517272	1750517272	1	1	PATEL, BINA G MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115094	None	None	0	In state provider	None	501 SOUTH BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
127946	Fee-for-Service	1548420201	1548420201	1	1	PHILLIPS, LORNIE J II MD	11/27/2014	208600000X	NA	General Surgery	026	PHYSICIANS	91829	02	General Surgery	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
127951	Fee-for-Service	1528595485	1528595485	1	1	POSADAS, EDLORD L	3/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 SUNRISE AVE	200C	ROSEVILLE	CA	95661	4516	31	06061	38.735307	-121.272048	Placer County
127958	Fee-for-Service	1568452704	1568452704	1	1	PARADA, THEODOR S MD	10/2/1998	207RC0200X	NA	Other	026	PHYSICIANS	41695	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1580 VALENCIA ST	STE 702	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
127981	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
127986	Fee-for-Service	1356361554	1356361554	1	1	PEGRAM, MARK D MD	9/30/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	46221	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
128004	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	12/8/2018	208000000X	NA	Pediatric Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
128006	Fee-for-Service	1033264999	1033264999	1	2	POORSATTAR, GULNAR P MD	2/8/2015	207RE0101X	NA	Endocrinology	026	PHYSICIANS	50561	67	Endocrinology	0	In state provider	None	2895 LOMA VISTA RD	STE E	VENTURA	CA	93003	1534	56	06111	34.27543868	-119.2574459	Ventura County
128024	Fee-for-Service	1568423762	1568423762	1	1	PAYANDEH, FARIBA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76703	22	Pathology (M.D. only)	0	In state provider	None	9301 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90210	5424	19	06037	34.06707307	-118.3946743	Los Angeles County
128044	Fee-for-Service	1902846546	1902846546	1	2	PUBLIC HOSPITAL DISTRICT NO	10/25/2020	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9801 FRONTIER AVE SE	None	SNOQUALMIE	WA	98065	5200	00	None	47.51295947	-121.885199	King County
128055	Fee-for-Service	1578767273	1578767273	1	1	PACIFIC NEPHROLOGY	12/6/2007	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1819	07	06013	37.98507961	-122.034189	Contra Costa County
128063	Fee-for-Service	1639108434	1639108434	1	1	PROVIDENCE WILLAMETTE FALLS	4/15/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 DIVISON ST	None	OREGON CITY	OR	97045	0000	00	None	45.35630784	-122.5883649	Clackamas County
128099	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
128114	Fee-for-Service	1689802167	1689802167	1	1	PALAZUELOS, LAUREN-RACHELLE	5/6/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	3325 PALO VERDE AVENUE,	SUITE 201	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
128131	Fee-for-Service	1386682177	1386682177	1	1	PATEL, SANGEETA H MD	9/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49867	None	None	0	In state provider	None	13372 NEWPORT AVE	STE B	TUSTIN	CA	92780	3426	30	06059	33.74482862	-117.8152129	Orange County
128147	Fee-for-Service	1841373800	1841373800	1	2	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
128154	Fee-for-Service	1467557702	1467557702	1	1	PHAM, TERI D MD	3/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89223	41	Internal Medicine	0	In state provider	DR ALFONSO BANUELOS-CMO	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
128157	Fee-for-Service	1811004799	1811004799	1	1	PETERSEN, JOHN L MD INC	9/12/2006	207R00000X	NA	Other	026	PHYSICIANS	74917	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
128173	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
128185	Fee-for-Service	1790989119	1790989119	1	1	PETTY-HANNUM, ALICE LMFT	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	406 CHINN ST	None	SANTA ROSA	CA	95404	4339	49	06097	38.444787	-122.707098	Sonoma County
128196	Fee-for-Service	1003398611	1003398611	1	1	POURTABIB, MICHELLE S MD	10/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177647	None	None	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
128236	Fee-for-Service	1386964740	1386964740	1	2	POMONA VALLEY HOME CARE INC	12/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1109 VIA VERDE	None	SAN DIMAS	CA	91773	4400	19	06037	34.07428332	-117.8288912	Los Angeles County
128249	Fee-for-Service	1568452704	1568452704	1	1	PARADA, THEODOR S MD	10/2/1998	207RC0200X	NA	Other	026	PHYSICIANS	41695	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 702	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
128272	Fee-for-Service	1033958087	1033958087	1	1	PAN, JOYCE CRNA	6/21/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
128276	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
128287	Fee-for-Service	1013241256	1013241256	1	1	PONCE, STEPHANIE H LMFT	2/4/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
128288	Fee-for-Service	1700406709	1700406709	1	1	PROVERBS CONSULTING SERVICES	3/8/2023	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC.	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
128294	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	4/22/2020	208000000X	NA	Pediatric Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
128296	Fee-for-Service	1033264999	1033264999	1	2	POORSATTAR, GULNAR P MD	2/8/2015	207RE0101X	NA	Endocrinology	026	PHYSICIANS	50561	41	Internal Medicine	0	In state provider	None	2895 LOMA VISTA RD	STE E	VENTURA	CA	93003	1534	56	06111	34.27543868	-119.2574459	Ventura County
128327	Fee-for-Service	1619166147	1619166147	1	1	PHAM, TRACY L MD	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99725	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
128334	Fee-for-Service	1902846546	1902846546	1	2	PUBLIC HOSPITAL DISTRICT NO	10/25/2020	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9801 FRONTIER AVE SE	None	SNOQUALMIE	WA	98065	5200	00	None	47.51295947	-121.885199	King County
128353	Fee-for-Service	1275161325	1275161325	1	1	PHARMEDQUEST PHARMACY SERVIC	5/26/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8787 HALL RD	ROOM A	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
128360	Fee-for-Service	1366606766	1366606766	1	1	PRIMA MEDICAL GROUP INC	10/8/2008	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	655 REDWOOD HWY	STE 216	MILL VALLEY	CA	94941	3055	21	06041	37.8918372	-122.5169699	Marin County
128365	Fee-for-Service	1366466633	1366466633	1	1	PAPEZ, ANDREW L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	MEDPRO	1919 E THOMAS ROAD	MAIN BLDG	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
128368	Fee-for-Service	1326535956	1326535956	1	1	PARK, CHARLIE MD	10/13/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2202 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5706	19	06037	34.03277088	-118.4813792	Los Angeles County
128371	Fee-for-Service	1992934541	1992934541	1	1	PANG, LINDA OD	1/22/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	SUITE 2	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
128387	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	8/26/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
128453	Fee-for-Service	1023027307	1023027307	1	1	PAREKH, SHEHZAD M MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	1225 E HANCOCK RD	STE 203	BULLHEAD CITY	AZ	86442	5962	00	None	35.108307	-114.6055365	Mohave County
128459	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
128478	Fee-for-Service	1255367058	1255367058	1	1	PRIMECARE NEVADA	7/1/2002	282NR1301X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NYE REGIONAL MEDICAL CTR	825 ERIE MAIN	None	TONOPAH	NV	89049	0391	00	None	38.061648	-117.2224755	Nye County
128489	Fee-for-Service	1871139485	1871139485	1	1	PREMIERCARE PHYSICIANS A CAL	12/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1470 BESSIE AVE	None	TRACY	CA	95376	3417	39	06077	37.74474	-121.433013	San Joaquin County
128490	Fee-for-Service	1497757587	1497757587	1	1	POTTENGER, ROY MD	1/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	39298	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	34	06067	38.668347	-121.3148745	Sacramento County
128500	Fee-for-Service	1790135754	1790135754	1	1	PRINSEN, JOSEPH DO	4/20/2023	207R00000X	NA	Other	026	PHYSICIANS	19528	None	None	0	In state provider	None	1205 EAST NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
128520	Fee-for-Service	1316270101	1316270101	1	1	PECANO-JONES, MELISSA A LPCC	4/9/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
128533	Fee-for-Service	1619544988	1619544988	1	1	PRUDENT TELEPSYCHIATRY CARE	8/4/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 208	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
128546	Fee-for-Service	1689776007	1689776007	1	1	PATEL, ASHISH R MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105476	33	Thoracic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
128551	Fee-for-Service	1184756397	1184756397	1	1	PALMER, KRYSTAL D. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
128558	Fee-for-Service	1841373800	1841373800	1	8	PERMANENTE MEDICAL GROUP INC	10/16/2012	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
128574	Fee-for-Service	1295016632	1295016632	1	1	PACE, ADAM C MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124782	01	General Practice	0	In state provider	None	2 MEDICAL PLAZA	STE 130	ROSEVILLE	CA	95661	3038	31	06061	38.76507948	-121.2477476	Placer County
128580	Fee-for-Service	1700406709	1700406709	1	1	PROVERBS CONSULTING SERVICES	3/8/2023	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC.	811 W. 7TH ST.	12TH FLOOR	LOS ANGELES	CA	90017	3403	19	06037	34.0489635	-118.2591312	Los Angeles County
128582	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	8/26/2019	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
128611	Fee-for-Service	1548200546	1548200546	1	1	PARKER, KAREN A MD	3/23/1994	207P00000X	NA	Other	026	PHYSICIANS	78555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
128621	Fee-for-Service	1568699700	1568699700	1	1	PRIMEMED INC	10/19/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	311 NORTH VERDUGO ROAD	SUITE A	GLENDALE	CA	91206	3944	19	06037	34.15041479	-118.2362431	Los Angeles County
128622	Fee-for-Service	1801853353	1801853353	2	1	PAZOUKI, NARGES MD	8/8/2010	193400000X	NA	Other	026	PHYSICIANS	86591	None	None	0	In state provider	None	1044 GEER RD	None	TURLOCK	CA	95380	3316	50	06099	37.503144	-120.848771	Stanislaus County
128626	Fee-for-Service	1760623763	1760623763	1	1	PINCARO, NIMROD C	8/10/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
128644	Fee-for-Service	1407845720	1407845720	1	1	PUNWANI, MANISHA MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55296	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
128675	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
128677	Fee-for-Service	1902117062	1902117062	1	1	PLANTING, ANNA L LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
128694	Fee-for-Service	1528165875	1528165875	1	1	PARAGON PHYSICIAN MED GR	6/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PHYSICIANS MED GROUP	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
128713	Fee-for-Service	1346503224	1346503224	1	2	PAYANES, RAELEIGH C MD	11/14/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133896	-	NOT APPLICABLE	0	In state provider	None	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
128715	Fee-for-Service	1245945278	1245945278	1	1	PLANNED PARENTHOOD	2/21/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	935 TRANCAS STREET	UNIT 4D	NAPA	CA	94558	2947	28	06055	38.32367324	-122.294977	Napa County
128746	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
128755	Fee-for-Service	1538430509	1538430509	1	2	PAUL M CHOI MD A CALIFORNIA	11/15/2019	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL CORP	266 S HARVARD BLVD	STE 250	LOS ANGELES	CA	90004	4884	19	06037	34.069221	-118.3041245	Los Angeles County
128767	Fee-for-Service	1255367058	1255367058	1	1	PRIMECARE NEVADA	7/1/2002	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NYE REGIONAL MEDICAL CTR	825 ERIE MAIN	None	TONOPAH	NV	89049	0391	00	None	38.061648	-117.2224755	Nye County
128777	Fee-for-Service	1497757587	1497757587	1	1	POTTENGER, ROY MD	1/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	39298	20	Orthopedic Surgery	0	In state provider	None	6403 COYLE AVE	STE 170	CARMICHAEL	CA	95608	0363	34	06067	38.668347	-121.3148745	Sacramento County
128794	Fee-for-Service	1215005228	1215005228	1	1	PERRENOUD, NICHOLAS A.	5/31/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	943 WALNUT AVE	None	REDLANDS	CA	92373	6633	36	06071	34.03660352	-117.182779	San Bernardino County
128808	Fee-for-Service	1871510651	1871510651	1	1	PASYA, SURESH K MD	3/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55468	None	None	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.741948	-121.848921	Butte County
128816	Fee-for-Service	1316978075	1316978075	2	1	PANJWANI, SONIA	6/23/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	51868	41	Internal Medicine	0	In state provider	None	12760 HESPERIA RD	STE B	VICTORVILLE	CA	92395	5806	36	06071	34.48276227	-117.2905134	San Bernardino County
128831	Fee-for-Service	1689776007	1689776007	1	1	PATEL, ASHISH R MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105476	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
128846	Fee-for-Service	1184670762	1184670762	1	1	PATHWAY MEDICAL GRP, INC	7/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1901	30	06059	33.77450141	-117.9123364	Orange County
128862	Fee-for-Service	1306233143	1306233143	1	1	PATEL, SAPNA Y DO	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16476	41	Internal Medicine	0	In state provider	None	1800 N CAROLINA ST	None	STOCKTON	CA	95204	6019	39	06077	37.99920833	-121.3525183	San Joaquin County
128874	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	8/28/2009	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
128892	Fee-for-Service	1962599183	1962599183	1	1	PRIMARY AND MULTI SPECIALTY	5/16/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CLINICS OF ANAHEIM INC	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
128900	Fee-for-Service	1952861213	1952861213	1	1	PARK, JOON	2/10/2023	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
128964	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	7/25/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
128969	Fee-for-Service	1710674940	1710674940	1	1	PUNSALAN, KATHLEEN ANNE PT	9/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
128971	Fee-for-Service	1417654765	1417654765	1	1	PARETTA, FRANCESCA V BIRTH D	2/19/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
128974	Fee-for-Service	1295087583	1295087583	1	1	PARK-STAUBER, EUN Y OT	1/27/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
128976	Fee-for-Service	1598183238	1598183238	1	1	PANNU, AMRITPAL S MD	8/15/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	129 N 5TH ST	None	CHOWCHILLA	CA	93610	2820	20	06039	37.12127646	-120.2633994	Madera County
129014	Fee-for-Service	1508964768	1508964768	1	1	PAI, KIHO	10/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15917 PIONEER BLVD	None	NORWALK	CA	90650	7117	19	06037	33.8871993	-118.08258	Los Angeles County
129032	Fee-for-Service	1043242795	1043242795	1	1	PAREKH, DILIPKUMAR MD	8/15/1995	208600000X	NA	General Surgery	026	PHYSICIANS	52788	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
129037	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129040	Fee-for-Service	1548633472	1548633472	1	1	PACIFIC SUNRISE HOME INC	10/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	28134 LOMO DRIVE	None	RANCHO PALOS VRDS	CA	90275	3226	19	06037	33.7783073	-118.3930652	Los Angeles County
129054	Fee-for-Service	1588382121	1588382121	1	1	PEREZ VERDUZCO, OSCAR S CNP	11/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
129066	Fee-for-Service	1548597305	1548597305	1	1	PLUME, ELIZABETH	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
129069	Fee-for-Service	1730138009	1730138009	1	1	PINSKER, JORDAN E MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83509	67	Endocrinology	0	In state provider	None	2219 BATH STREET	None	SANTA BARBARA	CA	93105	4321	42	06083	34.43002275	-119.7212929	Santa Barbara County
129081	Fee-for-Service	1699842526	1699842526	1	1	PLEHN, CHARLES R MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54213	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
129083	Fee-for-Service	1215005228	1215005228	1	1	PERRENOUD, NICHOLAS A.	9/1/2005	367500000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	943 WALNUT AVE	None	REDLANDS	CA	92373	6633	36	06071	34.03660352	-117.182779	San Bernardino County
129097	Fee-for-Service	1043387053	1043387053	1	1	PAGE, CHARLES M MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70882	34	Urology and Urological Surgery	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
129120	Fee-for-Service	1013009679	1013009679	1	1	PITTS, FREDERICK D MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
129132	Fee-for-Service	1184670762	1184670762	1	1	PATHWAY MEDICAL GRP, INC	7/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	12665 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1901	30	06059	33.77450141	-117.9123364	Orange County
129140	Fee-for-Service	1356367817	1356367817	1	1	PARMEKAR, SAMIR MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52553	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
129146	Fee-for-Service	1497836423	1497836423	1	1	PEACE, JAMES N MD	2/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41199	18	Ophthalmology	0	In state provider	None	431 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	1413	19	06037	33.9697001	-118.3440391	Los Angeles County
129154	Fee-for-Service	1972735173	1972735173	1	1	PHILOBOS, RAFIK W LCSW	1/28/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S MAIN ST	SUITE 101	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
129157	Fee-for-Service	1104146000	1104146000	1	1	PANIAGUA, RICARDO T MD	5/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135187	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DRIVE	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
129159	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	12/29/2018	208600000X	NA	General Surgery	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
129180	Fee-for-Service	1962599183	1962599183	1	1	PRIMARY AND MULTI SPECIALTY	5/16/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CLINICS OF ANAHEIM INC	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
129201	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	9/7/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
129209	Fee-for-Service	1770216855	1770216855	1	1	PNC MSK, PC	8/21/2024	207XX0004X	NA	Orthopedic Surgery	027	PODIATRISTS	-	None	None	0	In state provider	PODIATRIC SPECIALISTS	172 WASHINGTON AVE	STE A	UKIAH	CA	95482	6319	23	06045	39.13417289	-123.2073629	Mendocino County
129248	Fee-for-Service	1255674537	1255674537	1	3	PHI HEALTH, LLC	1/7/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	415 WASHINGTON AVE	APT 10	TUCUMCARI	NM	88401	3812	00	None	35.15732745	-103.7220885	Quay County
129249	Fee-for-Service	1023513009	1023513009	1	1	PLACONE, NICHOLAS MD	8/5/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164390	10	Gastroenterology (M.D. only)	0	In state provider	None	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1940	42	06083	34.971759	-120.4356175	Santa Barbara County
129252	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
129257	Fee-for-Service	1639789035	1639789035	1	1	PACIFIC MANOR RECOVERY, LLC	1/18/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3686 PACIFIC AVE	None	JURUPA VALLEY	CA	92509	1948	33	06065	34.00576256	-117.4203762	Riverside County
129261	Fee-for-Service	1598183238	1598183238	1	1	PANNU, AMRITPAL S MD	8/15/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	129 N 5TH ST	None	CHOWCHILLA	CA	93610	2820	20	06039	37.12127646	-120.2633994	Madera County
129274	Fee-for-Service	1639113897	1639113897	1	1	PEREZ, JORGE F MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64393	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129283	Fee-for-Service	1437682531	1437682531	1	1	PHU, JOHNNY MD	10/7/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160287	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
129294	Fee-for-Service	1326094020	1326094020	1	2	PHI HEALTH, LLC	6/28/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	8744 LUSCCOMB	None	SHOW LOW	AZ	85901	0010	00	None	34.346142	-109.9592685	Navajo County
129314	Fee-for-Service	1720095425	1720095425	1	1	PARKER, SHARON LMFT	12/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	555 SOQUEL AVE.	STE. 260	SANTA CRUZ	CA	95062	2340	44	06087	36.97623386	-122.0170137	Santa Cruz County
129315	Fee-for-Service	1407815772	1407815772	1	1	POPOVICH, TEPPE MD	1/7/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158133	30	Radiology	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
129324	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129334	Fee-for-Service	1871097287	1871097287	1	1	PATEL, POOJA H MD	2/1/2023	207L00000X	NA	Other	026	PHYSICIANS	163832	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
129338	Fee-for-Service	1093856312	1093856312	1	2	P & G PHARMACY, INC.	12/31/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1166 MISSION RD	None	SOUTH SAN FRANCIS	CA	94080	1303	41	06081	37.66149806	-122.4391404	San Mateo County
129351	Fee-for-Service	1730138009	1730138009	1	1	PINSKER, JORDAN E MD	10/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83509	40	Pediatrics	0	In state provider	None	2219 BATH STREET	None	SANTA BARBARA	CA	93105	4321	42	06083	34.43002275	-119.7212929	Santa Barbara County
129352	Fee-for-Service	1386732188	1386732188	1	1	PARK, SANG H	12/9/1985	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42333	None	None	0	In state provider	None	945 S WESTERN AVE	STE 100	LOS ANGELES	CA	90006	1008	19	06037	34.054218	-118.3091085	Los Angeles County
129356	Fee-for-Service	1356335053	1356335053	1	1	POORHILL, MARY M MD	1/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53535	08	Family Practice	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
129369	Fee-for-Service	1699842526	1699842526	1	1	PLEHN, CHARLES R MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54213	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
129379	Fee-for-Service	1043224074	1043224074	1	1	PYNOOS, ROBERT S MD	12/31/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	36252	36	Psychiatry	0	In state provider	U C LOS ANGELES	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
129383	Fee-for-Service	1043387053	1043387053	1	1	PAGE, CHARLES M MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70882	01	General Practice	0	In state provider	None	3788 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1408	15	06029	35.39420177	-119.0081678	Kern County
129442	Fee-for-Service	1669542932	1669542932	1	1	PITCHER, TRACY J MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89698	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
129446	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	6/12/2020	208600000X	NA	General Surgery	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
129461	Fee-for-Service	1417236738	1417236738	1	1	PIERCE, SARAH M LCSW	11/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RAPY	516 OAKLAND AVE	STE. 102	OAKLAND	CA	94611	5429	01	06001	37.81940802	-122.2530212	Alameda County
129465	Fee-for-Service	1962599183	1962599183	1	1	PRIMARY AND MULTI SPECIALTY	5/16/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	CLINICS OF ANAHEIM INC	500 S ANAHEIM HILLS RD	STE 230	ANAHEIM	CA	92807	4760	30	06059	33.8427954	-117.7772895	Orange County
129473	Fee-for-Service	1548402811	1548402811	1	1	PRESTON, JULIETTE S MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114185	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
129487	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	3/5/2021	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
129507	Fee-for-Service	1336355320	1336355320	1	1	PARKLANE MEDICAL GROUP	5/26/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
129521	Fee-for-Service	1730150848	1730150848	1	1	PATEL, SUNIL H MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	43957	41	Internal Medicine	0	In state provider	None	445 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.743354	-121.432495	San Joaquin County
129532	Fee-for-Service	1558719799	1558719799	1	1	PADILLA, JACLYN M LMFT	8/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
129539	Fee-for-Service	1639252604	1639252604	1	23	PERMANENTE MEDICAL GROUP INC	5/16/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
129563	Fee-for-Service	1639113897	1639113897	1	1	PEREZ, JORGE F MD	8/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64393	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
129600	Fee-for-Service	1962555078	1962555078	1	1	PENSE, NOELLE M LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53876	-	NOT APPLICABLE	0	In state provider	None	2344 OLD SONOMA ROAD	BLDGS A, B, C, F, J	NAPA	CA	94559	1344	28	06055	38.2878005	-122.298057	Napa County
129611	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129649	Fee-for-Service	1700817632	1700817632	1	1	PATEL, AMIKSHA S MD	12/31/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78581	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
129704	Fee-for-Service	1922552884	1922552884	1	1	PANGILINAN, JOHN SIMON S LCS	4/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
129735	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	8/28/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
129771	Fee-for-Service	1104310176	1104310176	1	1	PESCHARD, VANESSA-GISELLE M	6/29/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	174647	None	None	0	In state provider	D	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129778	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	10/18/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
129785	Fee-for-Service	1730160441	1730160441	1	1	PHILLIPS, ANTHONY F MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85239	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
129798	Fee-for-Service	1336355320	1336355320	1	1	PARKLANE MEDICAL GROUP	5/26/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
129809	Fee-for-Service	1730150848	1730150848	1	1	PATEL, SUNIL H MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	43957	01	General Practice	0	In state provider	None	445 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.743354	-121.432495	San Joaquin County
129819	Fee-for-Service	1609170232	1609170232	1	2	PREMIER HEALTH PARTNERS	11/18/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	820 MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
129879	Fee-for-Service	1245493014	1245493014	1	1	POINTER, SARA A PHD	8/7/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
129886	Fee-for-Service	1427270446	1427270446	1	1	PATEL, VIMAL B MD	2/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108905	08	Family Practice	0	In state provider	None	450 N GREENFIELD AVE	None	HANFORD	CA	93230	0000	16	06031	36.328968	-119.6582195	Kings County
129897	Fee-for-Service	1861142028	1861142028	1	1	PANGILINAN, DONDAE C NP	4/6/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
129899	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	9/17/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
129924	Fee-for-Service	1073893020	1073893020	1	1	PASCO-PINELLAS HILLSBOROUGH	12/19/2012	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMMUNITY HEALTH SYSTEM	2600 BRUCE B DOWNS BLVD	None	WESLEY CHAPEL	FL	33544	9207	00	None	28.195596	-82.3509675	Pasco County
129926	Fee-for-Service	1508859323	1508859323	1	2	PIH HEALTH GOOD SAMARITAN	7/24/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1245 WILSHIRE BLVD	SUITE 101	LOS ANGELES	CA	90017	4801	19	06037	34.05362775	-118.2661889	Los Angeles County
129932	Fee-for-Service	1699263269	1699263269	1	1	PHAM, LYSIANNE V NP	7/24/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129959	Fee-for-Service	1215151154	1215151154	1	1	PORTER HOSPITAL LLC	12/21/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	85 E US HWY 6	None	VALPARAISO	IN	46383	8917	00	None	41.554026	-87.05128298	Porter County
129966	Fee-for-Service	1831167378	1831167378	1	1	PARK, INA U MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80262	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129972	Fee-for-Service	1023283009	1023283009	1	1	PETER SHAW MD	3/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	725 NORTH ST	None	PITTSFIELD	MA	01201	4109	00	None	42.459417	-73.2494295	Berkshire County
129994	Fee-for-Service	1134777378	1134777378	1	1	PARONIAN, VIOLETA OD	9/25/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6765 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	1696	19	06037	34.19368795	-118.3878213	Los Angeles County
130024	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	4/22/2020	208600000X	NA	General Surgery	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
130063	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	9/10/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
130087	Fee-for-Service	1336355320	1336355320	1	1	PARKLANE MEDICAL GROUP	5/26/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
130121	Fee-for-Service	1063807048	1063807048	1	1	PRASAD, NANDAN MD	11/1/2019	207P00000X	NA	Other	026	PHYSICIANS	162822	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
130168	Fee-for-Service	1346272010	1346272010	1	1	PARSONS, PAUL M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33906	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 100	ROSEVILLE	CA	95661	3752	31	06061	38.74234873	-121.2521259	Placer County
130171	Fee-for-Service	1508971912	1508971912	1	1	PALMER, SYLVAIN MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	38616	14	Neurological Surgery	0	In state provider	#561	26732 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6306	30	06059	33.56347704	-117.66546	Orange County
130182	Fee-for-Service	1326094020	1326094020	1	3	PHI HEALTH, LLC	6/11/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	52 NORTHRIDGE	None	WICKENBURG	AZ	85390	3579	00	None	33.97968	-112.7409615	Maricopa County
130184	Fee-for-Service	1528262870	1528262870	1	1	PATEL, PARUL S MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98915	45	Nephrology (Renal-Kidney)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
130187	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
130211	Fee-for-Service	1073893020	1073893020	1	1	PASCO-PINELLAS HILLSBOROUGH	12/19/2012	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMMUNITY HEALTH SYSTEM	2600 BRUCE B DOWNS BLVD	None	WESLEY CHAPEL	FL	33544	9207	00	None	28.195596	-82.3509675	Pasco County
130246	Fee-for-Service	1215151154	1215151154	1	1	PORTER HOSPITAL LLC	12/21/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	85 E US HWY 6	None	VALPARAISO	IN	46383	8917	00	None	41.554026	-87.05128298	Porter County
130254	Fee-for-Service	1831167378	1831167378	1	1	PARK, INA U MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80262	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130283	Fee-for-Service	1376105692	1376105692	1	1	PIETRZYK, KRISTEN MD	9/5/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	5437 KIETZKE LANE	None	RENO	NV	89511	1088	00	None	39.46515231	-119.7902663	Washoe County
130296	Fee-for-Service	1245539964	1245539964	1	1	PROFITA, ELIZABETH L MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158015	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
130312	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	8/2/2019	208600000X	NA	General Surgery	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
130316	Fee-for-Service	1467484246	1467484246	1	1	PERSONS, BARBARA L MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	64843	02	General Surgery	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
130336	Fee-for-Service	1942405188	1942405188	1	1	PINA, EDWARD S	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
130352	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
130366	Fee-for-Service	1134557648	1134557648	1	1	PEREZ JR, RODOLFO M NP	2/8/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9635 MONTE VISTA AVE SUI	None	MONTCLAIR	CA	91763	2235	36	06071	34.07975926	-117.6982207	San Bernardino County
130382	Fee-for-Service	1740447945	1740447945	1	3	PRIME HEALTHCARE SERVICES	11/14/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
130438	Fee-for-Service	1205122314	1205122314	1	1	PATEL, NEIL D MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129575	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
130442	Fee-for-Service	1447696745	1447696745	1	1	PATEL, VATSAL B MD	11/2/2020	2085R0001X	NA	Other	026	PHYSICIANS	170315	32	Radiation Therapy (D.O. only)	0	In state provider	None	1316 NELSON AVE	None	MODESTO	CA	95350	5341	50	06099	37.66206042	-120.9881734	Stanislaus County
130471	Fee-for-Service	1528262870	1528262870	1	1	PATEL, PARUL S MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98915	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
130472	Fee-for-Service	1316996564	1316996564	1	1	PREMIER EMERGENCY	4/5/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS OF CA MED GRP	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
130476	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	12/7/2016	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
130490	Fee-for-Service	1992731905	1992731905	1	1	PHEND, MICHAEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5215 HOLY CROSS PKWY	None	MISHAWAKA	IN	46545	1469	00	None	41.707305	-86.174298	St. Joseph County
130497	Fee-for-Service	1477539831	1477539831	1	1	PACE, JONATHAN B MD	9/20/2007	208600000X	NA	General Surgery	026	PHYSICIANS	47910	01	General Practice	0	In state provider	None	184 HOT SPRINGS RD	None	GREENVILLE	CA	95947	9747	32	06063	40.14071313	-120.9360918	Plumas County
130500	Fee-for-Service	1295812204	1295812204	1	2	PEREZ, XAVIER MD	2/20/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	82813	-	NOT APPLICABLE	0	In state provider	None	1399 N HAMILTON PKWY	CLASSROOM 2	NOVATO	CA	94949	8206	21	06041	38.0614169	-122.5288722	Marin County
130539	Fee-for-Service	1073289070	1073289070	1	1	PHARMACY OF THE WEST LLC	5/22/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1465 TAMARIND AVE # 3	None	LOS ANGELES	CA	90028	8412	19	06037	34.09756974	-118.3190804	Los Angeles County
130541	Fee-for-Service	1831167378	1831167378	1	1	PARK, INA U MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80262	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130546	Fee-for-Service	1982814398	1982814398	1	1	PASCUAL, PURI L MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107372	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
130588	Fee-for-Service	1033144928	1033144928	1	1	PARK, STEVEN T MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76420	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
130599	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
130617	Fee-for-Service	1992804504	1992804504	1	1	PIERAMICI, DANTE J MD	1/4/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50523	18	Ophthalmology	0	In state provider	None	23861 MCBEAN PKWY	STE E28	VALENCIA	CA	91355	4457	19	06037	34.39567343	-118.5542698	Los Angeles County
130638	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	9/11/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
130646	Fee-for-Service	1245464460	1245464460	1	1	PETERSEN, TRAM H OD	7/16/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5814 VAN ALLEN WAY	SUITE 146	CARLSBAD	CA	92008	7359	37	06073	33.13600632	-117.2876273	San Diego County
130673	Fee-for-Service	1124555008	1124555008	1	1	PATEL, VIRAL C MD	11/27/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	191220	None	None	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
130675	Fee-for-Service	1932659737	1932659737	1	1	PERALES, JULIE E PT	6/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1132 E LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.22949281	-119.3296994	Tulare County
130689	Fee-for-Service	1457973802	1457973802	1	1	PRECISION ADULT CARE SERVICE	6/4/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	S CORP	83113 LOS CABOS AVE	None	COACHELLA	CA	92236	6320	33	06065	33.69447694	-116.2147492	Riverside County
130694	Fee-for-Service	1669870739	1669870739	1	3	PETALUMA HEALTH CENTER INC	3/4/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6040 COMMERCE BLD	STE 108	ROHNERT PARK	CA	94928	2181	49	06097	38.35191405	-122.7101718	Sonoma County
130743	Fee-for-Service	1366068132	1366068132	1	1	PREMIER SURGICAL GROUP CORPO	6/3/2021	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	RATION	105 W EL PORTAL DR	None	MERCED	CA	95348	2858	24	06047	37.32673363	-120.4696925	Merced County
130763	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
130765	Fee-for-Service	1932308285	1932308285	1	1	PATEL, SEJAL M MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104427	02	General Surgery	0	In state provider	None	941 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	4722	19	06037	34.04918291	-118.1391218	Los Angeles County
130767	Fee-for-Service	1619402740	1619402740	1	1	PRECIOUS CARGO MEDICAL	6/23/2017	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION LLC	22573 BARTON ROAD	None	GRAND TERRACE	CA	92313	5910	36	06071	34.03390452	-117.3119985	San Bernardino County
130784	Fee-for-Service	1386104412	1386104412	1	1	POUSTCHI, SHIRIN MD	4/28/2023	207R00000X	NA	Other	026	PHYSICIANS	178838	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
130801	Fee-for-Service	1871666768	1871666768	1	1	PHAM, TUONG DO MD INC	10/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	35098	08	Family Practice	0	In state provider	None	439 OFARRELL ST	None	SAN FRANCISCO	CA	94102	2009	38	06075	37.78589862	-122.4120158	San Francisco County
130809	Fee-for-Service	1952344988	1952344988	1	1	PRYOR, ELLSWORTH P III MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29880	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 208	SANTA CLARITA	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
130811	Fee-for-Service	1679228316	1679228316	1	1	PACIFIC DIAGNOSTICS INC	8/3/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15725 POMERADO RD	108	POWAY	CA	92064	2058	37	06073	33.00037882	-117.0580735	San Diego County
130819	Fee-for-Service	1982075107	1982075107	1	6	PEDIATRIC AND FAMILY MEDICAL	8/31/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	15477 VENTURA BLVD	SUITE 300	SHERMAN OAKS	CA	91403	3006	19	06037	34.15468022	-118.4712272	Los Angeles County
130836	Fee-for-Service	1679145684	1679145684	1	1	PATIL, RUHI DO	10/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22640	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
130857	Fee-for-Service	1235458837	1235458837	1	1	PATEL, SHALU S MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135334	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
130860	Fee-for-Service	1013929512	1013929512	1	1	PARENT, MARIA M PHD	7/2/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3786 LA CRESCENTA AVE	101	GLENDALE	CA	91208	1059	19	06037	34.210962	-118.2399715	Los Angeles County
130868	Fee-for-Service	1033592779	1033592779	1	1	PURCELL, HOLLY C LMFT	2/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 149	FRESNO	CA	93710	7917	10	06019	36.80872147	-119.765979	Fresno County
130886	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	208600000X	NA	General Surgery	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
130908	Fee-for-Service	1598993156	1598993156	1	1	PATEL, RITESHKUMAR B MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126142	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
130928	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	12/1/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
130948	Fee-for-Service	1558437285	1558437285	2	1	PRINTZ, RICHARD H MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31741	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
130957	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	2/9/2023	207Q00000X	NA	Adult Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
130983	Fee-for-Service	1669870739	1669870739	1	3	PETALUMA HEALTH CENTER INC	3/4/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6040 COMMERCE BLD	STE 108	ROHNERT PARK	CA	94928	2181	49	06097	38.35191405	-122.7101718	Sonoma County
130997	Fee-for-Service	1629424213	1629424213	1	1	PALMER, HAROLD	2/21/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	41122 PASCALI LANE	None	LAKE ELSINORE	CA	92532	2592	33	06065	33.69639318	-117.3193074	Riverside County
131032	Fee-for-Service	1326292897	1326292897	1	1	PREMIER HEALTHCARE SERVICES	7/27/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	625 THE CITY DRIVE	STE 390	ORANGE	CA	92868	4924	30	06059	33.77774031	-117.8892271	Orange County
131035	Fee-for-Service	1558362723	1558362723	1	1	PHAM, THUY DICH DO	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7794	None	None	0	In state provider	None	760 WASHBURN AVE	None	CORONA	CA	92882	3303	33	06065	33.87374678	-117.5678721	Riverside County
131052	Fee-for-Service	1841373800	1841373800	1	5	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
131056	Fee-for-Service	1275977803	1275977803	1	1	PULLEY, MICHELLE D MD	5/11/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	142644	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
131076	Fee-for-Service	1306024815	1306024815	1	1	POLISETTY, RAMA D MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93133	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
131108	Fee-for-Service	1366703233	1366703233	1	1	PIATKOWSKI, BRIAN A RN	5/1/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
131117	Fee-for-Service	1992095087	1992095087	1	1	PTC LABORATORIES INC	4/10/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	300 PORTLAND STREET	None	COLUMBIA	MO	65201	6569	00	None	38.95633111	-92.287426	Boone County
131119	Fee-for-Service	1689003683	1689003683	1	1	PARK, CLAYTON	5/9/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	24352 ROCKFIELD	None	LAKE FOREST	CA	92630	4742	30	06059	33.61599427	-117.7037904	Orange County
131151	Fee-for-Service	1700892304	1700892304	1	1	PERRY, PATRICIA K MD	7/21/2008	261QM2500X	NA	Other	026	PHYSICIANS	95371	07	Dermatology	0	In state provider	A PROFESSIONAL MEDI CORP	2625 W ALAMEDA AVENUE	STE 504	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
131161	Fee-for-Service	1245438159	1245438159	1	1	PALAFOX, EDWARD E	11/1/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 EDGEMONT ST	None	LOS ANGELES	CA	90024	5260	19	06037	34.098921	-118.2961105	Los Angeles County
131165	Fee-for-Service	1447515911	1447515911	1	1	PROPRIUS HEALTH MEDICAL	11/13/2013	193200000X	NA	Other	026	PHYSICIANS	110631	25	Physical Medicine and Rehabilitation	0	In state provider	GROUP PC	3530 ATLANTIC AVENUE	SUITE 101	LONG BEACH	CA	90807	4569	19	06037	33.820875	-118.1850035	Los Angeles County
131173	Fee-for-Service	1396900650	1396900650	1	1	PASADENA HOSP ASSN, LTD	12/18/2007	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
131174	Fee-for-Service	1144392853	1144392853	1	1	PAR ANESTHESIOLOGY MED	7/31/2006	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	450 STANYON ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
131175	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	6/21/2019	208600000X	NA	General Surgery	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
131194	Fee-for-Service	1952842379	1952842379	1	1	PAN, ELIZABETH MD	6/28/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	157192	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131209	Fee-for-Service	1538321823	1538321823	1	1	PENUGONDA, MADHURI MD	3/4/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	157042	None	None	0	In state provider	None	2790 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.807708	-118.185004	Los Angeles County
131215	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	6/3/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
131219	Fee-for-Service	1447017058	1447017058	1	1	PARSONS, ZOE L BIRTH DOULA	3/7/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
131238	Fee-for-Service	1467530287	1467530287	1	1	PHAM, LE CHI MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65291	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
131242	Fee-for-Service	1710293675	1710293675	1	1	PARK, NAOMI MD	1/20/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170746	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
131247	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
131259	Fee-for-Service	1033103676	1033103676	1	3	PACIFIC REDWOOD MEDICAL GROU	2/2/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	242 HOSPITAL DRIVE	SUITE A	UKIAH	CA	95482	4531	23	06045	39.15258291	-123.2037212	Mendocino County
131268	Fee-for-Service	1154561710	1154561710	1	1	PESSEGUEIRO, ANTONIO M MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107566	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
131276	Fee-for-Service	1598843690	1598843690	1	1	PARK, MICHAEL I MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51837	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
131286	Fee-for-Service	1629424213	1629424213	1	1	PALMER, HAROLD	2/21/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	41122 PASCALI LANE	None	LAKE ELSINORE	CA	92532	2592	33	06065	33.69639318	-117.3193074	Riverside County
131299	Fee-for-Service	1659839801	1659839801	1	1	PATEL, PRATIK U PSYD	4/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
131393	Fee-for-Service	1720347453	1720347453	1	1	PASCUAL, ANA-LIZA E MD	7/25/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	125440	09	Gynecology (D.O. only)	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
131416	Fee-for-Service	1710900477	1710900477	1	1	PHAN, TUYET-MAI M MD	9/30/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	57670	18	Ophthalmology	0	In state provider	None	21320 HAWTHORNE BLVD	STE 104	TORRANCE	CA	90503	5621	19	06037	33.83462628	-118.3529587	Los Angeles County
131456	Fee-for-Service	1487870788	1487870788	1	1	PORTEOUS, JOETTE T	4/19/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
131462	Fee-for-Service	1396900650	1396900650	1	1	PASADENA HOSP ASSN, LTD	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
131463	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	8/26/2019	208600000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
131483	Fee-for-Service	1922322726	1922322726	1	1	PUTZ, KATHERINE S MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124788	01	General Practice	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
131504	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	1/17/2022	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
131535	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	2/9/2023	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
131547	Fee-for-Service	1033103676	1033103676	1	3	PACIFIC REDWOOD MEDICAL GROU	2/2/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	242 HOSPITAL DRIVE	SUITE A	UKIAH	CA	95482	4531	23	06045	39.15258291	-123.2037212	Mendocino County
131559	Fee-for-Service	1245452796	1245452796	1	1	POINDEXTER, GABRIELE B MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107793	07	Dermatology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
131566	Fee-for-Service	1326094020	1326094020	1	6	PHI HEALTH, LLC	10/22/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	732 DEER VALLEY	#1-C	PHOENIX	AZ	85027	2137	00	None	33.685335	-112.0830165	Maricopa County
131573	Fee-for-Service	1760542203	1760542203	1	1	PANDYA, NIRAV K MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110499	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
131577	Fee-for-Service	1568549418	1568549418	1	1	PAN, MINGGUI MD	12/24/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64776	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
131580	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	7/4/2020	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
131589	Fee-for-Service	1689755167	1689755167	1	1	PIONK, MARY JANE MD	6/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78133	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
131648	Fee-for-Service	1689755670	1689755670	1	1	PROVIDENCE HEALTH AND	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	SERVICES OREGON	1111 CRATER LAKE AVE	None	MEDFORD	OR	97504	6225	00	None	42.339654	-122.861086	Jackson County
131654	Fee-for-Service	1629048350	1629048350	1	1	POLAN, RUTH L MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44076	30	Radiology	0	In state provider	None	2230 LYNN RD	FL 2	THOUSAND OAKS	CA	91360	1901	56	06111	34.20894685	-118.885185	Ventura County
131666	Fee-for-Service	1487933099	1487933099	1	1	PHAM, HUNG T MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123634	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
131684	Fee-for-Service	1720347453	1720347453	1	1	PASCUAL, ANA-LIZA E MD	7/25/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	125440	15	Obstetrics (D.O. only)	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
131703	Fee-for-Service	1255674537	1255674537	1	2	PHI HEALTH, LLC	2/24/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1200 DALE CARNUTTE RD	None	MILAN	NM	87021	0000	00	None	0	0	None
131704	Fee-for-Service	1790314805	1790314805	1	1	PATEL, KISHAN MD	3/1/2025	163WM0705X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
131707	Fee-for-Service	1629603667	1629603667	1	1	PRAKASH, AVINESH NP	8/23/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
131750	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	6/12/2020	208000000X	NA	Pediatric Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
131751	Fee-for-Service	1396900650	1396900650	1	1	PASADENA HOSP ASSN, LTD	12/1/1979	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
131789	Fee-for-Service	1841223344	1841223344	1	1	PICKERING, BRETTEN D MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2244 29TH STREET	None	SAN DIEGO	CA	92104	5425	37	06073	32.72952002	-117.1320431	San Diego County
131791	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	3/19/2021	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
131796	Fee-for-Service	1356367817	1356367817	1	2	PARMEKAR, SAMIR MD	9/5/2023	208M00000X	NA	Other	026	PHYSICIANS	52553	None	None	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
131807	Fee-for-Service	1992125520	1992125520	1	1	PIERCE, MATTHEW A MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148761	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
131823	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
131836	Fee-for-Service	1033103676	1033103676	1	3	PACIFIC REDWOOD MEDICAL GROU	2/2/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	242 HOSPITAL DRIVE	SUITE A	UKIAH	CA	95482	4531	23	06045	39.15258291	-123.2037212	Mendocino County
131839	Fee-for-Service	1861551426	1861551426	1	1	PENG, HEIDI W DO	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7908	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
131847	Fee-for-Service	1497439640	1497439640	1	1	PANNU, MANVIR K	8/9/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
131854	Fee-for-Service	1942276084	1942276084	1	1	PAUL S JERRY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 PINE GROVE AVE	None	PORT HURON	MI	48060	3511	00	None	42.986844	-82.42983	St. Clair County
131855	Fee-for-Service	1639896384	1639896384	1	1	PCCC SURGERY CENTER INC.	1/22/2025	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5771 N FRESNO ST STE 101	None	FRESNO	CA	93710	6091	10	06019	36.822348	-119.7813565	Fresno County
131866	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	4/22/2020	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
131887	Fee-for-Service	1891895439	1891895439	1	1	PRIEST, ANNE M DO	1/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8937	08	Family Practice	0	In state provider	None	8421 AUBURN BLVD	STE 160	CITRUS HEIGHTS	CA	95610	0394	34	06067	38.719026	-121.291335	Sacramento County
131924	Fee-for-Service	1134362205	1134362205	2	1	P, CHUNG GLORIA HA	7/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	11437	40	Pediatrics	0	In state provider	None	1101 E HOLT AVENUE	SUITE G	POMONA	CA	91767	5800	19	06037	34.06297561	-117.7280971	Los Angeles County
131927	Fee-for-Service	1689755670	1689755670	1	1	PROVIDENCE HEALTH AND	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	SERVICES OREGON	1111 CRATER LAKE AVE	None	MEDFORD	OR	97504	6225	00	None	42.339654	-122.861086	Jackson County
131930	Fee-for-Service	1164639704	1164639704	1	1	PARK, WILSON H MD INC	6/18/2007	207R00000X	NA	Other	026	PHYSICIANS	45867	41	Internal Medicine	0	In state provider	None	3663 W 6TH ST	STE 100	LOS ANGELES	CA	90020	3047	19	06037	34.06360557	-118.30199	Los Angeles County
131952	Fee-for-Service	1598830069	1598830069	1	1	PRADO, AMELIA MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94931	08	Family Practice	0	In state provider	None	1530 WEST 6TH ST	STE 109	CORONA	CA	92882	2784	33	06065	33.87842412	-117.5950761	Riverside County
131980	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
132007	Fee-for-Service	1902392509	1902392509	1	1	PHAM, BICH-VAN T NP	12/21/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
132036	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	5/16/2020	208600000X	NA	General Surgery	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
132037	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	10/23/2017	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
132057	Fee-for-Service	1326707803	1326707803	1	1	PRIME 1 HOME HEALTH	10/27/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14531 HAMLIN ST	STE 106	VAN NUYS	CA	91411	4130	19	06037	34.18870941	-118.449902	Los Angeles County
132078	Fee-for-Service	1841223344	1841223344	1	1	PICKERING, BRETTEN D MD	7/21/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61063	40	Pediatrics	0	In state provider	None	2244 29TH STREET	None	SAN DIEGO	CA	92104	5425	37	06073	32.72952002	-117.1320431	San Diego County
132079	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	3/12/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
132109	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	5/21/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
132136	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
132141	Fee-for-Service	1972669091	1972669091	1	1	PHAN, SON MD	6/25/2008	390200000X	NA	Other	026	PHYSICIANS	102974	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
132146	Fee-for-Service	1750640967	1750640967	1	1	PAD DIAGNOSTICS INC	6/13/2014	208D00000X	NA	Adult Primary Care	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	417 W WINDSOR ROAD	SUITE 5	GLENDALE	CA	91204	1944	19	06037	34.13656555	-118.2616041	Los Angeles County
132154	Fee-for-Service	1760861306	1760861306	1	1	PACIFIC CENTRAL COAST HEALTH	8/7/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	5075 S BRADLEY ROAD	STE 131	SANTA MARIA	CA	93455	5045	42	06083	34.864155	-120.4187955	Santa Barbara County
132155	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	12/8/2018	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
132175	Fee-for-Service	1952347288	1952347288	1	1	POTTER, MICHAEL B MD	5/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72832	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
132182	Fee-for-Service	1841379070	1841379070	1	1	PENCZAK, FREDERICK W MD	9/17/2008	208600000X	NA	General Surgery	026	PHYSICIANS	68512	02	General Surgery	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1784	21	06041	37.9469952	-122.5373892	Marin County
132198	Fee-for-Service	1881055044	1881055044	1	1	PELAEZ, AMANDA LMFT	6/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
132228	Fee-for-Service	1427268747	1427268747	1	2	PHILIP D. SZOLD, MD, INC	4/30/1992	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8881 FLETCHER PKWY	200	LA MESA	CA	91942	3134	37	06073	32.78442148	-117.0073814	San Diego County
132231	Fee-for-Service	1144306648	1144306648	2	1	PANG, ALLEN G MD	10/31/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82386	08	Family Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
132234	Fee-for-Service	1063928604	1063928604	1	1	POETER, ALEXA CCC-SLP	6/26/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
132235	Fee-for-Service	1669495198	1669495198	1	1	PIECUCH, ROBERT	1/1/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	32993	None	None	0	In state provider	None	533 PARNASSUS AVE	# U587	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
132241	Fee-for-Service	1801983101	1801983101	3	1	PHARMACYWORX INC	10/4/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	202 E OJAI AVE	None	OJAI	CA	93023	2737	56	06111	34.44780554	-119.2457646	Ventura County
132256	Fee-for-Service	1639691405	1639691405	1	1	PARRY, ANGELA N LMFT	5/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
132262	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	9/16/2019	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
132298	Fee-for-Service	1598976839	1598976839	1	1	PULLELA, SUJATA V MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104843	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
132314	Fee-for-Service	1609875756	1609875756	1	1	PANT, MAHESH C MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72603	78	Neoplastic Diseases/Oncology	0	In state provider	None	963 BUTTE ST	None	REDDING	CA	96001	0828	45	06089	40.58567535	-122.3853786	Shasta County
132326	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	12/8/2018	208600000X	NA	General Surgery	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
132327	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
132369	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
132389	Fee-for-Service	1487035234	1487035234	1	1	PARRA JAIMES, ALEJANDRA Y LM	10/7/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
132398	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	1/3/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
132407	Fee-for-Service	1699889840	1699889840	1	1	PUFFER, JAMES C MD	2/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36090	08	Family Practice	0	In state provider	None	1072 GAYLEY AVE	None	LOS ANGELES	CA	90024	3402	19	06037	34.06071361	-118.4468596	Los Angeles County
132425	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
132445	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	2/1/2018	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
132449	Fee-for-Service	1619362761	1619362761	1	1	PHAN, AMANDA MD	3/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
132450	Fee-for-Service	1578769337	1578769337	1	1	PARKS, KARMEN A MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80614	40	Pediatrics	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
132490	Fee-for-Service	1316295082	1316295082	2	1	PES-EBS INC	9/23/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	340 LINCOLN ST	None	ROSEVILLE	CA	95678	2230	31	06061	38.75160571	-121.2848973	Placer County
132515	Fee-for-Service	1427268747	1427268747	1	2	PHILIP D. SZOLD, MD, INC	4/30/1992	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8881 FLETCHER PKWY	200	LA MESA	CA	91942	3134	37	06073	32.78442148	-117.0073814	San Diego County
132533	Fee-for-Service	1386778033	1386778033	1	1	PHAN, CONG T MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78092	41	Internal Medicine	0	In state provider	None	7777 MILLIKEN AVE	STE 140	RANCHO CUCAMONGA	CA	91730	6781	36	06071	34.10843256	-117.5570865	San Bernardino County
132546	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	2/26/2013	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
132570	Fee-for-Service	1114211109	1114211109	1	1	POORE, TIMOTHY C MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124060	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
132585	Fee-for-Service	1912062647	1912062647	1	1	PETRECCIA & TROTTER MEDI	12/31/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	INFECTIOUS DISEASE CONSU	1275 N ROSE DR	STE 134	PLACENTIA	CA	92870	3919	30	06059	33.8868003	-117.8420447	Orange County
132614	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	4/18/2017	208600000X	NA	General Surgery	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
132616	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	6/12/2020	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
132629	Fee-for-Service	1639707243	1639707243	1	1	PERDOMO, JENNIFER MD	9/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188828	None	None	0	In state provider	None	450 E SPRING STREET	SUITE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
132633	Fee-for-Service	1285647297	1285647297	1	1	PERSON, JOHN L MD	6/30/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	36284	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132640	Fee-for-Service	1023217874	1023217874	1	1	PHILIPS, HEIDI B LCSW	9/15/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132641	Fee-for-Service	1447320304	1447320304	1	1	PAKIER, OSCAR MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27132	36	Psychiatry	0	In state provider	None	18226 VENTURA BLVD	STE 210	TARZANA	CA	91356	4246	19	06037	34.16628399	-118.5299288	Los Angeles County
132652	Fee-for-Service	1982960266	1982960266	1	1	PAREKH, VISHWAS P MD	7/18/2017	207ZP0102X	NA	Other	026	PHYSICIANS	147938	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
132656	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	10/13/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
132686	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	6/24/2024	207Q00000X	NA	Adult Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
132717	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
132731	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	10/5/2020	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
132744	Fee-for-Service	1578769337	1578769337	1	1	PARKS, KARMEN A MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80614	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
132775	Fee-for-Service	1114082542	1114082542	2	1	PNK PHARMACY INC	12/28/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 WEST COVINA PKWY	SUITE 100	WEST COVINA	CA	91790	2729	19	06037	34.06953243	-117.9391587	Los Angeles County
132817	Fee-for-Service	1487653556	1487653556	1	1	PHILIP, JOLLY A MD	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52441	08	Family Practice	0	In state provider	None	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
132832	Fee-for-Service	1053581124	1053581124	1	1	PATTERSON, LINDSAY K MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128505	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
132833	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/19/2016	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
132855	Fee-for-Service	1194827063	1194827063	1	1	PINEDA III, CARLOS	8/9/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 203	LAKEWOOD	CA	90805	4589	19	06037	33.86018093	-118.1537163	Los Angeles County
132868	Fee-for-Service	1659387553	1659387553	1	1	PHAM, MY-LINH K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88709	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	145 N CLARK ST	None	FRESNO	CA	93701	2108	10	06019	36.744102	-119.7860465	Fresno County
132884	Fee-for-Service	1528557972	1528557972	1	1	PALMISANO, BRIAN T MD	4/2/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163894	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132902	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	8/26/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
132903	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
132916	Fee-for-Service	1962585117	1962585117	1	1	PESCOSOLIDO, ELLEN S	9/1/2002	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
132923	Fee-for-Service	1285647297	1285647297	1	1	PERSON, JOHN L MD	6/30/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	36284	10	Gastroenterology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132943	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	5/17/2022	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
132948	Fee-for-Service	1427102979	1427102979	1	1	PUIG-LLANO, MANUEL MD	1/31/1985	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40586	18	Ophthalmology	0	In state provider	None	276 CHURCH AVE	STE E	CHULA VISTA	CA	91910	2729	37	06073	32.64220367	-117.0791904	San Diego County
132956	Fee-for-Service	1053433235	1053433235	1	1	PARK, HEE BANG CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	HEE BANG PARK ACUPUNCTUR	22640 GOLDEN SPRINGS DR	STE B	DIAMOND BAR	CA	91765	2200	19	06037	34.00715974	-117.8207087	Los Angeles County
132958	Fee-for-Service	1609302629	1609302629	1	1	PROSPER HOME HEALTH CARE	12/21/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	409 S GLENDALE AVE	SUITE 201	GLENDALE	CA	91205	2292	19	06037	34.14127385	-118.249963	Los Angeles County
132964	Fee-for-Service	1568455384	1568455384	2	1	PICKREL, KEVAN A MD	12/3/2010	207R00000X	NA	Other	026	PHYSICIANS	54451	41	Internal Medicine	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
132965	Fee-for-Service	1831291731	1831291731	1	1	PAQUETTE, LISA B MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73324	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
132973	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	1/3/2024	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
132980	Fee-for-Service	1730330523	1730330523	1	1	PIRASTEHFAR, HOSSEIN N	1/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103626	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
132992	Fee-for-Service	1730284936	1730284936	1	1	PRAMANIK, SHARMILA B MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	43267	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
132994	Fee-for-Service	1831104470	1831104470	1	1	PRESCRIPTION HEADQUARTERS IN	8/21/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	C	1340 TULLY ROAD	STE 312	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
132999	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
133009	Fee-for-Service	1982685384	1982685384	1	1	PORT HURON HOSPITAL	9/19/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1221 PINE GROVE AVE	None	PORT HURON	MI	48061	5011	00	None	42.986844	-82.42983	St. Clair County
133020	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
133044	Fee-for-Service	1306993464	1306993464	1	1	PACIFIC HILLS SURGERY CENTER	3/1/2012	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	24022 CALLE DE LA PLAYA	SUITE 180	LAGUNA HILLS	CA	92653	3627	30	06059	33.6104493	-117.7110924	Orange County
133080	Fee-for-Service	1982895108	1982895108	1	2	PANAGOTACOS, JOHN MD	2/22/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	89953	13	Neurology (M.D. only)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
133103	Fee-for-Service	1598016453	1598016453	1	1	PEHLE, LAURA A	8/29/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7097	34	06067	38.56554	-121.4664615	Sacramento County
133122	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/19/2016	106H00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
133132	Fee-for-Service	1326629494	1326629494	1	1	PRIEST, KELSEY MD	11/16/2023	390200000X	NA	Other	026	PHYSICIANS	181246	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
133140	Fee-for-Service	1528602877	1528602877	1	1	PALOMAREZ, KHRYSTINA M LMFT	10/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
133141	Fee-for-Service	1093949703	1093949703	1	1	PANNALA, DIVYA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	116350	08	Family Practice	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
133143	Fee-for-Service	1457512329	1457512329	1	1	PATEL, JIGNASA G MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110669	42	Nuclear Medicine	0	In state provider	None	11370 ANDERSON ST	STE B 100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
133173	Fee-for-Service	1528557972	1528557972	1	1	PALMISANO, BRIAN T MD	4/2/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163894	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133189	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	1/28/2019	208000000X	NA	Pediatric Primary Care	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
133190	Fee-for-Service	1073612552	1073612552	1	1	PATTEN, MARIA B DO	5/15/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	6473	25	Physical Medicine and Rehabilitation	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
133191	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	1/28/2019	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
133192	Fee-for-Service	1134167588	1134167588	1	1	PAONI, ADAM S. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	302 N. HOSPITAL DRIVE	None	GIRARD	KS	66743	0000	00	None	37.51462395	-94.8583732	Crawford County
133193	Fee-for-Service	1164481677	1164481677	1	1	PARMA COMMUNITY GENERAL	5/13/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	7007 POWERS BLVD	None	PALMA	OH	44129	5437	00	None	41.38275149	-81.73188744	Cuyahoga County
133212	Fee-for-Service	1083771646	1083771646	1	1	PARSONNET, JULIE MD	10/31/1989	207R00000X	NA	Other	026	PHYSICIANS	67987	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
133219	Fee-for-Service	1598794331	1598794331	1	1	PICO URGENT CARE AND	11/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FAMILY MEDICAL CENTER	6632 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	3533	19	06037	33.98507282	-118.0954502	Los Angeles County
133231	Fee-for-Service	1841373800	1841373800	1	13	PERMANENTE MEDICAL GROUP INC	3/12/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
133236	Fee-for-Service	1124231022	1124231022	1	1	PARIKH, SWAPNA R MD	5/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94927	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
133251	Fee-for-Service	1831291731	1831291731	1	1	PAQUETTE, LISA B MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73324	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133263	Fee-for-Service	1770093734	1770093734	1	2	PROVIDENCE SAINT JOHN'S MEDI	2/9/2023	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
133264	Fee-for-Service	1457552341	1457552341	1	1	PARRISH, VICKI J CRNA	7/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
133287	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
133298	Fee-for-Service	1982685384	1982685384	1	1	PORT HURON HOSPITAL	9/19/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1221 PINE GROVE AVE	None	PORT HURON	MI	48061	5011	00	None	42.986844	-82.42983	St. Clair County
133304	Fee-for-Service	1447477161	1447477161	1	1	PROFESSIONAL IMAGING	6/13/1988	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
133306	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	3/7/2022	207R00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
133308	Fee-for-Service	1851867758	1851867758	1	1	PETER STOOPS D.O. INC	6/26/2019	261QP2300X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	13312 RANCHERO RD	SUITE 16	OAK HILLS	CA	92344	4802	36	06071	34.38313445	-117.3719655	San Bernardino County
133347	Fee-for-Service	1194084384	1194084384	1	1	PARK, JI YOUNG MD	11/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	132156	None	None	0	In state provider	None	4770 HERNDON	105	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
133369	Fee-for-Service	1356357388	1356357388	1	1	POLLACK, HENRY C III MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77462	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
133382	Fee-for-Service	1942671904	1942671904	1	1	PANDEY, SAUMYA DO	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13744	01	General Practice	0	In state provider	None	355 ABBOTT ST	STE 100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
133384	Fee-for-Service	1134219751	1134219751	1	1	PETTI, CATHY A MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53562	77	Infectious Disease	0	In state provider	None	222 W 39TH STREETT	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
133410	Fee-for-Service	1427405737	1427405737	1	1	PIH HEALTH PHYSICIANS	12/15/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12291 WASHINGTON BLVD	SUITE 500	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
133411	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	9/21/2015	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
133477	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	8/2/2019	208000000X	NA	Pediatric Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
133478	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
133481	Fee-for-Service	1164481677	1164481677	1	1	PARMA COMMUNITY GENERAL	5/13/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	7007 POWERS BLVD	None	PALMA	OH	44129	5437	00	None	41.38275149	-81.73188744	Cuyahoga County
133499	Fee-for-Service	1952669996	1952669996	1	1	PATEL, SHREENA MD	9/3/2019	390200000X	NA	Other	026	PHYSICIANS	163348	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133510	Fee-for-Service	1437164894	1437164894	1	1	PAO, BING SHIH MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53127	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
133539	Fee-for-Service	1831291731	1831291731	1	1	PAQUETTE, LISA B MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73324	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133546	Fee-for-Service	1669834610	1669834610	1	1	POWELL, GREGORY S MD	10/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151368	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
133572	Fee-for-Service	1881181204	1881181204	1	1	POCHEBYT, MAXIM MD	6/13/2022	207L00000X	NA	Other	026	PHYSICIANS	165096	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133574	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
133580	Fee-for-Service	1073501573	1073501573	1	1	PATEL, HITENDRA T MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50926	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
133584	Fee-for-Service	1457624033	1457624033	1	1	PATEL, SAUHANG B MD	4/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129540	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	8823	15	06029	35.35253312	-119.1144456	Kern County
133592	Fee-for-Service	1902999477	1902999477	1	1	PHILPOTT, KRISTINA H MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61590	03	Allergy	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
133595	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	4/24/2020	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
133620	Fee-for-Service	1790502896	1790502896	1	1	PEREZ, NICHOLAS	3/13/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	36	06071	33.98274451	-117.7129305	San Bernardino County
133621	Fee-for-Service	1295826816	1295826816	1	1	PATEL, NEETA MD	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89331	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
133644	Fee-for-Service	1356541429	1356541429	2	1	PEDIATRIC CARDIOLOGY SPECIAL	10/6/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ISTS	350 E VANDERBILT WAY	STE A	SAN BERNARDINO	CA	92408	3593	36	06071	34.06877914	-117.2773555	San Bernardino County
133692	Fee-for-Service	1851971022	1851971022	1	1	PANDIA PHARMACY, INC.	3/7/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 CAMDEN AVENUE	SUITE 101	SAN JOSE	CA	95124	2944	43	06085	37.26166552	-121.9236804	Santa Clara County
133698	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
133765	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	1/11/2019	208000000X	NA	Pediatric Primary Care	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
133767	Fee-for-Service	1881650588	1881650588	1	1	PADILLA, ALFONSO J MD	4/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91866	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
133774	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	5/16/2020	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
133794	Fee-for-Service	1003874702	1003874702	2	3	PROHEALTH ADVANCED IMAGING M	8/5/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	7345 MEDICAL CENTER DR	STE 130	WEST HILLS	CA	91307	1932	19	06037	34.20369349	-118.629837	Los Angeles County
133800	Fee-for-Service	1376742346	1376742346	1	1	PATES, JASON A MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153808	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
133801	Fee-for-Service	1124443544	1124443544	1	1	PAFF, MICHELLE MD	5/19/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	128197	14	Neurological Surgery	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
133806	Fee-for-Service	1780630087	1780630087	1	1	PETROLEUM HELICOPTER INC	1/1/2005	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	PHI AIR MED/AIR MED TEAM	801 AIRPORT WAY	STE D	MODESTO	CA	95354	3904	50	06099	37.62719812	-120.9515294	Stanislaus County
133863	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
133882	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	2/25/2019	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
133934	Fee-for-Service	1326094020	1326094020	1	4	PHI HEALTH, LLC	9/1/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	5459 LOS CAPANOS DR	None	SIERRA VISTA	AZ	85635	8302	00	None	31.547016	-110.2355685	Cochise County
133946	Fee-for-Service	1063822740	1063822740	1	1	PATEL, NILAY MD	11/20/2017	390200000X	NA	Other	026	PHYSICIANS	138501	None	None	0	In state provider	None	3460 E LA PALMA AVENUE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
133987	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	7/24/2017	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
134016	Fee-for-Service	1144289653	1144289653	1	1	PATEL, RATNADEEP MD	4/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93592	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
134027	Fee-for-Service	1851456602	1851456602	1	1	PFEFFER, JOHN C MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40062	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 MCHENRY AVE	STE 150	MODESTO	CA	95350	4569	50	06099	37.666233	-120.993933	Stanislaus County
134053	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	1/11/2019	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
134054	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	5/16/2020	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
134071	Fee-for-Service	1053480467	1053480467	1	1	PATEL, NIRAV H	9/16/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24012 CALLE DE LA PLATA	#300	LAGUNA HILLS	CA	92653	7062	30	06059	33.61012113	-117.7115908	Orange County
134088	Fee-for-Service	1245556653	1245556653	1	1	PENG, KEVIN A MD	1/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	2100 WEST 3RD ST	STE 111	LOS ANGELES	CA	90057	1999	19	06037	34.06308947	-118.2733326	Los Angeles County
134129	Fee-for-Service	1740410182	1740410182	1	13	PACIFIC DERMATOLOGY INSTITUT	9/16/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	25405 HANCOCK AVE.	200	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
134153	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
134171	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
134176	Fee-for-Service	1396950465	1396950465	1	1	PHUNG, PHIET THE MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52767	01	General Practice	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
134273	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	2/24/2019	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
134303	Fee-for-Service	1548230337	1548230337	1	1	PONCE, JEANETTE R MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68979	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
134320	Fee-for-Service	1386063782	1386063782	1	1	PATEL, KUSHAL R MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150247	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
134344	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	5/16/2020	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
134345	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	6/21/2019	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
134389	Fee-for-Service	1114909058	1114909058	1	1	PRASAD R PALAKURTHY M.D.	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PENN AVE	STE 100	DES MOINES	IA	50316	2364	00	None	0	0	None
134392	Fee-for-Service	1538812201	1538812201	1	1	PETRA MEDICAL TRANSPORTATION	2/20/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	4904 VAN STEYN CT	None	ELK GROVE	CA	95757	3537	34	06067	38.385342	-121.44708	Sacramento County
134398	Fee-for-Service	1558396705	1558396705	1	1	PERCH, PAUL G MD	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82121	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
134419	Fee-for-Service	1740410182	1740410182	1	13	PACIFIC DERMATOLOGY INSTITUT	9/16/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	25405 HANCOCK AVE.	200	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
134436	Fee-for-Service	1609223361	1609223361	1	1	PATEL, MITAL	6/4/2021	390200000X	NA	Other	026	PHYSICIANS	152700	None	None	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
134439	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
134458	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	8/28/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
134561	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	9/11/2012	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
134602	Fee-for-Service	1255383337	1255383337	1	1	POISSON, BRETT	8/8/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
134604	Fee-for-Service	1265059638	1265059638	1	1	PARVEEN KAUR MD INC	12/15/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
134629	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	6/21/2019	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
134630	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	7/25/2020	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
134631	Fee-for-Service	1649336298	1649336298	1	1	PARK, ALICE J MD	5/19/2008	207R00000X	NA	Other	026	PHYSICIANS	90337	45	Nephrology (Renal-Kidney)	0	In state provider	None	3780 KILROY AIRPORT	STE 115	LONG BEACH	CA	90806	2458	19	06037	33.80733529	-118.1450095	Los Angeles County
134688	Fee-for-Service	1720840416	1720840416	1	1	PINEDA RUIZ, DENNIS RCP	9/25/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
134692	Fee-for-Service	1649339045	1649339045	1	1	PERLMAN, RACHEL K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69596	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
134701	Fee-for-Service	1891879391	1891879391	1	1	PLATE, DAVID P PT	3/10/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
134705	Fee-for-Service	1962181529	1962181529	1	1	PENARANDA, DANIEL MD	11/12/2024	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
134727	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	12/13/2016	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
134733	Fee-for-Service	1851471320	1851471320	2	1	PLATT LLC	8/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL ARTS PHARMACY	1320 MARICOPA HWY	None	OJAI	CA	93023	3154	56	06111	34.44248874	-119.2654707	Ventura County
134747	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	4/24/2020	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
134758	Fee-for-Service	1811270549	1811270549	1	1	PARE, REBECCA A NP	3/21/2019	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
134849	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/4/2020	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
134853	Fee-for-Service	1578526521	1578526521	1	1	PALANCA-CAPISTRANO, ANGELITA	1/2/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	91568	18	Ophthalmology	0	In state provider	M MD	720 MAGNOLIA AVENUE	SUITE A-4	CORONA	CA	92879	3119	33	06065	33.8581661	-117.5555574	Riverside County
134860	Fee-for-Service	1538497862	1538497862	1	1	PAIK, KENNETH S	10/19/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
134912	Fee-for-Service	1841220308	1841220308	1	1	PATEL, DEEP A MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80002	78	Neoplastic Diseases/Oncology	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
134917	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	5/16/2020	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
134918	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	12/29/2018	208000000X	NA	Pediatric Primary Care	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
134921	Fee-for-Service	1649336298	1649336298	1	1	PARK, ALICE J MD	5/19/2008	207R00000X	NA	Other	026	PHYSICIANS	90337	41	Internal Medicine	0	In state provider	None	3780 KILROY AIRPORT	STE 115	LONG BEACH	CA	90806	2458	19	06037	33.80733529	-118.1450095	Los Angeles County
134965	Fee-for-Service	1770977233	1770977233	1	1	PENTECOST, ALLISON N B PHD	8/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
134972	Fee-for-Service	1326435116	1326435116	1	1	POON, CHI KONG MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	155310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
135015	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	7/14/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
135020	Fee-for-Service	1881753440	1881753440	1	1	PRIME, DONALD J MD	7/1/1984	2080P0210X	NA	Nephrology	026	PHYSICIANS	37321	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
135025	Fee-for-Service	1669571410	1669571410	1	1	PINO, DAVID M MD	8/31/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	34344	41	Internal Medicine	0	In state provider	None	30200 RANCHO VIEJO RD	STE E	SAN JUAN CAPISTRA	CA	92675	1560	30	06059	33.5242119	-117.6659263	Orange County
135035	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	8/14/2020	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
135044	Fee-for-Service	1851525703	1851525703	1	1	PFOHL, MARISSA S CNP	2/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
135061	Fee-for-Service	1750059465	1750059465	1	1	PENNACHIO, ALEXANDRA CCC-SL	5/28/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
135085	Fee-for-Service	1841597143	1841597143	1	1	POSTMA, SARAH R MD	8/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110670	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
135089	Fee-for-Service	1497795223	1497795223	1	1	PAINTAL, NITA MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61220	36	Psychiatry	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
135124	Fee-for-Service	1073583431	1073583431	1	1	PRANAY KATHURIA	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10205 N 110TH EAST AVE	None	OWASSO	OK	74055	4374	00	None	36.30309253	-95.85180959	Tulsa County
135136	Fee-for-Service	1316095102	1316095102	1	1	PARK, MAXWELL C MD	10/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86589	20	Orthopedic Surgery	0	In state provider	MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
135140	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	6/19/2017	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
135144	Fee-for-Service	1083792675	1083792675	1	1	PAWLOWSKI, JENNIFER MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76489	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
135154	Fee-for-Service	1033144027	1033144027	1	1	PLANNED PARENTHOOD	10/2/2002	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF THE PACIFIC SOUTHWEST	12900 FREDERICK ST	STE C	MORENO VALLEY	CA	92553	5266	33	06065	33.932655	-117.261383	Riverside County
135165	Fee-for-Service	1548439151	1548439151	1	1	PAUZUOLIS, KARINE CRNA	6/9/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
135198	Fee-for-Service	1841220308	1841220308	1	1	PATEL, DEEP A MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80002	30	Radiology	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
135207	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	6/23/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
135208	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	1/11/2019	208600000X	NA	General Surgery	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
135217	Fee-for-Service	1508924507	1508924507	1	1	PRASAD, NALEEN L	4/22/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15035 E 14TH ST	None	SAN LEANDRO	CA	94578	1901	07	06013	37.70496067	-122.1281915	Alameda County
135241	Fee-for-Service	1528014941	1528014941	1	1	PHAM, NGHI GIA MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37172	01	General Practice	0	In state provider	None	14411 BROOKHURST ST	STE D	GARDEN GROVE	CA	92843	4667	30	06059	33.753348	-117.9550255	Orange County
135242	Fee-for-Service	1164546651	1164546651	1	1	POSEY, DEBORAH D OD	4/30/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	427 E HILLCREST BLVD	None	INGLEWOOD	CA	90301	2407	19	06037	33.96134987	-118.3494637	Los Angeles County
135275	Fee-for-Service	1285275974	1285275974	1	1	PEACE & COMFORT HOSPICE AND	5/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	16200 VENTURA BLVD	STE 310A	ENCINO	CA	91436	4929	19	06037	34.15659457	-118.485532	Los Angeles County
135302	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
135316	Fee-for-Service	1548404700	1548404700	1	1	PYPER, HARMONY OT	9/21/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
135324	Fee-for-Service	1972899615	1972899615	1	1	PASUPNETI, SHRAVANI MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130386	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135325	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	3/9/2020	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
135335	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
135340	Fee-for-Service	1285754911	1285754911	1	1	PROLO, MARY S MFT	3/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53651	-	NOT APPLICABLE	0	In state provider	None	2101 ALEXIAN DR	SUITE 110	SAN JOSE	CA	95116	4209	43	06085	37.35943657	-121.848055	Santa Clara County
135359	Fee-for-Service	1073907044	1073907044	1	1	PHAM, MAGGIE C DO	8/1/2019	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17125	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1135 S SUNSET AVE	STE 408	WEST COVINA	CA	91790	3964	19	06037	34.06215064	-117.9453997	Los Angeles County
135375	Fee-for-Service	1497795223	1497795223	1	1	PAINTAL, NITA MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61220	66	Emergency Medicine (Urgent Care)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
135406	Fee-for-Service	1487746327	1487746327	2	1	PEARL VENTURES	11/30/2019	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1012 E COOLEY DR STE N	None	COLTON	CA	92324	3949	36	06071	34.05458499	-117.3111871	San Bernardino County
135427	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/29/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
135434	Fee-for-Service	1104070119	1104070119	1	1	PETERSEN, TIMOTHY A PSY	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	19159	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD ST	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
135447	Fee-for-Service	1568522878	1568522878	1	1	PATEL, JAGDISH A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31816	08	Family Practice	0	In state provider	None	644 W 12TH ST	None	TRACY	CA	95376	3437	39	06077	37.74063054	-121.4352135	San Joaquin County
135479	Fee-for-Service	1811916638	1811916638	1	1	PRASAD, PRAVEEN MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	39974	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
135493	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	7/25/2020	208600000X	NA	General Surgery	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
135495	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	12/8/2018	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
135553	Fee-for-Service	1699806133	1699806133	1	1	PHAM, HOANG N MD	1/7/2019	207R00000X	NA	Other	026	PHYSICIANS	77386	41	Internal Medicine	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
135564	Fee-for-Service	1285275974	1285275974	1	1	PEACE & COMFORT HOSPICE AND	5/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	16200 VENTURA BLVD	STE 310A	ENCINO	CA	91436	4929	19	06037	34.15659457	-118.485532	Los Angeles County
135570	Fee-for-Service	1184807976	1184807976	1	1	PORTERVILLE ONCOLOGY	4/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52459	78	Neoplastic Diseases/Oncology	0	In state provider	ASSOCIATES, INC	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
135579	Fee-for-Service	1730814617	1730814617	1	1	PALUMBO, MARIE A LMFT	8/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	960 GRAND AVE	H	GROVER BEACH	CA	93433	2121	40	06079	35.12144113	-120.6196384	San Luis Obispo County
135591	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
135603	Fee-for-Service	1972765956	1972765956	1	1	PELE, NICOLE ANDREA DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12335	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
135608	Fee-for-Service	1922426816	1922426816	1	1	PATEL, NEAL A MD	5/6/2020	208800000X	NA	Other	026	PHYSICIANS	168319	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
135612	Fee-for-Service	1972899615	1972899615	1	1	PASUPNETI, SHRAVANI MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130386	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135614	Fee-for-Service	1841373800	1841373800	1	9	PERMANENTE MEDICAL GROUP INC	5/3/2019	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
135625	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
135647	Fee-for-Service	1881240604	1881240604	1	1	PITTMAN, SARAH M MD	8/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163813	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135671	Fee-for-Service	1063656064	1063656064	1	1	PATEL, KETAN MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
135677	Fee-for-Service	1851309157	1851309157	1	1	PACHECO-OCAMPO, MERLIE A	7/5/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43505	08	Family Practice	0	In state provider	None	8540 ALONDRA BLVD	STE B2	PARAMOUNT	CA	90723	5200	19	06037	33.88915049	-118.1500515	Los Angeles County
135694	Fee-for-Service	1427082346	1427082346	1	1	PETTIS, ROBERT M MD	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77461	04	Otology, Laryngology, Rhinology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
135702	Fee-for-Service	1083803621	1083803621	1	1	PAN, CAROLYN K MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116645	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135712	Fee-for-Service	1144827981	1144827981	1	1	PALAZZOLO, AUSTIN J PT	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	60 PENNY LANE	None	WATSONVILLE	CA	95076	3079	44	06087	36.93074806	-121.7788515	Santa Cruz County
135717	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
135766	Fee-for-Service	1811916638	1811916638	1	1	PRASAD, PRAVEEN MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	39974	14	Neurological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
135782	Fee-for-Service	1639252604	1639252604	1	16	PERMANENTE MEDICAL GROUP INC	12/29/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1000 FRANKLIN PARKWAY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
135785	Fee-for-Service	1639252604	1639252604	1	11	PERMANENTE MEDICAL GROUP INC	5/16/2020	208600000X	NA	General Surgery	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
135800	Fee-for-Service	1003138660	1003138660	1	1	PERIVOLIOTIS, EFSTATHIA LMF	7/17/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
135816	Fee-for-Service	1730620741	1730620741	1	1	PAGE, NOLAN R DO	4/28/2020	207P00000X	NA	Other	026	PHYSICIANS	16708	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
135881	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
135899	Fee-for-Service	1972899615	1972899615	1	1	PASUPNETI, SHRAVANI MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130386	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135912	Fee-for-Service	1386871325	1386871325	1	1	POULOS, ELIJAH M MD	3/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	1200 N BEAVER STREET	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
135913	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	3/7/2022	193200000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
135920	Fee-for-Service	1992883664	1992883664	1	1	PERRY, CHARLES W MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87534	24	Plastic Surgery	0	In state provider	None	3800 J ST	STE 210	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
135944	Fee-for-Service	1124538624	1124538624	1	1	PALACIO, SARAH C LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 W FOOTHILL BLVD	STE 140	UPLAND	CA	91786	3686	36	06071	34.10715453	-117.6734115	San Bernardino County
135964	Fee-for-Service	1851309157	1851309157	1	1	PACHECO-OCAMPO, MERLIE A	7/5/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43505	01	General Practice	0	In state provider	None	8540 ALONDRA BLVD	STE B2	PARAMOUNT	CA	90723	5200	19	06037	33.88915049	-118.1500515	Los Angeles County
135973	Fee-for-Service	1518369289	1518369289	1	1	PATEL, CALVIN P MD	1/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132345	None	None	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
136004	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	4/24/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
136010	Fee-for-Service	1669490819	1669490819	1	1	PROVIDENCE HEALTH SYSTEM	8/22/2018	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
136017	Fee-for-Service	1316932346	1316932346	1	1	PEARL, RACHEL C MD	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92033	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
136071	Fee-for-Service	1639252604	1639252604	1	7	PERMANENTE MEDICAL GROUP INC	7/25/2020	208000000X	NA	Pediatric Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
136074	Fee-for-Service	1730598061	1730598061	1	1	PRESTIGE MEDICAL SOLUTIONS	3/14/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17150 EUCLID ST	SUITE A222	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
136083	Fee-for-Service	1164054383	1164054383	1	1	PERFECT, ZAHRA NP	10/23/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
136101	Fee-for-Service	1275681157	1275681157	1	1	PAGE, ALEXANDRA E MD	10/1/1998	204D00000X	NA	Other	026	PHYSICIANS	84448	20	Orthopedic Surgery	0	In state provider	None	250 PROSPECT PLACE	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
136113	Fee-for-Service	1376588160	1376588160	1	1	PADIDAR, ARASH M MD	5/22/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	74857	30	Radiology	0	In state provider	None	455 OCONNOR DR	STE 390	SAN JOSE	CA	95128	1600	43	06085	37.326654	-121.939897	Santa Clara County
136166	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	7/14/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
136195	Fee-for-Service	1376742700	1376742700	1	2	PUANGCO, JOSE J MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91074	13	Neurology (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
136201	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	12/8/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
136202	Fee-for-Service	1386871325	1386871325	1	1	POULOS, ELIJAH M MD	3/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	1200 N BEAVER STREET	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
136234	Fee-for-Service	1932269644	1932269644	1	1	PLANNED PARENTHOOD	2/29/1984	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	FAIRFIELD CENTER	1325 TRAVIS BLVD	STE C	FAIRFIELD	CA	94533	4611	48	06095	38.25798926	-122.0518837	Solano County
136252	Fee-for-Service	1508918616	1508918616	1	1	PARK, BRIAN D MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	97247	02	General Surgery	0	In state provider	None	2725 CAPITOL AVE	STE 402	SACRAMENTO	CA	95816	6032	34	06067	38.571084	-121.471074	Sacramento County
136260	Fee-for-Service	1356779482	1356779482	1	1	PERSONAL EVOLUTION PSYCHOTHE	1/27/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RAPY, INC	438 CAMINO DEL RIO S	STE 112	SAN DIEGO	CA	92108	3509	37	06073	32.76144507	-117.1604009	San Diego County
136290	Fee-for-Service	1336222397	1336222397	1	8	PERMANENTE MEDICAL GROUP INC	6/19/2017	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
136297	Fee-for-Service	1790168441	1790168441	1	1	PATEL, IRYNA MD	7/14/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	None	39.4735137	-119.7995156	Washoe County
136302	Fee-for-Service	1568925006	1568925006	1	1	PARTNERS HOSPICE QUALITY	12/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE, LLC	317 WEST LA HABRA BLVD	SUITE 200	LA HABRA	CA	90631	5497	30	06059	33.93189049	-117.9489645	Orange County
136323	Fee-for-Service	1962552729	1962552729	1	1	PARK, JOSEPH H DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9995	41	Internal Medicine	0	In state provider	None	161 N MILL ST	None	TEHACHAPI	CA	93561	1347	15	06029	35.13410412	-118.4520157	Kern County
136329	Fee-for-Service	1356950869	1356950869	1	1	PHAM, LOI T	3/12/2020	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 INTERNATIONAL BLVD	STE 105	OAKLAND	CA	94606	2987	01	06001	37.79488125	-122.2528163	Alameda County
136355	Fee-for-Service	1790881159	1790881159	1	1	PALIWAL, AMIT R MD	10/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95984	08	Family Practice	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 206	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
136427	Fee-for-Service	1386080117	1386080117	1	1	PHAM, JOEY P H LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101170	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
136455	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	7/4/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
136459	Fee-for-Service	1144007154	1144007154	1	1	PAQUIN, ALEXANDRA	10/11/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
136463	Fee-for-Service	1538618590	1538618590	1	1	PACIFIC CENTRAL COAST HEALTH	3/27/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	2 JAMES WAY	STE 209	PISMO BEACH	CA	93449	4976	40	06079	35.13869436	-120.630734	San Luis Obispo County
136466	Fee-for-Service	1336824143	1336824143	1	1	PURE ASSISTED LIVING INC	7/18/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9550 REMICK AVENUE	None	PACOIMA	CA	91331	4114	19	06037	34.24360816	-118.4189849	Los Angeles County
136487	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
136500	Fee-for-Service	1639415862	1639415862	1	1	PINNACLE EMERGENCY PHYSICIAN	2/1/2013	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF BAKERSFIELD APC	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
136503	Fee-for-Service	1306049671	1306049671	1	1	PRECISE MRI CORP	11/21/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6710 KESTER AVE	None	LOS ANGELES	CA	91405	4553	19	06037	34.192737	-118.457412	Los Angeles County
136512	Fee-for-Service	1902052913	1902052913	1	1	PURSNANI, SEEMA K MD	2/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117088	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
136549	Fee-for-Service	1356779482	1356779482	1	1	PERSONAL EVOLUTION PSYCHOTHE	1/27/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	RAPY, INC	438 CAMINO DEL RIO S	STE 112	SAN DIEGO	CA	92108	3509	37	06073	32.76144507	-117.1604009	San Diego County
136582	Fee-for-Service	1255383873	1255383873	1	1	PHAM, HOANG-TUAN K DO	1/14/2013	207R00000X	NA	Other	026	PHYSICIANS	11044	41	Internal Medicine	0	In state provider	None	1575 SKYLINE DR	None	MONTEREY	CA	93940	4110	27	06053	36.59190732	-121.9174351	Monterey County
136587	Fee-for-Service	1790168441	1790168441	1	1	PATEL, IRYNA MD	7/14/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	None	39.4735137	-119.7995156	Washoe County
136589	Fee-for-Service	1568925006	1568925006	1	1	PARTNERS HOSPICE QUALITY	12/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE, LLC	317 WEST LA HABRA BLVD	SUITE 200	LA HABRA	CA	90631	5497	30	06059	33.93189049	-117.9489645	Orange County
136608	Fee-for-Service	1205996048	1205996048	1	1	PHAM, AN T MD	3/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67904	40	Pediatrics	0	In state provider	None	600 INTERNATIONAL BLVD S	None	OAKLAND	CA	94606	2993	01	06001	37.79488125	-122.2528163	Alameda County
136611	Fee-for-Service	1962552729	1962552729	1	1	PARK, JOSEPH H DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9995	02	General Surgery	0	In state provider	None	161 N MILL ST	None	TEHACHAPI	CA	93561	1347	15	06029	35.13410412	-118.4520157	Kern County
136615	Fee-for-Service	1740454602	1740454602	1	1	PEREZ ACOSTA, CLAUDIA M MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120851	08	Family Practice	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
136650	Fee-for-Service	1548013287	1548013287	1	1	PORTILLO, NATALIE	5/15/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	20020 HAWTHORNE BLVD	None	TORRANCE	CA	90503	0000	19	06037	33.849909	-118.353614	Los Angeles County
136663	Fee-for-Service	1235521873	1235521873	1	1	PINNACLE HOSPICE CARE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4050 KATELLA AVENUE	SUITE 209	LOS ALAMITOS	CA	90720	3434	30	06059	33.80296949	-118.061964	Orange County
136706	Fee-for-Service	1538279914	1538279914	1	1	PATCHETT, MARGARET A MD	5/11/2020	207L00000X	NA	Other	026	PHYSICIANS	64062	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
136731	Fee-for-Service	1629224175	1629224175	1	1	PALMER, GENEVIEVE R MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111241	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
136743	Fee-for-Service	1841373800	1841373800	1	11	PERMANENTE MEDICAL GROUP INC	7/14/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
136777	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	3/9/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
136795	Fee-for-Service	1265600498	1265600498	1	1	PREDDY, JAMES L DO	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
136813	Fee-for-Service	1982052700	1982052700	1	1	PISCOYA, ANDRES S MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	186573	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
136817	Fee-for-Service	1992799530	1992799530	2	1	PANCHAL, PRAVIN M MD	11/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66826	41	Internal Medicine	0	In state provider	None	3975 JACKSON ST	STE 103	RIVERSIDE	CA	92503	3938	33	06065	33.92729721	-117.4413503	Riverside County
136875	Fee-for-Service	1578500492	1578500492	1	1	PROVIDENCE HEALTH AND	8/31/2005	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES OREGON	725 S WAHANNA RD	None	SEASIDE	OR	97208	3397	00	None	45.99034686	-123.9131204	Clatsop County
136906	Fee-for-Service	1528623634	1528623634	1	1	PAPARIAN, MATTHEW S DO	5/19/2022	207P00000X	NA	Other	026	PHYSICIANS	19521	None	None	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
136908	Fee-for-Service	1730613951	1730613951	1	1	PALMER, BENJAMIN DO	11/17/2020	207R00000X	NA	Other	026	PHYSICIANS	18120	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
136949	Fee-for-Service	1235521873	1235521873	1	1	PINNACLE HOSPICE CARE LLC	6/7/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4050 KATELLA AVENUE	SUITE 209	LOS ALAMITOS	CA	90720	3434	30	06059	33.80296949	-118.061964	Orange County
136980	Fee-for-Service	1841734167	1841734167	1	1	PARENT SOLUTIONS A LICENSED	6/5/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1132 MCKENDRIE ST	None	SAN JOSE	CA	95126	2220	43	06085	37.34121241	-121.9246913	Santa Clara County
137063	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	4/24/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
137069	Fee-for-Service	1659577971	1659577971	2	1	PROFESSIONAL NURSING, INC	5/5/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12501 CHANDLER BLVD	SUITE 205	VALLEY VILLAGE	CA	91607	1938	19	06037	34.16870346	-118.4056065	Los Angeles County
137081	Fee-for-Service	1558979625	1558979625	1	1	PATTERSON, TAYLOR L	6/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	805 E WALNUT AVE	None	LOMPOC	CA	93436	7027	42	06083	34.64061286	-120.4487303	Santa Barbara County
137084	Fee-for-Service	1457303646	1457303646	1	1	PRESS, BARRY H J MD	5/26/1987	208200000X	NA	General Surgery	026	PHYSICIANS	60188	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
137152	Fee-for-Service	1013568781	1013568781	1	1	PALAFOX, ADBNI NP	2/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44444 20TH ST W	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
137159	Fee-for-Service	1578500492	1578500492	1	1	PROVIDENCE HEALTH AND	8/31/2005	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES OREGON	725 S WAHANNA RD	None	SEASIDE	OR	97208	3397	00	None	45.99034686	-123.9131204	Clatsop County
137162	Fee-for-Service	1205833811	1205833811	1	1	PAK, PETER H. MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84741	01	General Practice	0	In state provider	None	2001 SANTA MONICA BLVD	STE 280W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
137200	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
137239	Fee-for-Service	1871092254	1871092254	1	1	PASCUAL, ANDREW A NP	3/27/2018	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
137243	Fee-for-Service	1295362440	1295362440	1	1	PARKER, ERICA MD	8/21/2024	390200000X	NA	Other	026	PHYSICIANS	188697	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
137350	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	8/14/2020	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
137357	Fee-for-Service	1205125093	1205125093	1	1	PATIERNO, SHAHEENA R MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123688	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
137379	Fee-for-Service	1003581208	1003581208	1	1	PORTER, DELANEY L PT	12/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	41421 DATE STREET	101	MURRIETA	CA	92562	7079	33	06065	33.53012372	-117.174507	Riverside County
137452	Fee-for-Service	1588869143	1588869143	1	1	PERALTA, ROBERT J MD	9/1/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	122019	18	Ophthalmology	0	In state provider	None	491 30TH STREET	STE 103	OAKLAND	CA	94609	3235	01	06001	37.81935528	-122.2667902	Alameda County
137457	Fee-for-Service	1558729053	1558729053	1	1	PANDA HOME HEALTHCARE INC	5/2/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	410 S SAN GABRIEL BLVD	UNIT A	SAN GABRIEL	CA	91776	1956	19	06037	34.097544	-118.090923	Los Angeles County
137488	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	8/2/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
137498	Fee-for-Service	1316248842	1316248842	1	1	PATEL, HARISHKUMAR MD	4/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113272	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
137527	Fee-for-Service	1558490631	1558490631	1	1	PANDES, MARIAM H LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
137542	Fee-for-Service	1194188748	1194188748	1	1	PHUON, SHELLEY Y OD	5/17/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
137565	Fee-for-Service	1689610792	1689610792	1	1	PAVLOVICH, RYAN P MD	8/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112414	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
137638	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	7/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
137653	Fee-for-Service	1174291868	1174291868	1	1	PARKER, CHRISTINA PSYD	4/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
137660	Fee-for-Service	1710984331	1710984331	1	1	PELIKAN, PETER MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43904	01	General Practice	0	In state provider	None	1124 W CARSON ST	# BLVDA1	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
137684	Fee-for-Service	1366464901	1366464901	1	1	PENA, KYOKO C MD	12/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92545	15	Obstetrics (D.O. only)	0	In state provider	None	1150 MAIN ST	STE 3	WATSONVILLE	CA	95076	3760	44	06087	36.9163164	-121.7698107	Santa Cruz County
137690	Fee-for-Service	1386058030	1386058030	1	1	PEACH, SHARON CORPORATION	7/21/2014	193400000X	NA	Other	026	PHYSICIANS	53730	66	Emergency Medicine (Urgent Care)	0	In state provider	None	345 SOUTH HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
137729	Fee-for-Service	1649407941	1649407941	1	1	PLOYNGAM, KIMBERLEE T DO	3/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11696	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137731	Fee-for-Service	1205684099	1205684099	1	1	PLANNED PARENTHOOD LOS ANGEL	10/10/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2690 PACIFIC AVENUE	SUITE 260	LONG BEACH	CA	90806	2661	19	06037	33.805854	-118.1936805	Los Angeles County
137734	Fee-for-Service	1477091825	1477091825	1	1	PFEFFERKORN, LISA K CRNA	2/28/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
137753	Fee-for-Service	1588731319	1588731319	1	1	PEARL, MICHAEL L MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	58210	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
137776	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	7/25/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
137848	Fee-for-Service	1154341188	1154341188	1	1	PEUS, JOSEPH C MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	21098	20	Orthopedic Surgery	0	In state provider	None	2324 BATH ST	None	SANTA BARBARA	CA	93105	4330	42	06083	34.43130628	-119.7229224	Santa Barbara County
137849	Fee-for-Service	1871541524	1871541524	1	1	PESTANER, JOHN C MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53049	30	Radiology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
137935	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
137952	Fee-for-Service	1063662211	1063662211	1	1	PENINSULA PATHOLGIST MED GRP	7/7/2009	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	393 E GRAND AVENUE	STE I	S SAN FRANCISCO	CA	94080	6233	41	06081	37.65128693	-122.3872057	San Mateo County
137959	Fee-for-Service	1780784348	1780784348	1	1	PATRICK, SHEA MD OD	7/9/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1109 KENNEDY PLACE	SUITE 1	DAVIS	CA	95616	1271	57	06113	38.55949385	-121.7382764	Yolo County
137971	Fee-for-Service	1366464901	1366464901	1	1	PENA, KYOKO C MD	12/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92545	08	Family Practice	0	In state provider	None	1150 MAIN ST	STE 3	WATSONVILLE	CA	95076	3760	44	06087	36.9163164	-121.7698107	Santa Cruz County
137976	Fee-for-Service	1386058030	1386058030	1	1	PEACH, SHARON CORPORATION	7/21/2014	193400000X	NA	Other	026	PHYSICIANS	53730	05	Anesthesiology	0	In state provider	None	345 SOUTH HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
137994	Fee-for-Service	1518258532	1518258532	1	1	PRISTINE REHABCARE INC	9/24/2018	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B2	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
138009	Fee-for-Service	1477625861	1477625861	1	1	PHILIPP, VIVIAN L	10/20/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 BROADWAY	None	REDWOOD CITY	CA	94063	2086	41	06081	37.4867809	-122.2236863	San Mateo County
138023	Fee-for-Service	1659609527	1659609527	1	1	PHAM, ANDREW Q MD	6/10/2010	207R00000X	NA	Other	026	PHYSICIANS	110232	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
138032	Fee-for-Service	1306225941	1306225941	1	1	PACIFIC CENTRAL COAST HEALTH	7/22/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1102 E CLARK AVENUE	SUITE 120A	SANTA MARIA	CA	93455	5123	42	06083	34.86499805	-120.4185338	Santa Barbara County
138035	Fee-for-Service	1689139735	1689139735	1	1	PANSMARTPILLPACK INC	5/5/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1693 FLANIGAN DR	105	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
138042	Fee-for-Service	1164961439	1164961439	1	1	PANNEERSELVAM, PRIYA B DO	7/23/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18805	None	None	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 408	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
138059	Fee-for-Service	1972585941	1972585941	1	1	POEN, JOSEPH CHARLES MD	6/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66706	30	Radiology	0	In state provider	RADIATION ONCOLOGY DEPT	1320 S ELISEO DR	# 100	GREENBRAE	CA	94904	2008	21	06041	37.9447135	-122.536758	Marin County
138064	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	8/26/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
138095	Fee-for-Service	1316248701	1316248701	1	1	PRIME HEALTHCARE ANAHEIM	11/16/2010	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3183	30	06059	33.82476552	-117.994914	Orange County
138113	Fee-for-Service	1841348653	1841348653	1	1	PHILLIPS, LILY Y	5/2/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66038	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
138125	Fee-for-Service	1477685436	1477685436	1	1	PROHEALTH PARTNERS, A MEDICA	5/1/1996	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	L GROUP, INC.	3939 ATLANTIC AVE	223	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
138135	Fee-for-Service	1154341188	1154341188	1	1	PEUS, JOSEPH C MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	21098	01	General Practice	0	In state provider	None	2324 BATH ST	None	SANTA BARBARA	CA	93105	4330	42	06083	34.43130628	-119.7229224	Santa Barbara County
138159	Fee-for-Service	1578907937	1578907937	1	1	PARAGON PSYCHOTHERAPY, INC.	8/8/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3727 W 6TH ST	614	LOS ANGELES	CA	90020	5111	19	06037	34.06358655	-118.3037656	Los Angeles County
138214	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	2/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
138242	Fee-for-Service	1104936574	1104936574	1	1	PETERS, ROBERT E MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63776	08	Family Practice	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
138254	Fee-for-Service	1255862835	1255862835	1	1	PERSCH, JASMIN A MD	7/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166049	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
138281	Fee-for-Service	1518258532	1518258532	1	1	PRISTINE REHABCARE INC	9/24/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B2	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
138315	Fee-for-Service	1720157274	1720157274	1	1	PIERSON, RAYMOND H MD	1/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	45467	20	Orthopedic Surgery	0	In state provider	None	813 COURT ST	STE 1	JACKSON	CA	95642	2131	03	06005	38.35290028	-120.7656399	Amador County
138317	Fee-for-Service	1548569866	1548569866	1	1	PATEL, MONA K MD	9/13/2018	207L00000X	NA	Other	026	PHYSICIANS	155867	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
138331	Fee-for-Service	1104997964	1104997964	1	1	PRING, MAYA ELIZABETH MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77003	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	SUITE 410	SAN DIEGO	CA	92123	4228	37	06073	32.798889	-117.150826	San Diego County
138347	Fee-for-Service	1972585941	1972585941	1	1	POEN, JOSEPH CHARLES MD	6/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66706	78	Neoplastic Diseases/Oncology	0	In state provider	RADIATION ONCOLOGY DEPT	1320 S ELISEO DR	# 100	GREENBRAE	CA	94904	2008	21	06041	37.9447135	-122.536758	Marin County
138353	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
138364	Fee-for-Service	1154718021	1154718021	1	1	PHAM, KEVIN T DPM	6/15/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138419	Fee-for-Service	1013011048	1013011048	1	2	PERSONAL HEARING SOLUTIONS I	3/11/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
138433	Fee-for-Service	1326501677	1326501677	1	1	PALMIRE, ASHLEY M DO	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19459	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
138467	Fee-for-Service	1063817716	1063817716	1	1	PASCUAL, JOEWEL D	8/11/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
138470	Fee-for-Service	1457919086	1457919086	1	1	PARSA, BAHAR MD	6/1/2022	208M00000X	NA	Other	026	PHYSICIANS	176760	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
138503	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
138531	Fee-for-Service	1104936574	1104936574	1	1	PETERS, ROBERT E MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63776	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
138532	Fee-for-Service	1033187588	1033187588	1	1	PAREKH, HEMAL J. MD	6/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85350	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
138534	Fee-for-Service	1396089645	1396089645	1	1	POURREZA, AFSHIN PSYD	11/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	550	IRVINE	CA	92612	4694	30	06059	33.650775	-117.838296	Orange County
138611	Fee-for-Service	1447577952	1447577952	1	1	PANDYA, NIKHIL DO	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12384	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
138622	Fee-for-Service	1851915888	1851915888	1	1	PANGEA LABORATORY LLC	6/7/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	14762 BENTLEY CIR	None	TUSTIN	CA	92780	7226	30	06059	33.71395683	-117.8077505	Orange County
138641	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
138706	Fee-for-Service	1013011048	1013011048	1	2	PERSONAL HEARING SOLUTIONS I	3/11/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	INC	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
138719	Fee-for-Service	1174703680	1174703680	1	1	POUNTNEY LEVESQUE, MARLENE E	3/28/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	93248	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2995	37	06073	33.14066871	-117.156095	San Diego County
138737	Fee-for-Service	1114213311	1114213311	1	1	PHAM, NHA T DPM	4/16/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
138771	Fee-for-Service	1417490889	1417490889	1	1	PACIFIC HEALTH CARE SYSTEMS	6/16/2017	335E00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	7846 BROADWAY	None	LEMON GROVE	CA	91945	1801	37	06073	32.74281027	-117.0295638	San Diego County
138792	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	6/23/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
138821	Fee-for-Service	1033187588	1033187588	1	1	PAREKH, HEMAL J. MD	6/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85350	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
138822	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/15/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
138851	Fee-for-Service	1922533819	1922533819	1	1	PARIASZEVSKI, ANETA S MD	2/16/2024	207PP0204X	NA	Other	026	PHYSICIANS	158954	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138867	Fee-for-Service	1699795856	1699795856	1	1	PHAM, PHUONG-THU T MD	9/1/1998	207RN0300X	NA	Nephrology	026	PHYSICIANS	66828	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
138869	Fee-for-Service	1093974248	1093974248	1	1	PACHA-DHARMA, JEEVARA T	7/31/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	103898	40	Pediatrics	0	In state provider	MD	830 SCENIC DRIVE	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
138886	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
138901	Fee-for-Service	1902596158	1902596158	1	1	PATEL, PRATIK NP	2/6/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	10001 COUNTY FARM RD	None	RIVERSIDE	CA	92503	3507	33	06065	33.92007421	-117.4585684	Riverside County
138910	Fee-for-Service	1760640742	1760640742	1	1	PAI, RAJIV P MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104008	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
138916	Fee-for-Service	1154391043	1154391043	1	1	PAUL LORRAINE GUERRY III MD	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5 RICHLAND MEDICAL PARK	None	COLUMBIA	SC	29203	6863	00	None	34.02757888	-81.03358168	Richland County
138928	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
138938	Fee-for-Service	1346390168	1346390168	1	1	PIMENTEL, KAREN E MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76053	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
138957	Fee-for-Service	1740332196	1740332196	1	1	PECORA, ANTHONY J CRNA	4/4/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
138967	Fee-for-Service	1992723456	1992723456	1	1	PAK, JONATHAN PJH MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76875	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
139003	Fee-for-Service	1609130921	1609130921	1	1	PHAM, MARTIN H MD	1/12/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	121590	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139008	Fee-for-Service	1053871491	1053871491	1	1	PERETIATKO, STEVEN MD	11/20/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190660	36	Psychiatry	0	In state provider	None	1303 MABLE AVE	None	MODESTO	CA	95355	1119	50	06099	37.69613281	-120.9756292	Stanislaus County
139021	Fee-for-Service	1255630398	1255630398	1	1	PRESTON, TRACY A NP	7/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
139069	Fee-for-Service	1174686901	1174686901	2	1	PULMONARY PROVIDERS, INC	12/30/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6457 INDEPENDENCE AVE	None	WOODLAND HILLS	CA	91367	2608	19	06037	34.18787651	-118.5906798	Los Angeles County
139079	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	10/5/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
139091	Fee-for-Service	1134228828	1134228828	1	1	PALMER, HIRAM S MD	9/14/2005	174400000X	NA	Other	026	PHYSICIANS	45372	41	Internal Medicine	0	In state provider	LOMA LINDA CARDIOLOGY	1701 E CESAR CHAVEZ AVE	STE S403	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
139105	Fee-for-Service	1811484934	1811484934	1	1	PETKO, KIMBERLY MD	7/12/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146932	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
139110	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	9/23/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
139162	Fee-for-Service	1982075107	1982075107	1	2	PEDIATRIC AND FAMILY MEDICAL	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	15211 VANOWEN AVE	SUITE 315	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
139176	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	10/9/2013	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
139215	Fee-for-Service	1972949287	1972949287	1	1	PUSKOOR, AKHILDEEP V MD	5/28/2020	208M00000X	NA	Other	026	PHYSICIANS	155027	41	Internal Medicine	0	In state provider	None	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
139217	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
139249	Fee-for-Service	1205362522	1205362522	1	2	PMH LABORATORY, INC	4/10/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	17791 FITCH	None	IRVINE	CA	92648	1224	30	06059	33.69337452	-117.8610165	Orange County
139297	Fee-for-Service	1134495542	1134495542	1	1	PIRYANI, KOMAL	11/12/2024	207R00000X	NA	Other	026	PHYSICIANS	170187	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
139303	Fee-for-Service	1558518571	1558518571	1	1	PETRUZZELLI, GLORIA PSYD	4/5/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
139322	Fee-for-Service	1316123714	1316123714	1	1	PHILLIPS, C VINCENT MD INC	3/25/2013	208600000X	NA	General Surgery	026	PHYSICIANS	37044	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3838 SAN DIMAS ST	STE B-231	BAKERSFIELD	CA	93311	3611	15	06029	35.3946385	-119.008203	Kern County
139327	Fee-for-Service	1043311277	1043311277	1	1	PEARLMAN, JUSTIN D MD	7/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	46006	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1700 MOUNT VERNON AVENUE	ATTN LINDA SHANLEY	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
139333	Fee-for-Service	1073902854	1073902854	1	1	PARR, DYAMOND A LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
139365	Fee-for-Service	1841373800	1841373800	1	10	PERMANENTE MEDICAL GROUP INC	6/20/2017	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
139368	Fee-for-Service	1134228828	1134228828	1	1	PALMER, HIRAM S MD	9/14/2005	174400000X	NA	Other	026	PHYSICIANS	45372	06	Cardiovascular Disease (M.D. only)	0	In state provider	LOMA LINDA CARDIOLOGY	1701 E CESAR CHAVEZ AVE	STE S403	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
139383	Fee-for-Service	1487901641	1487901641	1	1	PACIFIC GROVE UNIFIED SCHOOL	7/1/2012	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	435 HILLCREST AVE	None	PACIFIC GROVE	CA	93950	4900	27	06053	36.61301677	-121.9172845	Monterey County
139397	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/15/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
139421	Fee-for-Service	1548258106	1548258106	1	1	PRIMA MEDICAL GROUP INC	10/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5 BON AIR RD	STE 101	LARKSPUR	CA	94939	1134	21	06041	37.9438204	-122.5395357	Marin County
139440	Fee-for-Service	1669039939	1669039939	1	1	PATRIOT TRANSPORTATION SERVI	3/21/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CES,INC	905 W.MAIN ST	G	EL CAJON	CA	92020	4443	37	06073	32.79494154	-116.9734635	San Diego County
139449	Fee-for-Service	1982075107	1982075107	1	2	PEDIATRIC AND FAMILY MEDICAL	8/20/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	15211 VANOWEN AVE	SUITE 315	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
139452	Fee-for-Service	1467535492	1467535492	1	1	PARK, LOUISE M. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 17TH AVE	None	SEATTLE	WA	98122	5788	00	None	47.60689769	-122.3102467	King County
139453	Fee-for-Service	1063706448	1063706448	1	1	PRIMERANO, JAIME J DO	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
139460	Fee-for-Service	1518916857	1518916857	1	1	PERDION, KAREN CNM	5/29/2012	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
139464	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
139490	Fee-for-Service	1538355672	1538355672	1	1	PARK, WALTER G MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88008	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
139494	Fee-for-Service	1801882360	1801882360	1	1	PINTO, MARK A	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70500	41	Internal Medicine	0	In state provider	None	758 E BULLARD AVE	STE 101	FRESNO	CA	93710	5472	10	06019	36.82313646	-119.7733995	Fresno County
139505	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	11/8/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
139508	Fee-for-Service	1124126628	1124126628	1	1	PHILLIPS, BENJAMIN CP	12/15/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ONTARIO PROSTHETICS	12981 PERRIS BLVD	STE 101	MORENO VALLEY	CA	92553	4108	33	06065	33.932205	-117.2263165	Riverside County
139514	Fee-for-Service	1508018748	1508018748	1	1	PARK AVENUE OPTOMETRY INC	6/1/2009	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PARK AVE	STE 120	POMONA	CA	91766	1501	19	06037	34.05635453	-117.7544297	Los Angeles County
139540	Fee-for-Service	1972636009	1972636009	1	1	PAVILION NEUROLOGY	6/17/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MEDICAL GROUP, INC	1140 W LA VETA AVE	STE 730	ORANGE	CA	92868	4229	30	06059	33.7802984	-117.8651669	Orange County
139554	Fee-for-Service	1548620404	1548620404	1	1	PEREZ-ROSENDAHL, MARI MD	5/24/2018	390200000X	NA	Other	026	PHYSICIANS	141371	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
139609	Fee-for-Service	1316123714	1316123714	1	1	PHILLIPS, C VINCENT MD INC	3/25/2013	208600000X	NA	General Surgery	026	PHYSICIANS	37044	02	General Surgery	0	In state provider	None	3838 SAN DIMAS ST	STE B-231	BAKERSFIELD	CA	93311	3611	15	06029	35.3946385	-119.008203	Kern County
139652	Fee-for-Service	1912403031	1912403031	1	1	PREIKSAITIS, CARL M MD	6/12/2022	207P00000X	NA	Other	026	PHYSICIANS	163647	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
139665	Fee-for-Service	1245522739	1245522739	1	1	PARK, HYUN S MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149954	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
139677	Fee-for-Service	1093848509	1093848509	1	1	PROHEALTH PARTNERS,A	8/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	MEDICAL GROUP,INC	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
139686	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	4/13/2020	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
139723	Fee-for-Service	1619195427	1619195427	1	1	PIRJANIAN, ZAREH MD	11/10/2009	207R00000X	NA	Other	026	PHYSICIANS	107211	41	Internal Medicine	0	In state provider	None	225 W BROADWAY	STE 100	GLENDALE	CA	91204	1393	19	06037	34.14673469	-118.257145	Los Angeles County
139724	Fee-for-Service	1821455452	1821455452	1	1	PETROSSIAN, EDMOND K DO	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15290	01	General Practice	0	In state provider	None	9089 BASELINE ROAD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
139737	Fee-for-Service	1982075107	1982075107	1	2	PEDIATRIC AND FAMILY MEDICAL	6/20/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	15211 VANOWEN AVE	SUITE 315	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
139753	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/4/2020	1041C0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
139754	Fee-for-Service	1851727986	1851727986	1	1	PENG, TIMOTHY T	2/28/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8001 VENTURA CANYON AVE	# MOB 51	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
139764	Fee-for-Service	1760462162	1760462162	1	1	PEREZ YOUNG, IRENE V MD	7/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160217	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
139773	Fee-for-Service	1467834044	1467834044	1	1	PATEL, JAY A MD	10/15/2021	207R00000X	NA	Other	026	PHYSICIANS	164610	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
139793	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	6/12/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
139803	Fee-for-Service	1760689020	1760689020	1	1	PARK, JAE H MD	8/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115962	05	Anesthesiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
139839	Fee-for-Service	1487303400	1487303400	1	1	PHARMA CASA, INC.	4/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 W WARNER AVE	UNIT D2	SANTA ANA	CA	92707	3179	30	06059	33.71616652	-117.882981	Orange County
139840	Fee-for-Service	1619074309	1619074309	1	1	PHAM, NGAN-THUY D MD	3/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82107	40	Pediatrics	0	In state provider	None	1025 ATLANTIC AVE	None	LONG BEACH	CA	90813	3402	19	06037	33.779403	-118.1850775	Los Angeles County
139933	Fee-for-Service	1659650679	1659650679	1	1	PARRETT, RYAN K	12/19/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
139952	Fee-for-Service	1245522739	1245522739	1	1	PARK, HYUN S MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149954	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
139967	Fee-for-Service	1093848509	1093848509	1	1	PROHEALTH PARTNERS,A	8/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP,INC	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
139972	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	10/25/2019	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
139978	Fee-for-Service	1790863439	1790863439	1	1	PUCCINELLI, MICHAEL J MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55986	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
140029	Fee-for-Service	1255899605	1255899605	1	1	PARIKH, SHUCHI R NP	5/22/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	685 N 13TH AVE	STE 7,8,9	UPLAND	CA	91786	4963	36	06071	34.10202219	-117.6339091	San Bernardino County
140037	Fee-for-Service	1457376980	1457376980	1	1	PARK, SHIRLEY MD	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88452	41	Internal Medicine	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
140040	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	10/9/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
140076	Fee-for-Service	1306281464	1306281464	1	1	PENWARDEN, KRISTINE OT	11/19/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41769 ENTERPRISE CIR N	STE 104	TEMECULA	CA	92590	5626	33	06065	33.51823541	-117.1701538	Riverside County
140080	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
140155	Fee-for-Service	1659705564	1659705564	1	1	P WILLIAMS, VICTORIA L DO	12/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14008	01	General Practice	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
140188	Fee-for-Service	1225369549	1225369549	1	1	PEREZ, ROGELIO JR PHD	6/20/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
140206	Fee-for-Service	1346874062	1346874062	1	1	PROVITAL CARE INC	5/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20953 DEVONSHIRE BLVD	SUITE 6	CHATSWORTH	CA	91311	2371	19	06037	34.25728152	-118.5904935	Los Angeles County
140244	Fee-for-Service	1629279971	1629279971	1	1	PETERSEN, DONNA K PT	7/10/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
140255	Fee-for-Service	1093848509	1093848509	1	1	PROHEALTH PARTNERS,A	8/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP,INC	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
140257	Fee-for-Service	1881799658	1881799658	1	1	PENA, JORGE MD	7/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75656	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2515 PARK MARINA DR	STE 103	REDDING	CA	96001	2831	45	06089	40.57722857	-122.3708794	Shasta County
140261	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/15/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
140266	Fee-for-Service	1558520676	1558520676	1	1	PAYNE, MATTHEW S MD	1/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124622	41	Internal Medicine	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
140314	Fee-for-Service	1508286444	1508286444	1	1	PARKER RICHARDS HILL	5/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
140330	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	10/9/2013	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
140360	Fee-for-Service	1346024817	1346024817	1	1	PLACE OF PRESERVATION HOLIST	9/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	IC FAMILY COUNSELING	5701 TRUXTUN AVE	STE. 220	BAKERSFIELD	CA	93309	0402	15	06029	35.36412529	-119.0677405	Kern County
140368	Fee-for-Service	1740410182	1740410182	1	17	PACIFIC DERMATOLOGY INSTITUT	11/4/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	57463 29 PALMS HWY	201	YUCCA VALLEY	CA	92284	2925	36	06071	34.12447835	-116.4106891	San Bernardino County
140370	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
140371	Fee-for-Service	1487713145	1487713145	1	1	PIETRANTONIO, ENRICO MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77641	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
140383	Fee-for-Service	1578986949	1578986949	1	2	PHIELIPP, NICOLAS M MD	8/21/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	161477	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
140384	Fee-for-Service	1407300411	1407300411	1	1	PIGNOTTI, JANELLE LCSW	6/24/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	19	06037	34.147521	-118.2549325	Los Angeles County
140425	Fee-for-Service	1447656566	1447656566	1	1	PACIFIC VILLA, INC	12/8/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3501 CEDAR AVE	None	LONG BEACH	CA	90807	3809	19	06037	33.82092336	-118.1954148	Los Angeles County
140442	Fee-for-Service	1811991474	1811991474	1	1	PETER W CASTELLANOS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 E IDAHO ST	None	BOISE	ID	83712	6267	00	None	43.61191085	-116.1938523	Ada County
140445	Fee-for-Service	1033103676	1033103676	1	4	PACIFIC REDWOOD MEDICAL GROU	10/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	P, INC.	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
140547	Fee-for-Service	1063463784	1063463784	1	1	PATIDAR, SANDIP MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84061	30	Radiology	0	In state provider	None	2466 1ST AVE	None	SAN DIEGO	CA	92101	1408	37	06073	32.731137	-117.1639695	San Diego County
140548	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
140567	Fee-for-Service	1942867353	1942867353	1	1	PEREZ, ALEXENDAR R MD	6/5/2024	207L00000X	NA	Other	026	PHYSICIANS	181483	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
140568	Fee-for-Service	1104226935	1104226935	1	1	PARK, EUGENE Y MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
140590	Fee-for-Service	1477083319	1477083319	1	1	POPP, SARAH LAC	11/8/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY DR	SUITE 180	SCOTTS VALLEY	CA	95066	3452	44	06087	37.06204883	-122.0069319	Santa Cruz County
140606	Fee-for-Service	1245266261	1245266261	1	1	PRIBYL,CHARLES R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 CEDAR ST	STE 6600	ALBUQUERQUE	NM	87106	0000	00	None	35.08078421	-106.6341683	Bernalillo County
140615	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/8/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
140655	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	6/21/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
140656	Fee-for-Service	1740410182	1740410182	1	17	PACIFIC DERMATOLOGY INSTITUT	11/4/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	57463 29 PALMS HWY	201	YUCCA VALLEY	CA	92284	2925	36	06071	34.12447835	-116.4106891	San Bernardino County
140728	Fee-for-Service	1033103676	1033103676	1	4	PACIFIC REDWOOD MEDICAL GROU	10/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC.	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
140751	Fee-for-Service	1205852985	1205852985	1	1	PRUTHI, JATINDER, S MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64919	41	Internal Medicine	0	In state provider	None	1331 W AVENUE J	# 12	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
140758	Fee-for-Service	1669042156	1669042156	1	1	PROTECTIVE HOME HEALTH CARE	1/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	221 E GLENOAKS BLVD	UNIT 222A	GLENDALE	CA	91207	2085	19	06037	34.15856042	-118.253151	Los Angeles County
140761	Fee-for-Service	1801000732	1801000732	1	1	PALACIOS, RICHARD E	2/13/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1101 TRUMAN ST	STE E	SAN FERNANDO	CA	91340	3237	19	06037	34.28359178	-118.4409913	Los Angeles County
140794	Fee-for-Service	1710993019	1710993019	1	1	PAYLESS DRUG STORE 6062	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	4004 FOOTHILLS BLVD	None	ROSEVILLE	CA	95747	7233	31	06061	38.752281	-121.3094065	Placer County
140802	Fee-for-Service	1205908019	1205908019	1	1	PARK, JUDITH J MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67521	02	General Surgery	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
140808	Fee-for-Service	1215095575	1215095575	1	1	PLANNED PARENTHOOD-	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANTIOCH	1104 BUCHANAN RD	None	ANTIOCH	CA	94509	4205	07	06013	37.99867244	-121.823243	Contra Costa County
140832	Fee-for-Service	1629392592	1629392592	2	1	PRECISION MEDICAL PRODUCTS,	4/8/2019	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC.	2217 PLAZA DR	None	ROCKLIN	CA	95765	4421	31	06061	38.79470153	-121.2719842	Placer County
140833	Fee-for-Service	1467505040	1467505040	1	1	POOR, PATRICK M LMFT	12/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4515 CENTRAL AVE.	203	RIVERSIDE	CA	92506	2374	33	06065	33.9535052	-117.4014216	Riverside County
140838	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	7/5/2019	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
140866	Fee-for-Service	1891741831	1891741831	1	1	PHYSICIANS RADIOLOGY MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	6386 ALVARADO CT	STE 121	SAN DIEGO	CA	92120	4906	37	06073	32.77666838	-117.0614255	San Diego County
140900	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/8/2015	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
140929	Fee-for-Service	1518056696	1518056696	1	1	PARKER, WILLIAM L &	8/1/1998	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCS INC	4201 TORRANCE BLVD	STE 140	TORRANCE	CA	90503	4500	19	06037	33.8375955	-118.358748	Los Angeles County
140946	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	5/16/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
140986	Fee-for-Service	1447389085	1447389085	1	1	PALLAS, ROBERT MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	32895	01	General Practice	0	In state provider	None	933 N CENTINELA AVE	None	INGLEWOOD	CA	90302	1501	19	06037	33.97609809	-118.356369	Los Angeles County
141014	Fee-for-Service	1033103676	1033103676	1	4	PACIFIC REDWOOD MEDICAL GROU	10/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	P, INC.	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
141039	Fee-for-Service	1205852985	1205852985	1	1	PRUTHI, JATINDER, S MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64919	10	Gastroenterology (M.D. only)	0	In state provider	None	1331 W AVENUE J	# 12	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
141058	Fee-for-Service	1154692549	1154692549	1	1	POLLOCK, YAOYAO G MD	8/10/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	147607	68	Hematology	0	In state provider	None	3555 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
141060	Fee-for-Service	1215202841	1215202841	1	1	PHO, ANTHONY	8/6/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
141079	Fee-for-Service	1396078002	1396078002	1	1	PHARES, TANYA M DO	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
141095	Fee-for-Service	1447455241	1447455241	1	1	PALMA, RACHEL C MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9604	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
141124	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
141139	Fee-for-Service	1083932990	1083932990	2	1	PATEL-PRINEAS, MUKTI J MD	7/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186669	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
141161	Fee-for-Service	1487995130	1487995130	1	1	PALLOTTA, GINA M PHD	7/3/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
141188	Fee-for-Service	1871911552	1871911552	1	1	PERILLA, ADRIANA S P MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152822	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
141193	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	2/24/2019	1041C0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
141204	Fee-for-Service	1861440273	1861440273	1	1	PELLETIER, GLENN J MD	11/13/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	86182	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
141206	Fee-for-Service	1285641233	1285641233	1	1	PATEL, KALPANA G	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55961	10	Gastroenterology (M.D. only)	0	In state provider	None	2880 ATLANTIC AVE	STE 100	LONG BEACH	CA	90806	1739	19	06037	33.809382	-118.185001	Los Angeles County
141232	Fee-for-Service	1639252604	1639252604	1	24	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3009	41	06081	37.63110308	-122.4181613	San Mateo County
141276	Fee-for-Service	1154970259	1154970259	1	1	PALACIO, EMILY F NP	3/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
141290	Fee-for-Service	1407908866	1407908866	1	1	PAGAL, JOANNE G MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7492	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
141342	Fee-for-Service	1568704864	1568704864	1	1	PATERSON, NEIL E MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137761	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
141358	Fee-for-Service	1235243882	1235243882	1	1	PARULEKAR, SANGEETA S DO	9/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8825	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
141391	Fee-for-Service	1013096155	1013096155	1	1	PATEL, MANISH T MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89507	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
141414	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	9/16/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
141436	Fee-for-Service	1922104223	1922104223	1	1	PERRY, KATHERINE W MD	7/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73952	40	Pediatrics	0	In state provider	None	5333 HOLLISTER AVENUE	STE 250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
141446	Fee-for-Service	1356312953	1356312953	1	1	PAPPOE, LAMIOKO S MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96681	45	Nephrology (Renal-Kidney)	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
141461	Fee-for-Service	1144251216	1144251216	1	1	PALM BEACH GARDENS COMMUNITY	12/6/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL INC	3360 BURNS ROAD	None	PALM BEACH GARDEN	FL	33410	4323	00	None	26.83072147	-80.08678947	Palm Beach County
141465	Fee-for-Service	1457456337	1457456337	1	1	PEDIATRIC PULMONARY	7/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
141481	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	2/8/2020	1041C0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
141546	Fee-for-Service	1427453166	1427453166	1	1	PEREZ, CARLOS J PSYD	11/16/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
141588	Fee-for-Service	1508922139	1508922139	1	1	PYSKATY, DONALD J MD	11/9/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80237	40	Pediatrics	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
141615	Fee-for-Service	1205144813	1205144813	1	1	PANKAJ M. KHEMKA, M.D., INC.	3/7/2025	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 410	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
141618	Fee-for-Service	1518313451	1518313451	1	1	PURAVATH, ABIN P MD	3/20/2024	207RR0500X	NA	Other	026	PHYSICIANS	192533	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
141666	Fee-for-Service	1255411534	1255411534	1	1	PERRY, ADAM D MD	2/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	97590	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
141675	Fee-for-Service	1598832487	1598832487	1	1	PARRA, DAVID C MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77932	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
141677	Fee-for-Service	1083978027	1083978027	1	1	PERRIN, MEREDITH A MD	9/12/2016	207N00000X	NA	Dermatology	026	PHYSICIANS	143933	07	Dermatology	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
141701	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
141717	Fee-for-Service	1952306268	1952306268	1	1	PAUL R CAPITO MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3623 LATROBE DR	STE 216	CHARLOTTE	NC	28211	2117	00	None	35.196597	-80.7973065	Mecklenburg County
141718	Fee-for-Service	1972593135	1972593135	1	1	PARKER, BRUCE R MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16392	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
141724	Fee-for-Service	1922104223	1922104223	1	1	PERRY, KATHERINE W MD	7/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73952	45	Nephrology (Renal-Kidney)	0	In state provider	None	5333 HOLLISTER AVENUE	STE 250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
141727	Fee-for-Service	1427584481	1427584481	1	1	PEREZ, NATALY PSYD	10/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
141734	Fee-for-Service	1356312953	1356312953	1	1	PAPPOE, LAMIOKO S MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96681	41	Internal Medicine	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
141748	Fee-for-Service	1144251216	1144251216	1	1	PALM BEACH GARDENS COMMUNITY	12/6/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL INC	3360 BURNS ROAD	None	PALM BEACH GARDEN	FL	33410	4323	00	None	26.83072147	-80.08678947	Palm Beach County
141756	Fee-for-Service	1669288585	1669288585	1	1	PINGATORE, JESSICA L NP	2/21/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141768	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/29/2018	1041C0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
141846	Fee-for-Service	1619058880	1619058880	1	1	PAUL, EDWARD G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
141945	Fee-for-Service	1033103676	1033103676	1	7	PACIFIC REDWOOD MEDICAL GROU	12/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC.	1 MARCELA DR	None	WILLITS	CA	95490	5769	23	06045	39.3901086	-123.339055	Mendocino County
141962	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	1/21/2022	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
141966	Fee-for-Service	1033291786	1033291786	1	1	PROCTOR, CHRISTOPHER S	7/28/1997	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	73974	20	Orthopedic Surgery	0	In state provider	None	536 E ARRELLAGA ST	STE 101	SANTA BARBARA	CA	93103	2262	42	06083	34.43335006	-119.702891	Santa Barbara County
141986	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	5/1/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
141995	Fee-for-Service	1699023929	1699023929	1	1	PATAKY, MORRIS MD	9/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
142014	Fee-for-Service	1710348628	1710348628	1	1	PEREZ ANDREU, VIRGINIA MD	12/9/2019	207R00000X	NA	Other	026	PHYSICIANS	163439	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
142018	Fee-for-Service	1598261448	1598261448	1	1	PAYONK, ELIZABETH MD	7/8/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
142024	Fee-for-Service	1396728044	1396728044	1	1	PEREZ, SANDRA L CNP	5/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
142046	Fee-for-Service	1386618841	1386618841	1	1	PEARL, LAURENCE B MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69783	02	General Surgery	0	In state provider	None	14571 MAGNOLIA ST	STE 204	WESTMINSTER	CA	92683	5576	30	06059	33.75097286	-117.9723502	Orange County
142053	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
142084	Fee-for-Service	1285639690	1285639690	1	1	POMERANZ, STEPHEN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PROSCAN RADIOLOGY	5400 KENNEDY AVE	None	CINCINNATI	OH	45213	0000	00	None	39.17088658	-84.41994184	Hamilton County
142097	Fee-for-Service	1992753842	1992753842	1	1	PLOTZ, PHILLIP B MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63826	01	General Practice	0	In state provider	None	582 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97663433	-121.9534022	Santa Cruz County
142101	Fee-for-Service	1841382272	1841382272	1	1	PAIUK, ELIAN D MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86586	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
142140	Fee-for-Service	1710084835	1710084835	1	1	PEREZ-LOPEZ, MINERVA H	11/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91942	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
142144	Fee-for-Service	1518498625	1518498625	1	1	PIETRYGA, JANEL MD	7/19/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176709	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142210	Fee-for-Service	1861611832	1861611832	1	1	PAAKKONEN, PIA U	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
142233	Fee-for-Service	1033103676	1033103676	1	7	PACIFIC REDWOOD MEDICAL GROU	12/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	P, INC.	1 MARCELA DR	None	WILLITS	CA	95490	5769	23	06045	39.3901086	-123.339055	Mendocino County
142247	Fee-for-Service	1073787800	1073787800	1	1	PATEL, ROBIN R MD	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124967	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
142251	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/9/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
142265	Fee-for-Service	1750571659	1750571659	1	1	PON, LINDA CRNA	8/28/2017	174400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
142275	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	12/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
142280	Fee-for-Service	1932413200	1932413200	1	1	PATEL, ASHISH A MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122093	41	Internal Medicine	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
142282	Fee-for-Service	1669849394	1669849394	1	1	PULMONARY & CRITICAL CARE	9/6/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	ASSOCIATES OF MODESTO IN	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
142342	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	9/16/2019	1041C0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
142354	Fee-for-Service	1740634971	1740634971	1	1	PARKS, MONICA M MD	7/2/2019	208M00000X	NA	Other	026	PHYSICIANS	153747	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
142357	Fee-for-Service	1982803524	1982803524	1	1	PANDYA, KHYATI MD	11/6/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
142386	Fee-for-Service	1386790780	1386790780	1	1	PADILLA-CASTRO, MARIA S LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	SUITE 150	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
142400	Fee-for-Service	1487903399	1487903399	1	1	PROHEALTH PARTNERS A MEDICAL	1/20/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	255 E BONITA AVE	STE 101	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
142429	Fee-for-Service	1902824758	1902824758	1	1	PROVIDENCE HEALTH SYSTEM	8/28/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
142451	Fee-for-Service	1598811358	1598811358	1	1	PETERSON, KIRK L MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	16298	01	General Practice	0	In state provider	DEPT OF MEDICINE	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
142496	Fee-for-Service	1700122686	1700122686	1	1	PECSON, SAMANTHA C DO	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12375	01	General Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
142522	Fee-for-Service	1952549073	1952549073	1	1	PARAMORE, KRISTINA A LMFT	6/10/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	92765	-	NOT APPLICABLE	0	In state provider	None	1523 LONGBRANCH AVE	None	GROVER BEACH	CA	93433	2508	40	06079	35.11917729	-120.6126498	San Luis Obispo County
142524	Fee-for-Service	1033103676	1033103676	1	7	PACIFIC REDWOOD MEDICAL GROU	12/1/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	P, INC.	1 MARCELA DR	None	WILLITS	CA	95490	5769	23	06045	39.3901086	-123.339055	Mendocino County
142532	Fee-for-Service	1760413330	1760413330	1	1	POON ADORA GK MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	104964	40	Pediatrics	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
142539	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	2/11/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
142566	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/15/2019	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
142570	Fee-for-Service	1669849394	1669849394	1	1	PULMONARY & CRITICAL CARE	9/6/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES OF MODESTO IN	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
142587	Fee-for-Service	1891741831	1891741831	1	2	PHYSICIANS RADIOLOGY MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC/SPLIT RADIOLOGY	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
142632	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	2/9/2018	1041C0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
142664	Fee-for-Service	1780612283	1780612283	1	1	PARK, ERIC E LAC	3/6/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	30110 CROWN VALLEY PKWY	SUITE 107	LAGUNA NIGUEL	CA	92677	2043	30	06059	33.52549167	-117.7125927	Orange County
142669	Fee-for-Service	1942629050	1942629050	1	1	PATTERSON, JOSHUA MD	5/23/2024	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
142676	Fee-for-Service	1912297375	1912297375	1	1	PERMUTT, ZACHARY D MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119583	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142677	Fee-for-Service	1982722369	1982722369	1	1	PHAN YEUNG, JULIA N OD	9/8/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 S. BEACH BLVD	None	LA HABRA	CA	90631	7475	30	06059	33.914655	-117.9662805	Orange County
142696	Fee-for-Service	1164415071	1164415071	1	1	PYTER, LUDMILA T MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50677	01	General Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
142716	Fee-for-Service	1467786277	1467786277	1	1	PRASAD, VINAYAK K MD	1/9/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	169093	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
142727	Fee-for-Service	1013757905	1013757905	1	1	PRIORITYCARE	8/24/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	270 E DOUGLAS AVE	STE 110D	EL CAJON	CA	92020	4514	37	06073	32.7938777	-116.9592516	San Diego County
142779	Fee-for-Service	1538664669	1538664669	1	1	PEI, TRIXIE LORRAINE C MD	7/26/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	184644	None	None	0	In state provider	None	3230 BEARD ROAD	SUITE 1	NAPA	CA	94558	3673	28	06055	38.3216968	-122.2953847	Napa County
142792	Fee-for-Service	1366627945	1366627945	1	1	PARONIAN, GREGOR MD	3/17/2021	207R00000X	NA	Other	026	PHYSICIANS	107875	None	None	0	In state provider	None	1713 E WALNUT ST	None	PASADENA	CA	91106	1611	19	06037	34.14957847	-118.11501	Los Angeles County
142798	Fee-for-Service	1437471174	1437471174	1	1	POOLE, ARNETTA MD INC	3/2/2010	193400000X	NA	Other	026	PHYSICIANS	75829	05	Anesthesiology	0	In state provider	None	1117 E DEVONSHIRE AVENUE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
142811	Fee-for-Service	1770783177	1770783177	1	1	PRICE, ERIK T MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69663	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
142815	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	2/28/1995	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
142819	Fee-for-Service	1760413330	1760413330	1	1	POON ADORA GK MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	104964	05	Anesthesiology	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
142827	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
142843	Fee-for-Service	1356505705	1356505705	1	1	POMERANTZ, MICHAEL L MD	10/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109105	20	Orthopedic Surgery	0	In state provider	None	955 LANE AVENUE	SUITE 200	CHULA VISTA	CA	91914	4525	37	06073	32.65121611	-116.9615942	San Diego County
142855	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/15/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
142902	Fee-for-Service	1316006901	1316006901	1	1	PETERS, HANS W MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22002	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
142905	Fee-for-Service	1396078002	1396078002	1	2	PHARES, TANYA M DO	2/22/2024	207R00000X	NA	Other	086	MEDICAL DIRECTORS	10911	-	NOT APPLICABLE	0	In state provider	None	2400-A COUNTY CENTER DR	None	SANTA ROSA	CA	95403	3004	49	06097	38.46366	-122.7255255	Sonoma County
142910	Fee-for-Service	1861820623	1861820623	1	1	PANORAMA MEDICAL GROUP INC	8/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	14526 ROSCOE BLVD	SUITE 101	PANORAMA CITY	CA	91402	4177	19	06037	34.22150447	-118.449873	Los Angeles County
142912	Fee-for-Service	1487991261	1487991261	1	2	POULSEN, TIFFANI PSYD	3/20/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
142916	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	10/15/2018	1041C0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
142970	Fee-for-Service	1871962076	1871962076	1	3	PORTOLA MEDICAL SERVICES, PC	7/21/2021	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	- LAKE FOREST	1511 E. KATELLA AVENUE	None	ORANGE	CA	92867	5025	30	06059	33.80921851	-117.837648	Orange County
143016	Fee-for-Service	1477737369	1477737369	1	1	POLE, SHIVANAND MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101547	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
143043	Fee-for-Service	1518289503	1518289503	1	1	PHAM, CAO VAN MD INC	4/7/2010	193400000X	NA	Other	026	PHYSICIANS	32951	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17742 BEACH BLVD	STE 230	HUNTINGTON BEACH	CA	92647	6835	30	06059	33.704487	-117.989061	Orange County
143052	Fee-for-Service	1467863043	1467863043	1	1	PETERSON, WILLIAM J MD	7/2/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	1500 EAST MEDICAL CENTER	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
143103	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/19/2016	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
143107	Fee-for-Service	1396199287	1396199287	1	1	PEREYRA, AUBREE D MD	6/23/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158358	None	None	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
143115	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/3/2023	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
143142	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	4/26/2020	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
143149	Fee-for-Service	1851311104	1851311104	1	2	PETERSON, RALPH L MD	11/20/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	49099	-	NOT APPLICABLE	0	In state provider	None	7200 BANCROFT AVENUE	SUITE 176	OAKLAND	CA	94605	2411	01	06001	37.768221	-122.17608	Alameda County
143151	Fee-for-Service	1124294756	1124294756	1	1	PURUSHOTHAM, WINOLA R MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109277	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
143166	Fee-for-Service	1386146587	1386146587	1	1	PATEL, JAGATKUMAR A MD	12/4/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186386	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
143201	Fee-for-Service	1861820623	1861820623	1	1	PANORAMA MEDICAL GROUP INC	8/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	14526 ROSCOE BLVD	SUITE 101	PANORAMA CITY	CA	91402	4177	19	06037	34.22150447	-118.449873	Los Angeles County
143202	Fee-for-Service	1285021139	1285021139	1	1	PHAM, JONATHAN M DO	8/9/2019	208M00000X	NA	Other	026	PHYSICIANS	15525	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
143207	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	2/12/2019	1041C0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
143220	Fee-for-Service	1639252604	1639252604	1	1	PERMANENTE MEDICAL GROUP INC	1/1/1994	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
143238	Fee-for-Service	1821429838	1821429838	1	1	PROHEALTH PARTNERS A MEDICAL	12/2/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	711 EAST ROSECRANS AVE	None	COMPTON	CA	90221	2143	19	06037	33.9035073	-118.2158303	Los Angeles County
143263	Fee-for-Service	1699909622	1699909622	1	1	PHUNG, THAO MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	125932	41	Internal Medicine	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
143293	Fee-for-Service	1295844587	1295844587	1	1	PAYLESS DRUG STORE 5387	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	THRIFTY PAYLESS INC	1642 WILLIAMS HWY	None	GRANTS PASS	OR	97527	5660	00	None	42.42014564	-123.3351655	Josephine County
143321	Fee-for-Service	1770011363	1770011363	1	1	PATEL, AVNI D DO	11/5/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18578	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143329	Fee-for-Service	1518289503	1518289503	1	1	PHAM, CAO VAN MD INC	4/7/2010	193400000X	NA	Other	026	PHYSICIANS	32951	41	Internal Medicine	0	In state provider	None	17742 BEACH BLVD	STE 230	HUNTINGTON BEACH	CA	92647	6835	30	06059	33.704487	-117.989061	Orange County
143330	Fee-for-Service	1144946948	1144946948	1	1	PENNY, ALEEZA R RCP	5/22/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
143332	Fee-for-Service	1194119008	1194119008	1	1	PUTTOCK, LUCAS A DO	9/2/2020	207R00000X	NA	Other	026	PHYSICIANS	18378	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
143347	Fee-for-Service	1730408568	1730408568	1	1	PERSONAL CARE HOSPICE SERVIC	11/15/2011	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	2318 W BURBANK BLVD	None	BURBANK	CA	91506	1236	19	06037	34.17918803	-118.3366966	Los Angeles County
143368	Fee-for-Service	1912599382	1912599382	1	1	PEDERSON, KELLI PT	3/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
143392	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
143403	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	1/28/2022	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
143418	Fee-for-Service	1447839592	1447839592	1	1	PRICE, RYAN K MD	4/24/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
143429	Fee-for-Service	1336222397	1336222397	1	16	PERMANENTE MEDICAL GROUP INC	2/8/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
143443	Fee-for-Service	1215905260	1215905260	1	1	PRIMACK, DAREN S MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	68135	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	845 S FAIRMONT AVE	STE 11	LODI	CA	95240	5113	39	06077	38.123217	-121.285878	San Joaquin County
143446	Fee-for-Service	1376621136	1376621136	1	1	PHELAN, MICHAEL J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	73755	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
143453	Fee-for-Service	1326094020	1326094020	1	5	PHI HEALTH, LLC	8/11/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	4740 TAYLOR ST	None	ELOY	AZ	85131	9736	00	None	32.804163	-111.5825175	Pinal County
143478	Fee-for-Service	1033341680	1033341680	1	2	PROHEALTH PARTNERS A MEDICAL	4/2/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	925 E SAN ANTONIO DR	STE 18	LONG BEACH	CA	90807	2210	19	06037	33.83838926	-118.1823231	Los Angeles County
143496	Fee-for-Service	1336222397	1336222397	1	15	PERMANENTE MEDICAL GROUP INC	3/9/2020	1041C0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
143519	Fee-for-Service	1669417598	1669417598	1	1	PLECHA, EDWARD MD	2/28/1993	2086S0129X	NA	General Surgery	026	PHYSICIANS	52040	02	General Surgery	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
143560	Fee-for-Service	1740207752	1740207752	1	1	PHAM, FRANCIS T MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88708	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
143574	Fee-for-Service	1720334626	1720334626	1	1	PRIORITY ONE HOSPICE INC	7/23/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 107C	MONTCLAIR	CA	91763	2357	36	06071	34.08129954	-117.6966135	San Bernardino County
143599	Fee-for-Service	1215563093	1215563093	1	1	PROCK, DANIELLE M CNP	8/9/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
143607	Fee-for-Service	1356970701	1356970701	1	1	PARK, JEONG SOO MD	2/10/2023	207R00000X	NA	Other	026	PHYSICIANS	183996	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
143615	Fee-for-Service	1093185183	1093185183	1	1	PASSMORE, TIMOTHY P CRNA	10/26/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
143622	Fee-for-Service	1639420540	1639420540	1	1	PATEL, RESHMA M MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124934	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	GE10	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
143634	Fee-for-Service	1730408568	1730408568	1	1	PERSONAL CARE HOSPICE SERVIC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	2318 W BURBANK BLVD	None	BURBANK	CA	91506	1236	19	06037	34.17918803	-118.3366966	Los Angeles County
143667	Fee-for-Service	1427390111	1427390111	1	1	PAIK, KRISTINE H MD	8/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148521	05	Anesthesiology	0	In state provider	None	8700 BEVELRY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
143679	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/29/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
143692	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
143704	Fee-for-Service	1619088630	1619088630	1	1	PONCELET, ANN N MD	5/31/1993	2084N0400X	NA	Neurology	026	PHYSICIANS	68502	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
143714	Fee-for-Service	1972510477	1972510477	1	1	PERLMAN, JONATHAN P /DBA	8/1/2002	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	610 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	57	06113	38.67351395	-121.7933438	Yolo County
143746	Fee-for-Service	1912299132	1912299132	1	1	PIERCE, CAROLYN M MD	2/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2801 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25271647	-121.787181	Klamath County
143752	Fee-for-Service	1700260296	1700260296	1	1	PELED, ANNE MD PC	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107480	24	Plastic Surgery	0	In state provider	None	2100 WEBSTER ST	STE 424	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
143781	Fee-for-Service	1275091373	1275091373	1	3	PRIME LIBERTY PHARMACY, INC.	8/24/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7335 VAN NUYS BOULEVARD	SUITE 107	VAN NUYS	CA	91405	1998	19	06037	34.203843	-118.448776	Los Angeles County
143806	Fee-for-Service	1316002264	1316002264	1	1	PANUSKA, JOHN M MD	6/12/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	155512	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
143856	Fee-for-Service	1720334626	1720334626	1	1	PRIORITY ONE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 107C	MONTCLAIR	CA	91763	2357	36	06071	34.08129954	-117.6966135	San Bernardino County
143865	Fee-for-Service	1215974258	1215974258	1	1	PAUL MCHALE, M.D.	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
143876	Fee-for-Service	1295042455	1295042455	1	1	PATEL, HITENKUMAR R MD	9/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113878	30	Radiology	0	In state provider	None	1520 SAN PABLO	LL-1600	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
143953	Fee-for-Service	1104393990	1104393990	1	1	PEARCEY, RICHARD M	2/26/2019	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2480 MACIEL LANE	None	CRESCENT CITY	CA	95531	8633	08	06015	41.81211214	-124.1544778	Del Norte County
143967	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	6/2/2004	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
143978	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	7/26/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
143987	Fee-for-Service	1770924508	1770924508	1	1	PAREDES, VALERIE LCSW	10/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
144013	Fee-for-Service	1194134114	1194134114	1	1	POLIKOWSKI, SAMANTHA E CRNA	1/26/2022	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
144048	Fee-for-Service	1568496198	1568496198	1	1	PATEL, ACHIT B DO	8/31/2018	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
144060	Fee-for-Service	1629605001	1629605001	1	1	PARAG, SAHIL DO	8/2/2024	207R00000X	NA	Other	026	PHYSICIANS	20911	41	Internal Medicine	0	In state provider	None	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
144107	Fee-for-Service	1790196046	1790196046	1	1	PATEL, JANKI MD	5/3/2024	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
144108	Fee-for-Service	1447614458	1447614458	1	1	PERELMUTTER, MARYLOU MFT	2/29/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36961	-	NOT APPLICABLE	0	In state provider	None	6109 AFTON PL	None	LOS ANGELES	CA	90028	8313	19	06037	34.09531447	-118.3226631	Los Angeles County
144120	Fee-for-Service	1740381938	1740381938	1	1	PRINCE, SABINA L. NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
144136	Fee-for-Service	1265881668	1265881668	1	1	PACIFIC POINT HEALTH CARE	8/19/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	6170 CORNERSTONE COURT E	SUITE 200A	SAN DIEGO	CA	92121	3767	37	06073	32.89597579	-117.1880762	San Diego County
144158	Fee-for-Service	1255445037	1255445037	1	1	PINZON-ARELLANO, SONIA E	4/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63249	40	Pediatrics	0	In state provider	None	650 META ST	None	OXNARD	CA	93030	7182	56	06111	34.195239	-119.1759535	Ventura County
144181	Fee-for-Service	1174094064	1174094064	1	1	PRECISION PSYCHIATRIC SERVIC	5/14/2021	2084N0400X	NA	Neurology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ES INC	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
144214	Fee-for-Service	1649220724	1649220724	1	1	PARK NICOLLET METHODIST	10/9/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	6500 EXCELSIOR BLVD	None	ST LOUIS PARK	MN	55416	4702	00	None	44.929818	-93.362229	Hennepin County
144215	Fee-for-Service	1316063936	1316063936	1	1	PAUL, SUPRITI MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120434	04	Otology, Laryngology, Rhinology	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
144216	Fee-for-Service	1740324060	1740324060	1	1	PALETZ AND AGATSTEIN	9/4/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UROLOGY MEDICAL GROUP	575 E HARDY ST	STE 215	INGLEWOOD	CA	90301	4041	19	06037	33.94909392	-118.3477665	Los Angeles County
144231	Fee-for-Service	1760992176	1760992176	1	1	PASCALE, FRANCESCA L LAC	12/10/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	21245 E CLIFF DR UNIT G	None	SANTA CRUZ	CA	95062	4869	44	06087	36.96433506	-121.9928636	Santa Cruz County
144240	Fee-for-Service	1467860221	1467860221	1	1	POPLI, PALLVI MD	3/14/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	188199	None	None	0	In state provider	None	12998 HESPERIA ROAD	SUITE 204	VICTORVILLE	CA	92395	8317	36	06071	34.48789715	-117.2906992	San Bernardino County
144256	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/19/2016	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
144257	Fee-for-Service	1093871873	1093871873	1	1	PO, JONATHAN B MD	12/30/1975	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23364	30	Radiology	0	In state provider	None	2044 ARMACOST AVE	STE 2	LOS ANGELES	CA	90025	6113	19	06037	34.03393989	-118.4533053	Los Angeles County
144267	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
144274	Fee-for-Service	1639889249	1639889249	1	1	PERKINS, ELIZABETH	12/28/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4568 FEATHER RIVER DR	C	STOCKTON	CA	95219	6503	39	06077	37.98287413	-121.347226	San Joaquin County
144297	Fee-for-Service	1073930624	1073930624	1	1	PASIEKA, CYNTHIA LMFT	7/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
144365	Fee-for-Service	1265033955	1265033955	1	1	PRO-MED HOSPICE	9/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 108	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
144372	Fee-for-Service	1316087844	1316087844	1	1	PAN, MARGARET W NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 N LEWIS ST	None	ORANGE	CA	92868	1537	30	06059	33.7900136	-117.8975432	Orange County
144398	Fee-for-Service	1144308636	1144308636	1	1	PHAN, LOI P MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90373	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
144421	Fee-for-Service	1265881668	1265881668	1	1	PACIFIC POINT HEALTH CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	6170 CORNERSTONE COURT E	SUITE 200A	SAN DIEGO	CA	92121	3767	37	06073	32.89597579	-117.1880762	San Diego County
144430	Fee-for-Service	1740859081	1740859081	1	1	PARDUE, ROBERT PT	10/10/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
144431	Fee-for-Service	1568648707	1568648707	1	1	PATEL, JAY R MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105841	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1937	19	06037	33.808185	-118.1850575	Los Angeles County
144437	Fee-for-Service	1487031167	1487031167	1	1	POPOVICH, JOHN MD	4/19/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	148666	02	General Surgery	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
144452	Fee-for-Service	1043469778	1043469778	1	1	PURANAM, SRILEKHA MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106383	41	Internal Medicine	0	In state provider	None	644 SOUTHLAND MALL DR	None	HAYWARD	CA	94545	2150	01	06001	37.65079738	-122.0986732	Alameda County
144465	Fee-for-Service	1598042178	1598042178	1	1	POLE, SHIVANAND R MD INC	2/22/2012	207R00000X	NA	Other	026	PHYSICIANS	101547	41	Internal Medicine	0	In state provider	None	3851 KATELLA AVENUE	SUITE 305	LOS ALAMITOS	CA	90720	3390	30	06059	33.80319053	-118.0657305	Orange County
144469	Fee-for-Service	1174094064	1174094064	1	1	PRECISION PSYCHIATRIC SERVIC	11/15/2019	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ES INC	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
144486	Fee-for-Service	1396164885	1396164885	1	1	PATEL, SHREYAS B MD	8/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150881	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
144497	Fee-for-Service	1306248240	1306248240	1	9	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	466 FLAGSHIP ROAD	None	NEWPORT BEACH	CA	92663	3635	30	06059	33.62834163	-117.9286241	Orange County
144498	Fee-for-Service	1649220724	1649220724	1	1	PARK NICOLLET METHODIST	10/9/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	6500 EXCELSIOR BLVD	None	ST LOUIS PARK	MN	55416	4702	00	None	44.929818	-93.362229	Hennepin County
144502	Fee-for-Service	1316063936	1316063936	1	1	PAUL, SUPRITI MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120434	01	General Practice	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
144504	Fee-for-Service	1740324060	1740324060	1	1	PALETZ AND AGATSTEIN	1/22/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	UROLOGY MEDICAL GROUP	575 E HARDY ST	STE 215	INGLEWOOD	CA	90301	4041	19	06037	33.94909392	-118.3477665	Los Angeles County
144517	Fee-for-Service	1518202522	1518202522	1	1	PALACIO, TRENNELL O LPCC	4/12/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
144544	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/7/2016	106H00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
144547	Fee-for-Service	1760619530	1760619530	1	1	PILUEK, WACHIRAPON J MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117838	18	Ophthalmology	0	In state provider	None	301 INDUSTRIAL RD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
144555	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	3/3/2022	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
144563	Fee-for-Service	1528890860	1528890860	1	1	PHOEBE HUA MD, INC	3/7/2025	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
144595	Fee-for-Service	1467796888	1467796888	1	1	PAXTON, TINA L LCSW	11/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
144623	Fee-for-Service	1932172525	1932172525	1	1	PHILIP STEVENS D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2220 CANTERBURY DR	None	HAYS	KS	67601	2370	00	None	38.880486	-99.2961225	Ellis County
144653	Fee-for-Service	1679753735	1679753735	1	1	PASCUAL, SERENITY A NP	8/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
144655	Fee-for-Service	1265033955	1265033955	1	1	PRO-MED HOSPICE	9/29/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 108	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
144670	Fee-for-Service	1558471789	1558471789	1	1	PRICE, LAWRENCE J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34713	01	General Practice	0	In state provider	None	45 CASTRO ST	STE 232	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
144730	Fee-for-Service	1457568818	1457568818	1	1	PEREAU, MELISSA J	8/22/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	93340	36	Psychiatry	0	In state provider	None	11374 MOUNTAIN VIEW AVE	# A	LOMA LINDA	CA	92354	3830	36	06071	34.0465275	-117.2436991	San Bernardino County
144734	Fee-for-Service	1669785770	1669785770	1	1	PORTER, FERNANDO MD	12/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177923	None	None	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
144737	Fee-for-Service	1043469778	1043469778	1	1	PURANAM, SRILEKHA MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106383	45	Nephrology (Renal-Kidney)	0	In state provider	None	644 SOUTHLAND MALL DR	None	HAYWARD	CA	94545	2150	01	06001	37.65079738	-122.0986732	Alameda County
144747	Fee-for-Service	1912071234	1912071234	1	1	PRICE, MARK MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	76924	24	Plastic Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
144755	Fee-for-Service	1174094064	1174094064	1	1	PRECISION PSYCHIATRIC SERVIC	12/22/2020	2084N0400X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ES INC	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
144807	Fee-for-Service	1053684399	1053684399	1	1	PUTNAM, ELIZABETH A DPM	9/27/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
144823	Fee-for-Service	1275763013	1275763013	1	1	PATEL, RAJAN P MD	10/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
144833	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/7/2016	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
144844	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	11/19/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
144863	Fee-for-Service	1962485243	1962485243	1	1	PAZ, JEANETTE C MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79785	08	Family Practice	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95340	0000	24	06047	37.28825369	-120.4963159	Merced County
144961	Fee-for-Service	1831713189	1831713189	1	1	PROSTHETIC & ORTHOTIC GROUP	10/27/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	SAN GABRIEL VALLEY, INC	5658 SEPULVEDA BLVD	STE 206	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
144971	Fee-for-Service	1750671392	1750671392	1	1	PEZHOUH, MARYAM K MD	7/28/2021	207ZP0102X	NA	Other	026	PHYSICIANS	141878	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
144996	Fee-for-Service	1306248240	1306248240	1	8	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	1445 SUPERIOR AVE	None	NEWPORT BEACH	CA	92663	6152	30	06059	33.62692785	-117.9328025	Orange County
145053	Fee-for-Service	1912563826	1912563826	1	1	PENG MD PLLC	2/5/2020	261QC1500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	500 DAMONTE RANCH PKWY	STE 1030	RENO	NV	89521	5968	00	None	39.42111331	-119.7527568	Washoe County
145057	Fee-for-Service	1073691077	1073691077	1	1	PETERS, JAMIE S OD	7/24/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8235 UNIVERSITY AVE	None	LA MESA	CA	91941	3820	37	06073	32.76742748	-117.0205886	San Diego County
145095	Fee-for-Service	1831186501	1831186501	1	1	PENNINGTON, GENA C MD	1/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34152	01	General Practice	0	In state provider	None	2773 HARRIS ST	STE F	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
145116	Fee-for-Service	1386795011	1386795011	1	1	PENINSULA BIOMEDICAL INC	11/30/2009	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	108 WHISPERING PINES DR	#115	SCOTTS VALLEY	CA	95066	4792	44	06087	37.04239796	-122.0275075	Santa Cruz County
145120	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145127	Fee-for-Service	1548295439	1548295439	1	1	PENUNURI, ISELA MD	1/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88564	08	Family Practice	0	In state provider	None	120 CRAVEN RD	SUITE 205	SAN MARCOS	CA	92078	4237	37	06073	33.12748853	-117.1662795	San Diego County
145132	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	1/13/2023	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
145148	Fee-for-Service	1780363705	1780363705	1	1	PAUL, MARGOT PSYD	10/18/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145176	Fee-for-Service	1295846723	1295846723	1	1	PENA-ROMERO, CESAR M MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49381	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
145225	Fee-for-Service	1982997417	1982997417	1	1	PHAM, TRUNG H MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122179	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
145264	Fee-for-Service	1194967174	1194967174	1	1	PERKINS CHEN, JENNIFER D MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122340	02	General Surgery	0	In state provider	None	513 PARNASSUS AVE	S738	SAN FRANCISCO	CA	94143	0476	38	06075	37.76344756	-122.4581992	San Francisco County
145310	Fee-for-Service	1629204714	1629204714	1	1	PETERSON, ERIN L LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
145333	Fee-for-Service	1770624702	1770624702	1	2	PAIN MEDICINE SPECIALTY	3/28/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	11160 WARNER AVE	STE 417	FOUNTAIN VALLEY	CA	92708	8703	30	06059	33.71630854	-117.934317	Orange County
145375	Fee-for-Service	1780642314	1780642314	1	1	PATEL, ALKA B MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92032	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
145393	Fee-for-Service	1780974212	1780974212	1	1	PARK, SHAUN H MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122388	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
145395	Fee-for-Service	1447904982	1447904982	1	1	PHARMEDQUEST PHARMACY SERVIC	5/4/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26800 CROWN VALLEY PKWY	185	MISSION VIEJO	CA	92691	7304	30	06059	33.56286021	-117.6673449	Orange County
145396	Fee-for-Service	1568569606	1568569606	1	1	POMERANCE, ELISE B MD	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	67568	01	General Practice	0	In state provider	None	605 E BADILLO ST	SUITE 300	COVINA	CA	91723	2847	19	06037	34.08628747	-117.87903	Los Angeles County
145399	Fee-for-Service	1134519663	1134519663	1	1	PUJJI, ANJOULIE DO	7/2/2019	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	15986	38	Geriatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145408	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	2/26/2013	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145420	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	10/22/2021	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
145422	Fee-for-Service	1861543142	1861543142	1	1	PEIPERL, LAURENCE MD	10/1/2000	207R00000X	NA	Other	026	PHYSICIANS	77718	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
145462	Fee-for-Service	1295846723	1295846723	1	1	PENA-ROMERO, CESAR M MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
145480	Fee-for-Service	1164885992	1164885992	1	1	PMDTC,LLC	3/1/2020	335V00000X	NA	Other	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	3745 W CALDWELL AVE	C	VISALIA	CA	93277	9230	54	06107	36.298116	-119.3323005	Tulare County
145483	Fee-for-Service	1841599107	1841599107	1	1	PHAM, ANH T MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122178	68	Hematology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145517	Fee-for-Service	1982997417	1982997417	1	1	PHAM, TRUNG H MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122179	77	Infectious Disease	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
145540	Fee-for-Service	1275007742	1275007742	1	1	PECK, ALEXANDRA NP	9/10/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
145545	Fee-for-Service	1871962076	1871962076	1	4	PORTOLA MEDICAL SERVICES, PC	11/7/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6876 KATELLA AVE	None	CYPRESS	CA	90630	5108	30	06059	33.8027637	-118.0127826	Orange County
145563	Fee-for-Service	1164865804	1164865804	1	1	PADMANABHA, BINDU MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151733	13	Neurology (M.D. only)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
145591	Fee-for-Service	1457439549	1457439549	1	1	POPPERT, DALE L JR MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	49046	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
145610	Fee-for-Service	1174786073	1174786073	1	1	PEDRANO, GUADALUPE C MD	3/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40246	01	General Practice	0	In state provider	None	2209 N SAN FERNANDO ROAD	None	LOS ANGELES	CA	90065	1231	19	06037	34.10340703	-118.2375875	Los Angeles County
145644	Fee-for-Service	1902303191	1902303191	1	1	PIETRO, KELSEY PSYD	7/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2599 E 28TH ST	STE 206	SIGNAL HILL	CA	90755	2139	19	06037	33.80808345	-118.160964	Los Angeles County
145650	Fee-for-Service	1841252707	1841252707	1	1	PAYNE, RICHARD E MD	12/31/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50467	08	Family Practice	0	In state provider	SUITE A306	477 N EL CAMINO REAL	None	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
145686	Fee-for-Service	1134519663	1134519663	1	1	PUJJI, ANJOULIE DO	7/2/2019	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	15986	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145695	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145707	Fee-for-Service	1336222397	1336222397	1	17	PERMANENTE MEDICAL GROUP INC	7/15/2022	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
145739	Fee-for-Service	1366879967	1366879967	1	1	POLON, LISA S PSYD	4/9/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
145742	Fee-for-Service	1609548700	1609548700	1	1	PADUA, CHRISTINE OT	10/4/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3525 LOMA VISTA RD	SUITE C	VENTURA	CA	93003	3165	56	06111	34.27680789	-119.2480851	Ventura County
145748	Fee-for-Service	1295846723	1295846723	1	1	PENA-ROMERO, CESAR M MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49381	41	Internal Medicine	0	In state provider	None	227 CHURCH AVE	None	CHULA VISTA	CA	91910	2702	37	06073	32.64410747	-117.0798279	San Diego County
145764	Fee-for-Service	1285923201	1285923201	1	1	PATEL, CHIRAG H MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123995	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
145771	Fee-for-Service	1841599107	1841599107	1	1	PHAM, ANH T MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122178	78	Neoplastic Diseases/Oncology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145797	Fee-for-Service	1710247085	1710247085	1	1	PONRARTANA, SORNYA MD INC	7/2/2012	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	102825	None	None	0	In state provider	None	3526 WEST 1ST ST	None	SANTA ANA	CA	92703	3302	30	06059	33.7451367	-117.9165177	Orange County
145814	Fee-for-Service	1558316083	1558316083	1	1	PENTON, BRIAN S MD	11/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84188	41	Internal Medicine	0	In state provider	None	77 CASA STREET	STE 204	SAN LUIS OBISPO	CA	93405	5882	40	06079	35.29306786	-120.6650709	San Luis Obispo County
145815	Fee-for-Service	1194967307	1194967307	1	1	POWERS, MICHAEL J MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121002	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
145841	Fee-for-Service	1255633038	1255633038	1	1	PATEL, JAYNESH KUMAR A MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124058	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
145861	Fee-for-Service	1952021925	1952021925	1	1	PADHYE, VIKRAM	11/10/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145871	Fee-for-Service	1326638958	1326638958	1	1	PETTIS, BETH S NP	11/30/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
145899	Fee-for-Service	1952042137	1952042137	1	1	PARK, ALBERT MD	1/27/2025	207R00000X	NA	Other	026	PHYSICIANS	189474	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
145935	Fee-for-Service	1922115732	1922115732	1	1	PIACENTININ, JOHN C PHD	1/10/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
145939	Fee-for-Service	1841252707	1841252707	1	1	PAYNE, RICHARD E MD	12/31/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50467	66	Emergency Medicine (Urgent Care)	0	In state provider	SUITE A306	477 N EL CAMINO REAL	None	ENCINITAS	CA	92024	1328	37	06073	33.05700866	-117.262449	San Diego County
145949	Fee-for-Service	1770870867	1770870867	2	1	PAKANATI, KRISHNA C MD	6/29/2022	207R00000X	NA	Other	026	PHYSICIANS	175506	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
145958	Fee-for-Service	1447892245	1447892245	1	1	PIRNAZAR, HAYDEH LMFT	10/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1426 AVIATION BLVD	SUITE 103	REDONDO BEACH	CA	90278	4061	19	06037	33.86748122	-118.3835864	Los Angeles County
145976	Fee-for-Service	1063423697	1063423697	1	1	PATHWAY PHARMACEUTICALS INC	10/1/2002	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 E TACHEVAH DR	STE 1W101	PALM SPRINGS	CA	92262	5772	33	06065	33.83753681	-116.5424435	Riverside County
145981	Fee-for-Service	1770924102	1770924102	1	1	PATHAK, RANJAN MD	4/15/2020	207RX0202X	NA	Oncology	026	PHYSICIANS	168183	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
145983	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	9/11/2012	1041C0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
145999	Fee-for-Service	1811168727	1811168727	1	1	POMONA HEALTHCARE & WELLNESS	6/17/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER, LLC	1550 N PARK AVE	None	POMONA	CA	91768	1834	19	06037	34.07451286	-117.7547916	Los Angeles County
146029	Fee-for-Service	1174970560	1174970560	1	1	PARK, RAYMOND	3/22/2018	390200000X	NA	Other	026	PHYSICIANS	15854	08	Family Practice	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
146081	Fee-for-Service	1487092813	1487092813	1	1	PHAN, JULIE OD	4/2/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 HARRIMAN PL	None	SAN BERNARDINO	CA	92408	4203	36	06071	34.06663955	-117.262629	San Bernardino County
146100	Fee-for-Service	1558316083	1558316083	1	1	PENTON, BRIAN S MD	11/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84188	66	Emergency Medicine (Urgent Care)	0	In state provider	None	77 CASA STREET	STE 204	SAN LUIS OBISPO	CA	93405	5882	40	06079	35.29306786	-120.6650709	San Luis Obispo County
146109	Fee-for-Service	1295870228	1295870228	1	1	PASADENA HOME HEALTH	8/12/2002	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	183 E GLENARM ST	UNIT 103	PASADENA	CA	91105	3446	19	06037	34.12756851	-118.1460253	Los Angeles County
146110	Fee-for-Service	1225304132	1225304132	1	1	PALLEGADDA, RANI R MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
146143	Fee-for-Service	1265174122	1265174122	1	1	POLINES, RACHEL JOY NP	5/7/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5100 6TH ST	157	FRESNO	CA	93710	7514	10	06019	36.810666	-119.763204	Fresno County
146164	Fee-for-Service	1104323047	1104323047	1	1	PARK, JANE MD	11/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174613	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
146166	Fee-for-Service	1326326711	1326326711	1	1	PARAFINCZUK, KATHLEEN N	10/3/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
146202	Fee-for-Service	1376542894	1376542894	1	1	PAK, WONKYU MD PC	6/18/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	59023	18	Ophthalmology	0	In state provider	None	4220 W 3RD ST	STE 206	LOS ANGELES	CA	90020	3450	19	06037	34.0689595	-118.306251	Los Angeles County
146224	Fee-for-Service	1053366021	1053366021	1	1	PHANCAO, FRANCOIS MD	4/7/2023	207R00000X	NA	Other	026	PHYSICIANS	90050	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
146240	Fee-for-Service	1457530842	1457530842	1	1	PETKAR, ARCHANA Y MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101500	01	General Practice	0	In state provider	None	133 W SANTA CLARA ST	None	VENTURA	CA	93001	2543	56	06111	34.27954148	-119.302884	Ventura County
146260	Fee-for-Service	1083053920	1083053920	1	1	PATEL, ANKIT G MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139803	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2601	07	06013	37.92643968	-122.0521822	Contra Costa County
146268	Fee-for-Service	1306248240	1306248240	1	10	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	19191 HARVARD AVE	None	IRVINE	CA	92612	4670	30	06059	33.65150104	-117.8317924	Orange County
146272	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
146335	Fee-for-Service	1760949952	1760949952	1	1	PELAYO, ALYSON E NP	8/1/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
146357	Fee-for-Service	1508859554	1508859554	1	2	PICKERT, CURTIS B MD	1/4/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85980	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1010 MURRAY ST	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.29101669	-120.6663647	San Luis Obispo County
146387	Fee-for-Service	1588675680	1588675680	1	1	PADHY, RANJIT K MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85812	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
146434	Fee-for-Service	1720412364	1720412364	1	1	PALMER, PATIENCE L	9/2/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
146442	Fee-for-Service	1871680314	1871680314	1	1	PETERS, WARREN R MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	68292	01	General Practice	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
146446	Fee-for-Service	1710377825	1710377825	1	1	PERSPECTIVE HOME HEALTH CARE	5/28/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	415 E HARVARD ST	STE 204	GLENDALE	CA	91205	1045	19	06037	34.14448348	-118.250604	Los Angeles County
146528	Fee-for-Service	1740410182	1740410182	1	3	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	1481 FORD ST	STE 102	REDLANDS	CA	92373	3917	36	06071	34.037946	-117.153036	San Bernardino County
146560	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/13/2016	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
146588	Fee-for-Service	1386952117	1386952117	1	1	PERRON-BURDICK, MISA D MD	7/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112385	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
146638	Fee-for-Service	1235329913	1235329913	1	1	PENA, MICHAEL LMFT	10/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
146648	Fee-for-Service	1508859554	1508859554	1	2	PICKERT, CURTIS B MD	1/4/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85980	40	Pediatrics	0	In state provider	None	1010 MURRAY ST	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.29101669	-120.6663647	San Luis Obispo County
146676	Fee-for-Service	1124191432	1124191432	1	1	PHAN, CINDY MD	11/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86593	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
146719	Fee-for-Service	1669253241	1669253241	1	1	PLEASANT HILL VILLA HOME	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE	1900 HOOVER AVE	None	PLEASANT HILL	CA	94523	4620	07	06013	37.92970506	-122.0737827	Contra Costa County
146761	Fee-for-Service	1366515306	1366515306	1	1	PACIFIC ENDOSCOPY SVS	11/26/2003	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3351 EL CAMINO REAL	STE 220	ATHERTON	CA	94027	3802	41	06081	37.4659667	-122.2071835	San Mateo County
146769	Fee-for-Service	1366853475	1366853475	1	1	PANELLI, DANIELLE M MD	7/20/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153866	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146800	Fee-for-Service	1609876523	1609876523	1	1	PETER J BURROWS, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	850 N KOLB RD	STE F	TUCSON	AZ	85710	1333	00	None	32.231871	-110.8401345	Pima County
146811	Fee-for-Service	1740410182	1740410182	1	3	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	1481 FORD ST	STE 102	REDLANDS	CA	92373	3917	36	06071	34.037946	-117.153036	San Bernardino County
146845	Fee-for-Service	1740410182	1740410182	1	2	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	18523 CORWIN RD	STE G	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
146847	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/8/2015	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
146890	Fee-for-Service	1023165750	1023165750	1	1	PURINO, M LORRAINE MD	6/30/1992	2084N0400X	NA	Neurology	026	PHYSICIANS	72256	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
146965	Fee-for-Service	1003012444	1003012444	1	1	PICEL, ANDREW C MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108134	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
146966	Fee-for-Service	1851692560	1851692560	1	1	PLANNED PARENTHOOD SHASTA	4/20/2011	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIABLO INC	1522 BUSH STREET	None	SAN FRANCISCO	CA	94109	5420	38	06075	37.78842019	-122.4225944	San Francisco County
146982	Fee-for-Service	1740410182	1740410182	1	14	PACIFIC DERMATOLOGY INSTITUT	11/13/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E INC	12332 HESPERIA RD	STE 2	VICTORVILLE	CA	92395	4796	36	06071	34.47538251	-117.2914696	San Bernardino County
146993	Fee-for-Service	1871962076	1871962076	1	2	PORTOLA MEDICAL SERVICES, PC	1/20/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	30	06059	33.66214655	-117.6532809	Orange County
146999	Fee-for-Service	1609259597	1609259597	1	1	PEREZ, DANIEL H CRNA	2/18/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3440 E LA PALMA AVENUE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
147042	Fee-for-Service	1679286611	1679286611	1	1	PASCHINGER, MANUEL	12/19/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
147058	Fee-for-Service	1083622120	1083622120	1	5	PRIME HEALTHCARE	3/31/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
147071	Fee-for-Service	1306248240	1306248240	1	3	PACIFIC HOSPITALIST ASSOCIAT	9/9/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	7781 GARFIELD AVE	None	HUNTINGTON BEACH	CA	92648	2026	30	06059	33.68671949	-117.992403	Orange County
147080	Fee-for-Service	1639729254	1639729254	1	1	PETROWSKY, STACEY E LMFT	11/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
147135	Fee-for-Service	1700204682	1700204682	1	1	PAJCINI, MARLEN MD	8/26/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	137993	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147136	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	11/11/1996	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
147137	Fee-for-Service	1740410182	1740410182	1	12	PACIFIC DERMATOLOGY INSTITUT	10/31/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	44605 AVENIDA DE MISSION	202	TEMECULA	CA	92592	5001	33	06065	33.47672591	-117.111462	Riverside County
147147	Fee-for-Service	1033123922	1033123922	1	1	PALMA, ROSARIO D MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29763	41	Internal Medicine	0	In state provider	None	175 N JACKSON AVE	STE 110	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
147153	Fee-for-Service	1366550253	1366550253	1	1	PAWAR, SANYUKTA S MD	6/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53273	41	Internal Medicine	0	In state provider	None	550 WEST RANCHVIEW DRIVE	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
147162	Fee-for-Service	1376628180	1376628180	1	1	PETER S NELSON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	MS 359110 C/O WOP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
147191	Fee-for-Service	1508268723	1508268723	1	1	PATEL, JAYMIN MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	151311	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
147223	Fee-for-Service	1952318586	1952318586	1	1	PSYCHOLOGICAL ADVANCES	10/13/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	77564 COUNTRY CLUB DR	SUITE 207	PALM DESERT	CA	92211	6248	33	06065	33.75833451	-116.3114325	Riverside County
147238	Fee-for-Service	1669849394	1669849394	1	2	PULMONARY & CRITICAL CARE	9/8/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
147270	Fee-for-Service	1740410182	1740410182	1	14	PACIFIC DERMATOLOGY INSTITUT	11/13/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E INC	12332 HESPERIA RD	STE 2	VICTORVILLE	CA	92395	4796	36	06071	34.47538251	-117.2914696	San Bernardino County
147280	Fee-for-Service	1871962076	1871962076	1	2	PORTOLA MEDICAL SERVICES, PC	10/5/2021	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	30	06059	33.66214655	-117.6532809	Orange County
147292	Fee-for-Service	1831446475	1831446475	1	1	PARKER, ROXANA LMFT	11/21/2024	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
147310	Fee-for-Service	1093093064	1093093064	1	1	PENNICOOKE, BRENTON H MD	6/7/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	160390	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
147320	Fee-for-Service	1427685429	1427685429	1	1	PANCHAL, VIRAJ R MD	10/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189486	09	Gynecology (D.O. only)	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
147332	Fee-for-Service	1659629905	1659629905	1	1	PHUNG-PAYNE, JENNY MD	9/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140329	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
147365	Fee-for-Service	1659735074	1659735074	1	1	PAK, PEONY MD	4/21/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	153936	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA # B200	None	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
147376	Fee-for-Service	1770977753	1770977753	1	1	PAGGETT, PATRICK A	7/31/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	55 E ATCHISON AVENUE	None	FRESNO	CA	93706	4020	10	06019	36.72044852	-119.8121514	Fresno County
147380	Fee-for-Service	1538453899	1538453899	1	1	PEZZELLA, LINA C MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
147386	Fee-for-Service	1255419024	1255419024	1	1	PETERSON, MICHAEL B MD	2/28/1983	208600000X	NA	General Surgery	026	PHYSICIANS	45972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
147390	Fee-for-Service	1861760670	1861760670	1	1	PAIN CARE PROVIDERS	7/5/2013	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL MEDICAL	113 WATERWORKS WAY	STE 345	IRVINE	CA	92618	3173	30	06059	33.66497942	-117.7635578	Orange County
147421	Fee-for-Service	1740410182	1740410182	1	2	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	18523 CORWIN RD	STE G	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
147423	Fee-for-Service	1336222397	1336222397	1	4	PERMANENTE MEDICAL GROUP INC	12/13/2016	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
147430	Fee-for-Service	1679010417	1679010417	1	1	PIVAC ASC LLC	5/25/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	6076 BRISTOL PKWY	SUITE 108	CULVER CITY	CA	90230	6600	19	06037	33.98557948	-118.3873452	Los Angeles County
147475	Fee-for-Service	1932120771	1932120771	1	1	PHILIPP, RONALD J DO INC	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	4777	01	General Practice	0	In state provider	None	2255 LAKEWOOD BLVD	None	LONG BEACH	CA	90815	2507	19	06037	33.79654624	-118.1432226	Los Angeles County
147477	Fee-for-Service	1508013343	1508013343	1	1	PAZ, PEDRO F MD	3/23/2015	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	110752	40	Pediatrics	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
147481	Fee-for-Service	1861583569	1861583569	1	1	PALMER, AMBER I LMFT	9/15/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 ESPLANADE	SUITE 15	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
147517	Fee-for-Service	1407934276	1407934276	1	1	PATTON, MARY G MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	54424	01	General Practice	0	In state provider	None	1545 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3425	38	06075	37.78393521	-122.4396714	San Francisco County
147521	Fee-for-Service	1669849394	1669849394	1	2	PULMONARY & CRITICAL CARE	9/8/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
147571	Fee-for-Service	1760955835	1760955835	1	1	PARSONS SVENDSEN, RACHAEL L	6/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22621 LYONS AVE	201	NEWHALL	CA	91321	1702	19	06037	34.3810623	-118.5308155	Los Angeles County
147585	Fee-for-Service	1811549496	1811549496	1	1	PHARMEDQUEST PHARMACY SERVIC	8/23/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	276 COLLEGE ST	None	COVINA	CA	91723	1902	19	06037	34.08747441	-117.8941951	Los Angeles County
147609	Fee-for-Service	1427685429	1427685429	1	1	PANCHAL, VIRAJ R MD	10/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189486	15	Obstetrics (D.O. only)	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
147649	Fee-for-Service	1780689802	1780689802	1	1	PAIN DIAGNOSTIC &	9/6/2000	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	TREATMENT CENTER, LP	2805 J ST	STE 200	SACRAMENTO	CA	95816	4307	34	06067	38.573982	-121.468419	Sacramento County
147664	Fee-for-Service	1770977753	1770977753	1	1	PAGGETT, PATRICK A	7/31/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	55 E ATCHISON AVENUE	None	FRESNO	CA	93706	4020	10	06019	36.72044852	-119.8121514	Fresno County
147713	Fee-for-Service	1740410182	1740410182	1	12	PACIFIC DERMATOLOGY INSTITUT	10/31/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	44605 AVENIDA DE MISSION	202	TEMECULA	CA	92592	5001	33	06065	33.47672591	-117.111462	Riverside County
147743	Fee-for-Service	1871607762	1871607762	1	49	PROVIDENCE MEDICAL FOUNDATIO	6/2/2014	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	121 SOTOYOME ST	STE 203	SANTA ROSA	CA	95405	4822	49	06097	38.44224	-122.70195	Sonoma County
147747	Fee-for-Service	1396004313	1396004313	1	1	PORTER, MERIDITH L OT	2/10/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
147794	Fee-for-Service	1932572906	1932572906	1	1	PARKER, MARY E LCSW	3/28/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
147806	Fee-for-Service	1770252363	1770252363	1	1	PIZANO, JOSHUA D LPCC	10/11/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
147835	Fee-for-Service	1508892894	1508892894	1	1	PIERCE, PAMELA MD	6/1/1995	207LP2900X	NA	Other	026	PHYSICIANS	79248	03	Allergy	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147837	Fee-for-Service	1598775538	1598775538	1	1	PAT, ILEANA M MD	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69940	67	Endocrinology	0	In state provider	None	7325 MEDICAL CENTER DR	SUITE 300	WEST HILLS	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
147845	Fee-for-Service	1992998926	1992998926	1	1	PARK, ALBERT K MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99085	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
147866	Fee-for-Service	1003255910	1003255910	1	1	PATEL, MITESHKUMAR K MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148920	01	General Practice	0	In state provider	None	450 STANYON STREET	6TH FLOOR	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
147882	Fee-for-Service	1346400348	1346400348	1	1	PAPASOZOMENOS, THEOGNOSIA M	12/11/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	158285	44	Public Health	0	In state provider	D	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
147895	Fee-for-Service	1851887335	1851887335	1	1	PRECISION SPINE & ORTHOPEDIC	9/29/2023	207X00000X	NA	Orthopedic Surgery	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	S INC.	222 W EULALIA ST	STE 309	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
147910	Fee-for-Service	1154718401	1154718401	1	1	PRODIGY HEALTHCARE, INC	5/4/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1 TILLER AVE	1,3,4,5,12,13,14	CARUTHERS	CA	93609	8211	10	06019	36.53797263	-119.8328891	Fresno County
147934	Fee-for-Service	1811088339	1811088339	1	1	PATEL, DAKSHESH B MD	8/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95868	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
147965	Fee-for-Service	1245801125	1245801125	1	1	PHAM, WENDY U OD	9/14/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1668 E 2ND ST	STE B	BEAUMONT	CA	92223	3168	33	06065	33.92359885	-116.9480354	Riverside County
148002	Fee-for-Service	1972527802	1972527802	1	1	POWAR, JAGDIP S MD	4/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	35206	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
148053	Fee-for-Service	1053493098	1053493098	1	1	PLUT, JOHN D MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19420	20	Orthopedic Surgery	0	In state provider	None	3640 LOMITA BLVD	STE 102	TORRANCE	CA	90505	3984	19	06037	33.81475516	-118.3486533	Los Angeles County
148055	Fee-for-Service	1326493438	1326493438	1	1	PATEL, VISHAL MD	2/17/2020	207R00000X	NA	Other	026	PHYSICIANS	158030	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
148098	Fee-for-Service	1649044512	1649044512	1	1	PHILLIPS, NATALIE L CCC-SLP	3/16/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
148109	Fee-for-Service	1972332484	1972332484	1	1	PENTON, KARLY S BIRTH DOULA	8/2/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
148139	Fee-for-Service	1821121542	1821121542	1	1	PROHEALTH PARTNERS	11/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL GROUP INC	5865 E NAPLES PLZ	None	LONG BEACH	CA	90803	5040	19	06037	33.75569352	-118.1195343	Los Angeles County
148157	Fee-for-Service	1396191987	1396191987	1	1	PASULA, SHIRISHA MD	11/27/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
148166	Fee-for-Service	1790756518	1790756518	1	1	PRINTZ, BETH JF	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88440	40	Pediatrics	0	In state provider	MD	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
148197	Fee-for-Service	1124785647	1124785647	1	1	PACIFIC CLINICS	5/30/2024	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11721 TELEGRAPH RD SUITE	None	SANTA FE SPRINGS	CA	90670	6835	19	06037	33.94629336	-118.0832752	Los Angeles County
148249	Fee-for-Service	1184605586	1184605586	1	1	PROGRESSIVE PHYSICAL	8/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	19510 VENTURA BLVD	STE 106	TARZANA	CA	91356	2974	19	06037	34.17275253	-118.558305	Los Angeles County
148261	Fee-for-Service	1366446767	1366446767	1	1	PUBLIC HOSPITAL DISTRICT 1A	12/31/2011	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF WHITMAN CO	835 SE BISHOP BLVD	None	PULLMAN	WA	99163	5512	00	None	46.71335435	-117.1694502	Whitman County
148286	Fee-for-Service	1649493297	1649493297	1	1	POSITIVE DIRECTIONS INC	9/22/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	417 ALHAMBRA AVE	None	DELANO	CA	93215	4001	15	06029	35.75733279	-119.2509051	Kern County
148301	Fee-for-Service	1760672430	1760672430	1	1	PERRY, RON PHD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22242	-	NOT APPLICABLE	0	In state provider	None	1124 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	4331	01	06001	37.79106984	-122.2484928	Alameda County
148358	Fee-for-Service	1407065535	1407065535	1	1	PROVENCIO, MARIA H	6/19/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
148375	Fee-for-Service	1679862411	1679862411	1	1	PARIKH, VICTORIA N MD	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125191	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
148384	Fee-for-Service	1356322705	1356322705	2	1	PLOCH, FLORIAN H MD	2/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	35122	30	Radiology	0	In state provider	None	1020 NUT TREE ROAD	STE 190	VACAVILLE	CA	95687	4100	48	06095	38.35512	-121.94973	Solano County
148389	Fee-for-Service	1902824733	1902824733	1	1	PHILBECK, GEORGE K	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY MEDICAL	3033 SOUTH PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
148390	Fee-for-Service	1487197885	1487197885	1	1	PARK, JESSICA OD	5/13/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
148392	Fee-for-Service	1538105788	1538105788	1	1	PAPPAS, DEMETRA D MD	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90455	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
148396	Fee-for-Service	1598211088	1598211088	1	1	PICINICH, CHRISTINE M NP	9/12/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
148400	Fee-for-Service	1689013195	1689013195	1	1	PARKER, MARIKIT B B MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150359	01	General Practice	0	In state provider	None	1200 B GALE WILSON DR	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
148412	Fee-for-Service	1366027187	1366027187	1	1	PEREZ, MELISSA CCC-SLP	9/17/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
148446	Fee-for-Service	1396191987	1396191987	1	1	PASULA, SHIRISHA MD	11/27/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
148460	Fee-for-Service	1487121133	1487121133	1	2	PACIFIC HEALTH EDUCATION COG	6/17/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	NITIVE CENTER INC	5300 CALIFORNIA AVE	400	BAKERSFIELD	CA	93309	1644	15	06029	35.35932416	-119.0610078	Kern County
148473	Fee-for-Service	1669578266	1669578266	1	1	PETERSON, BRETT A	2/1/2000	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	888 N ALTA AVE	STE 102	DINUBA	CA	93618	3089	54	06107	36.552825	-119.395071	Tulare County
148475	Fee-for-Service	1588072250	1588072250	1	1	PECK, KARI LPCC	9/26/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
148480	Fee-for-Service	1265896856	1265896856	1	1	PEARCE, ALEX K MD	6/6/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	151955	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
148490	Fee-for-Service	1841226990	1841226990	1	3	PHYSICIAN FOUNDATION	2/20/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	MEDICAL ASSOCIATES, INC	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
148507	Fee-for-Service	1629700786	1629700786	1	1	PIANE, GINA M LMFT	6/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2675 VUELTA GRANDE AVENU	None	LONG BEACH	CA	90815	2254	19	06037	33.8049455	-118.1102877	Los Angeles County
148509	Fee-for-Service	1881611598	1881611598	2	1	PALU INC	11/21/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4726 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6902	19	06037	33.98008975	-118.4384514	Los Angeles County
148510	Fee-for-Service	1073503462	1073503462	1	1	PHILLIPS, ALFRED M MD	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
148517	Fee-for-Service	1528441789	1528441789	1	1	PINKERTON, WALTER E LMFT	3/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	42525 RANCHO MIRAGE LN	10	RANCHO MIRAGE	CA	92270	4312	33	06065	33.73905433	-116.4139153	Riverside County
148549	Fee-for-Service	1366446767	1366446767	1	1	PUBLIC HOSPITAL DISTRICT 1A	11/7/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF WHITMAN CO	835 SE BISHOP BLVD	None	PULLMAN	WA	99163	5512	00	None	46.71335435	-117.1694502	Whitman County
148550	Fee-for-Service	1598304958	1598304958	1	1	PHILLIP, SOPHIA CNP	11/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1060 N. 13TH AVE	None	UPLAND	CA	91786	3402	36	06071	34.10782111	-117.6335087	San Bernardino County
148624	Fee-for-Service	1487653341	1487653341	1	1	PENNISI, VINCENT P MD	8/21/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45259	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	645 W HARDING WAY	STE 4	STOCKTON	CA	95204	5688	39	06077	37.96586464	-121.3036751	San Joaquin County
148638	Fee-for-Service	1316099609	1316099609	1	1	PAWEL, BRUCE R MD	2/12/2019	174400000X	NA	Other	026	PHYSICIANS	158754	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
148650	Fee-for-Service	1336672070	1336672070	1	1	PROPP, DENNIS MD	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	178228	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
148672	Fee-for-Service	1467103358	1467103358	1	1	PEACH TREE HEALTHCARE	10/6/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5730 PACKARD AVE	STE 620	MARYSVILLE	CA	95901	7119	58	06115	39.12014523	-121.5659991	Yuba County
148718	Fee-for-Service	1104322726	1104322726	1	1	PYON, GRACE	10/10/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
148744	Fee-for-Service	1417560830	1417560830	1	1	PURPLE HEART HOSPICE INC	9/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2600 W OLIVE AVE	STE # 590	BURBANK	CA	91505	4549	19	06037	34.15993924	-118.3307814	Los Angeles County
148760	Fee-for-Service	1093160913	1093160913	1	1	PAVIO, MICHAEL MD	2/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175142	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
148776	Fee-for-Service	1295763761	1295763761	1	1	POPE, WHITNEY MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72115	30	Radiology	0	In state provider	None	10833 LECOSTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
148779	Fee-for-Service	1194809442	1194809442	1	1	PETER RUDLOWSKI M.D.	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 ULUKAHIKI ST	None	KAILUA	HI	96734	4454	00	None	21.38090913	-157.758388	Honolulu County
148848	Fee-for-Service	1558629394	1558629394	1	1	PIO, DANIEL S MD	12/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127155	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
148866	Fee-for-Service	1043269145	1043269145	2	1	PHAN, NGO C MD	8/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64044	41	Internal Medicine	0	In state provider	None	330 S GARFIELD AVE	STE 268	ALHAMBRA	CA	91801	3896	19	06037	34.09137167	-118.1241735	Los Angeles County
148880	Fee-for-Service	1740410182	1740410182	1	5	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	585 N MOUNTAIN AVE	STE A	UPLAND	CA	92307	8516	36	06071	34.10114204	-117.6702497	San Bernardino County
148889	Fee-for-Service	1295708683	1295708683	1	1	PACIFIC COUNTY HOSPITAL	7/24/2007	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT #2	800 ALDER ST	None	SOUTH BEND	WA	98586	0000	00	None	46.66222533	-123.8120798	Pacific County
148893	Fee-for-Service	1164414066	1164414066	1	1	POLLOCK, SHERWIN MD	10/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182978	30	Radiology	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
148909	Fee-for-Service	1295387967	1295387967	1	1	PATEL, NEIL D	9/1/2022	390200000X	NA	Other	026	PHYSICIANS	179436	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
148935	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	12/4/2020	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
148939	Fee-for-Service	1255302956	1255302956	1	1	PARK, BOYLE MD.	6/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66902	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
148961	Fee-for-Service	1124177829	1124177829	1	1	PARK, SUN O MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103438	77	Infectious Disease	0	In state provider	None	1135 S SUNSET AVE	SUITE 208	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
148980	Fee-for-Service	1396071304	1396071304	1	1	PAKDAMAN, MEHRDAD MD INC	8/8/2011	261Q00000X	NA	Other	026	PHYSICIANS	88797	08	Family Practice	0	In state provider	None	1115 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1403	19	06037	34.056684	-118.3837295	Los Angeles County
149000	Fee-for-Service	1730373101	1730373101	1	1	PATT, S MD INC	6/8/2009	193200000X	NA	Other	026	PHYSICIANS	32823	07	Dermatology	0	In state provider	None	1818 N ORANGE GROVE BLVD	STE 104	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
149003	Fee-for-Service	1194215319	1194215319	1	1	PEGANY, ROMA MD	12/4/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	192035	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
149006	Fee-for-Service	1104322726	1104322726	1	1	PYON, GRACE	10/10/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
149010	Fee-for-Service	1609327667	1609327667	2	1	PSYCHHEALING COUNSELING CENT	10/8/2019	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ER, INC.	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
149019	Fee-for-Service	1881662278	1881662278	1	1	PATWA, GEETA J MD	8/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40367	41	Internal Medicine	0	In state provider	None	175 E BONITA AVE	None	POMONA	CA	91767	1942	19	06037	34.09629825	-117.747176	Los Angeles County
149025	Fee-for-Service	1598785891	1598785891	1	1	PATEL, CHIRAG V MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78878	02	General Surgery	0	In state provider	None	101 CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
149032	Fee-for-Service	1417560830	1417560830	1	1	PURPLE HEART HOSPICE INC	9/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2600 W OLIVE AVE	STE # 590	BURBANK	CA	91505	4549	19	06037	34.15993924	-118.3307814	Los Angeles County
149045	Fee-for-Service	1659439040	1659439040	1	1	POURRABBANI, SHAHRAM MD	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89999	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
149051	Fee-for-Service	1013952159	1013952159	1	1	PARESA, KENITH K MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66233	01	General Practice	0	In state provider	None	8635 W 3RD ST	STE 260W	LOS ANGELES	CA	90048	6113	19	06037	34.07361928	-118.3803143	Los Angeles County
149076	Fee-for-Service	1144651654	1144651654	1	1	PROJECT NINETY, INC	10/10/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	535 BADEN AVENUE	None	S SAN FRANCISCO	CA	94080	3511	41	06081	37.65580784	-122.4179424	San Mateo County
149169	Fee-for-Service	1740410182	1740410182	1	5	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	585 N MOUNTAIN AVE	STE A	UPLAND	CA	92307	8516	36	06071	34.10114204	-117.6702497	San Bernardino County
149177	Fee-for-Service	1295708683	1295708683	1	1	PACIFIC COUNTY HOSPITAL	7/24/2007	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DISTRICT #2	800 ALDER ST	None	SOUTH BEND	WA	98586	0000	00	None	46.66222533	-123.8120798	Pacific County
149191	Fee-for-Service	1285126664	1285126664	1	1	PATEL, VIDHI DPM	8/24/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11332 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3854	36	06071	34.04709935	-117.2436936	San Bernardino County
149225	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	10/15/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
149255	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	6/23/2017	207RA0201X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149271	Fee-for-Service	1407880719	1407880719	1	1	PULMONARY MEDICINE ASSOCIATE	4/10/2017	207RC0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	EASE & CRITICAL CARE CON	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
149273	Fee-for-Service	1154104461	1154104461	1	1	PACIFIC SENIOR GROUP	1/10/2025	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2424 VISTA WAY	STE 105	OCEANSIDE	CA	92054	6178	37	06073	33.18326195	-117.3355017	San Diego County
149298	Fee-for-Service	1609327667	1609327667	2	1	PSYCHHEALING COUNSELING CENT	5/28/2021	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ER, INC.	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
149306	Fee-for-Service	1598785891	1598785891	1	1	PATEL, CHIRAG V MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78878	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
149336	Fee-for-Service	1366572083	1366572083	1	1	PAOLINI, SANDRA M	11/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	325 CUMBERLAND ST	SUITE B	PITTSBURG	CA	94565	2205	07	06013	38.03292256	-121.882228	Contra Costa County
149404	Fee-for-Service	1639739279	1639739279	1	1	PARAB, TRISHA MD	10/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185497	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
149416	Fee-for-Service	1023141124	1023141124	1	1	PROHEALTH PARTNERS, A	9/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP, INC	911 E SAN ANTONIO DR	STE 1	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
149492	Fee-for-Service	1699968503	1699968503	2	1	PUDUNAGAR SUBBIAH, SHANMUGA	5/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119729	None	None	0	In state provider	S MD	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
149513	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
149520	Fee-for-Service	1518973759	1518973759	1	1	PHAM, LUYEN D MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83145	40	Pediatrics	0	In state provider	None	1062 S K ST	None	TULARE	CA	93274	6421	54	06107	36.19548226	-119.3433058	Tulare County
149525	Fee-for-Service	1396796124	1396796124	1	1	PATTON, HEATHER M MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75284	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149541	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	2/11/2013	207RA0201X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149559	Fee-for-Service	1407880719	1407880719	1	1	PULMONARY MEDICINE ASSOCIATE	4/30/1995	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EASE & CRITICAL CARE CON	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
149561	Fee-for-Service	1154104461	1154104461	1	1	PACIFIC SENIOR GROUP	1/10/2025	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2424 VISTA WAY	STE 105	OCEANSIDE	CA	92054	6178	37	06073	33.18326195	-117.3355017	San Diego County
149564	Fee-for-Service	1700204567	1700204567	1	1	PRUCHA, JOHN G MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139437	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
149585	Fee-for-Service	1609327667	1609327667	2	1	PSYCHHEALING COUNSELING CENT	3/2/2025	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ER, INC.	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
149598	Fee-for-Service	1598785891	1598785891	1	1	PATEL, CHIRAG V MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78878	01	General Practice	0	In state provider	None	101 CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
149644	Fee-for-Service	1427622364	1427622364	1	1	PIVOVAR, LANA S LMFT	12/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3175 SUNSET	104	ROCKLIN	CA	95677	3091	31	06061	38.78584705	-121.2496644	Placer County
149652	Fee-for-Service	1659313880	1659313880	1	1	PETER ANDERSON MD MED CO	7/1/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY PHYS FNTN VLY	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
149692	Fee-for-Service	1770679631	1770679631	1	1	PAEK, JASON S MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	58208	None	None	0	In state provider	GOLDEN SPRINGS MEDICAL C	20627 GOLDEN SPRINGS DR	STE 2D	WALNUT	CA	91789	4817	19	06037	33.99684913	-117.8548347	Los Angeles County
149738	Fee-for-Service	1962876904	1962876904	1	1	PASCOE, JENNIFER K AU	11/1/2018	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
149758	Fee-for-Service	1326052028	1326052028	1	1	PARIKH, RAKESH MD	2/3/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	94341	None	None	0	In state provider	None	6555 COYLE AVE	SUITE 330	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
149763	Fee-for-Service	1720090640	1720090640	1	1	PINTO, REGINA M PHD	6/24/2022	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
149775	Fee-for-Service	1891892741	1891892741	1	1	PINELAKE REGIONAL HOSP	8/29/2005	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	JACKSON PURCHASE MED CTR	1099 MEDICAL CENTER	CIRCLE	MAYFIELD	KY	42066	1099	00	None	36.75868178	-88.65245007	Graves County
149796	Fee-for-Service	1235239070	1235239070	1	1	PHAM, DOAN T DPM	5/2/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149800	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
149803	Fee-for-Service	1598131211	1598131211	1	1	PRIOR, TAMI L CNP	7/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10121 PINE AVENUE	None	TRUCKEE	CA	96161	4856	29	06057	39.3245308	-120.2013097	Nevada County
149831	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
149853	Fee-for-Service	1619406758	1619406758	1	1	PETERSON, DAYMON D MD	8/23/2021	207P00000X	NA	Other	026	PHYSICIANS	173077	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
149868	Fee-for-Service	1790900074	1790900074	1	1	P&A STEELE INC	4/3/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	STEELE'S QUALITY LIVING	20015 ROAD 212	None	LINDSAY	CA	93247	9489	54	06107	36.15313603	-119.0988119	Tulare County
149870	Fee-for-Service	1720142177	1720142177	1	1	PRESBYTERIAN INTER-COMM	10/2/1991	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL PHARMACY	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
149878	Fee-for-Service	1609327667	1609327667	2	1	PSYCHHEALING COUNSELING CENT	10/8/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ER, INC.	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
149879	Fee-for-Service	1649809203	1649809203	1	1	PANNU, JASPREET MD	1/15/2025	207R00000X	NA	Other	026	PHYSICIANS	176829	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149886	Fee-for-Service	1912194309	1912194309	1	1	PHYSICIANS IMAGING VISALIA	3/11/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	LLC	137 SOUTH ASPEN COURT	STE A	VISALIA	CA	93291	5175	54	06107	36.32885419	-119.3529996	Tulare County
149910	Fee-for-Service	1114109121	1114109121	1	2	PUBLIC HEALTH FOUNDATION ENT	3/28/2024	172V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	13300 CROSSROADS PKWY NO	450	CITY OF INDUSTRY	CA	91746	3405	19	06037	34.03109034	-118.0102539	Los Angeles County
149926	Fee-for-Service	1770595910	1770595910	1	1	PAMINTUAN, NYDA H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
149959	Fee-for-Service	1215768627	1215768627	1	1	PEELE, HALEY PHD	11/7/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
149976	Fee-for-Service	1144389230	1144389230	1	2	PERINATAL DIAGNOSTIC CENTER	8/16/2023	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	23101 SHERMAN PLACE	STE. 304	WEST HILLS	CA	91307	2003	19	06037	34.20099112	-118.6297991	Los Angeles County
149984	Fee-for-Service	1780746107	1780746107	1	1	PIERCE, JEFFREY M MD	1/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93247	08	Family Practice	0	In state provider	None	5176 HILL ROAD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
150020	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	12/29/2018	207RA0201X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
150034	Fee-for-Service	1063532794	1063532794	1	1	PLEVNEY, BRENDA L PT	12/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12411 SLAUSON AVE	STE H	WHITTIER	CA	90606	2835	19	06037	33.96028839	-118.0529975	Los Angeles County
150052	Fee-for-Service	1598740953	1598740953	1	1	PAPILLION, GERLIE L MD	6/1/1983	207RR0500X	NA	Other	026	PHYSICIANS	40095	41	Internal Medicine	0	In state provider	None	700 W 6TH ST	STE P	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
150064	Fee-for-Service	1891892741	1891892741	1	1	PINELAKE REGIONAL HOSP	8/30/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	JACKSON PURCHASE MED CTR	1099 MEDICAL CENTER	CIRCLE	MAYFIELD	KY	42066	1099	00	None	36.75868178	-88.65245007	Graves County
150086	Fee-for-Service	1790246049	1790246049	1	1	PARAMBAN, SINDU B CNP	3/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
150088	Fee-for-Service	1659532893	1659532893	1	1	PATHARE, NEIL MD	9/29/2021	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	131267	None	None	0	In state provider	None	2500 HILBORN RD.	None	FAIRFIELD	CA	94534	1097	48	06095	38.27621282	-122.0523491	Solano County
150089	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	2/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
150111	Fee-for-Service	1275715245	1275715245	1	1	PENN, BENNETT H MD	7/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101621	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
150113	Fee-for-Service	1720569098	1720569098	1	1	PARTHENIA CARE INC	9/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	UNIT 212	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
150117	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	4/24/2009	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
150127	Fee-for-Service	1356407787	1356407787	1	1	POST, ELLEN R LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
150140	Fee-for-Service	1114013737	1114013737	1	1	PITTMAN, JEROME S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47112	40	Pediatrics	0	In state provider	PITTMAN PEDIATRIC CENTER	2500 WILSHIRE BLVD	STE 108	LOS ANGELES	CA	90057	4319	19	06037	34.06026667	-118.2809971	Los Angeles County
150161	Fee-for-Service	1609327667	1609327667	2	1	PSYCHHEALING COUNSELING CENT	10/8/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ER, INC.	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
150189	Fee-for-Service	1154553345	1154553345	1	1	PODESTA, TERRY A LCSW	7/18/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
150204	Fee-for-Service	1669014007	1669014007	1	1	PHARMACY & HEALTH MANAGEMENT	1/26/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5020 S C ST	None	OXNARD	CA	93033	7502	56	06111	34.155378	-119.180584	Ventura County
150216	Fee-for-Service	1033349220	1033349220	1	1	PACIFIC FOOT AND ANKLE	3/24/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ASSOCIATES INC	150 W FOOTHILL BLVD	SUITE F	SAN DIMAS	CA	91773	1102	19	06037	34.12480006	-117.8083927	Los Angeles County
150243	Fee-for-Service	1881705192	1881705192	1	1	POGORELOV, YAROSLAV MD	12/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90154	01	General Practice	0	In state provider	None	6699 ALVARADO RD	STE 2100	SAN DIEGO	CA	92120	5238	37	06073	32.77665383	-117.0540279	San Diego County
150250	Fee-for-Service	1124079868	1124079868	1	1	PALM DESERT RAD MED GRP	7/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	EISENHOWER RADIOLOGY MED	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
150254	Fee-for-Service	1780981266	1780981266	1	1	PELLECCHIA, KRISTYN G NP	12/4/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150274	Fee-for-Service	1801377189	1801377189	1	1	PETTY, META L LCSW	12/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
150282	Fee-for-Service	1982671541	1982671541	1	1	PENNER, ROBERT MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	681 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.6284656	-117.0748498	San Diego County
150286	Fee-for-Service	1255358727	1255358727	1	1	PANDITA, DEEPTI MD	10/30/2023	207R00000X	NA	Other	026	PHYSICIANS	186805	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
150291	Fee-for-Service	1043426745	1043426745	1	1	PATEL, PIYAL P DO	9/28/2010	208M00000X	NA	Other	026	PHYSICIANS	10751	41	Internal Medicine	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	8801	40	06079	35.292168	-120.6658665	San Luis Obispo County
150301	Fee-for-Service	1992743009	1992743009	1	1	PALMER, TERESA MD	6/14/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45373	08	Family Practice	0	In state provider	None	4070 19TH ST	None	SAN FRANCISCO	CA	94114	2562	38	06075	37.75936807	-122.4342361	San Francisco County
150308	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	10/16/2012	207RA0201X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
150315	Fee-for-Service	1194732404	1194732404	1	1	PANZARELLO, BRENDEN F MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	49603	05	Anesthesiology	0	In state provider	None	817 COFFEE RD	STE C3	MODESTO	CA	95355	4241	50	06099	37.655235	-120.975616	Stanislaus County
150316	Fee-for-Service	1235526021	1235526021	1	1	PAUL, ZACHARY J MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149979	01	General Practice	0	In state provider	None	1760 CHICAGO AVE	J3	RIVERSIDE	CA	92507	2358	33	06065	33.995538	-117.348333	Riverside County
150342	Fee-for-Service	1598740953	1598740953	1	1	PAPILLION, GERLIE L MD	6/1/1983	207RR0500X	NA	Other	026	PHYSICIANS	40095	83	Rheumatology	0	In state provider	None	700 W 6TH ST	STE P	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
150343	Fee-for-Service	1033244611	1033244611	1	1	PALLIVATHUCAL, ROSALIND	6/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43918	01	General Practice	0	In state provider	CLINICA MARIA MED CTR IN	8100 CALIFORNIA AVE	STE K	SOUTH GATE	CA	90280	2469	19	06037	33.96254377	-118.2048029	Los Angeles County
150354	Fee-for-Service	1285190173	1285190173	1	1	PHARMACY WORLD INC	5/15/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1637 THIRD AVE	A	CHULA VISTA	CA	91911	5823	37	06073	32.59656	-117.0644835	San Diego County
150355	Fee-for-Service	1336117738	1336117738	1	1	PRADHAN, RITA K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63665	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
150376	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
150384	Fee-for-Service	1124333455	1124333455	1	1	PARK, LILY	9/19/2013	207N00000X	NA	Dermatology	026	PHYSICIANS	12765	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
150388	Fee-for-Service	1225549082	1225549082	1	1	PARK, LISA S H NP	5/10/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150390	Fee-for-Service	1033127519	1033127519	1	1	PUN, KIN-KEE MD	1/15/1996	207RE0101X	NA	Endocrinology	026	PHYSICIANS	50479	67	Endocrinology	0	In state provider	None	950 STOCKTON ST	STE 375	SAN FRANCISCO	CA	94108	1618	38	06075	37.79469747	-122.4079497	San Francisco County
150399	Fee-for-Service	1720569098	1720569098	1	1	PARTHENIA CARE INC	9/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	UNIT 212	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
150406	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	4/27/2017	207RA0201X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
150421	Fee-for-Service	1306921457	1306921457	1	1	PLAZA LANE OPTOMETRY	2/24/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1537 PACIFIC AVE	SUITE 100	SANTA CRUZ	CA	95060	3942	44	06087	36.97596432	-122.0267851	Santa Cruz County
150423	Fee-for-Service	1649303116	1649303116	1	1	PRETSKY, JOSHUA E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68344	36	Psychiatry	0	In state provider	None	11980 SAN VICENTE BLVD	STE 910	LOS ANGELES	CA	90049	6607	19	06037	34.05221538	-118.4721745	Los Angeles County
150431	Fee-for-Service	1942733530	1942733530	1	1	PHILLIPS, TRASIE M LCSW	12/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
150544	Fee-for-Service	1285852293	1285852293	1	1	PATTERSON, TAMULA M MD	11/2/2010	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	113727	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
150561	Fee-for-Service	1851819742	1851819742	1	1	PATEL, MINAL A CNP	8/18/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4910 E ASHLAN AVENUE	SUITE 116	FRESNO	CA	93726	3020	10	06019	36.79411387	-119.7309194	Fresno County
150565	Fee-for-Service	1982671541	1982671541	1	1	PENNER, ROBERT MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5922	18	Ophthalmology	0	In state provider	None	681 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.6284656	-117.0748498	San Diego County
150587	Fee-for-Service	1992743009	1992743009	1	1	PALMER, TERESA MD	6/14/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45373	01	General Practice	0	In state provider	None	4070 19TH ST	None	SAN FRANCISCO	CA	94114	2562	38	06075	37.75936807	-122.4342361	San Francisco County
150588	Fee-for-Service	1033194410	1033194410	1	1	PULMONARY MEDICINE ASSOC	1/1/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
150595	Fee-for-Service	1184935082	1184935082	1	1	PARKER, DANA L	6/9/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50 GREAT OAKS BLVD	None	SAN JOSE	CA	95119	1310	43	06085	37.23606784	-121.7768408	Santa Clara County
150596	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	10/22/2014	207RA0201X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
150639	Fee-for-Service	1902895766	1902895766	2	1	PNS PHARMA INC	3/3/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14384 BROOKHURST ST	None	GARDEN GROVE	CA	92843	4608	30	06059	33.753825	-117.954801	Orange County
150667	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	2/12/2019	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
150672	Fee-for-Service	1124333455	1124333455	1	1	PARK, LILY	9/19/2013	207N00000X	NA	Dermatology	026	PHYSICIANS	12765	07	Dermatology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
150695	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	9/11/2012	207RA0201X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
150743	Fee-for-Service	1184920480	1184920480	1	1	PARTNERS URGENT CARE-	4/3/2012	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	RANCH0	9878 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92129	2893	37	06073	32.96028359	-117.114844	San Diego County
150751	Fee-for-Service	1336275528	1336275528	1	2	PLATINUM CARE HOME HEALTH,	8/12/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	16909 PARTHENIA ST	STE 104B	NORTH HILLS	CA	91343	4562	19	06037	34.22852346	-118.500687	Los Angeles County
150781	Fee-for-Service	1033241898	1033241898	1	1	PETERSON, TAMATHA S LCSW	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
150789	Fee-for-Service	1699932681	1699932681	1	1	PATEL, RAJ MD	6/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	6412 LAUREL AVE	None	MOUNTAIN MESA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
150810	Fee-for-Service	1255093316	1255093316	1	1	PROFESSIONAL & HONEST HOME	3/14/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	6356 VAN NUYS BLVD	STE 220	VAN NUYS	CA	91404	2627	19	06037	34.185861	-118.4487045	Los Angeles County
150826	Fee-for-Service	1285950253	1285950253	1	1	PHAM, STEVE MD	10/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132658	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
150854	Fee-for-Service	1427519552	1427519552	1	1	PATEL, SAMIR MD	11/22/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	177071	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
150859	Fee-for-Service	1144663048	1144663048	1	1	PAMULA, AKHILA MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131863	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
150866	Fee-for-Service	1669510228	1669510228	1	1	PARK, YONG E	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	WILMONT ORIENTAL MED CTR	903 S CRENSHAW BLVD	# 301	LOS ANGELES	CA	90019	1967	19	06037	34.05617593	-118.3221956	Los Angeles County
150884	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	12/4/2020	207RA0201X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
150898	Fee-for-Service	1871992644	1871992644	1	1	PARKWAY WOMEN'S CARE A	9/17/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	59011	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL CORPORATION	488 E VALLEY PARKWAY	SUITE 107	ESCONDIDO	CA	92025	3363	37	06073	33.12523814	-117.0769715	San Diego County
150915	Fee-for-Service	1699883207	1699883207	1	1	PELLETIER, MARC P MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71958	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150953	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
150960	Fee-for-Service	1780147744	1780147744	1	1	PATEL, PRANAVI MD	1/27/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
150981	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	6/15/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151006	Fee-for-Service	1396421459	1396421459	1	1	PRASAI, CAITLYN E CCC-SLP	1/27/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
151032	Fee-for-Service	1912096223	1912096223	1	1	PHELAN, JEFFREY P MD	4/30/1983	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44399	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1338 S HOPE ST	None	LOS ANGELES	CA	90015	2902	19	06037	34.03778533	-118.2667518	Los Angeles County
151033	Fee-for-Service	1023090206	1023090206	1	1	PARK, JEANNY K MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68672	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
151111	Fee-for-Service	1417213802	1417213802	1	1	PRIDGEN, BRIAN C MD	12/3/2020	163WS0121X	NA	Other	026	PHYSICIANS	127478	None	None	0	In state provider	None	45 CASTRO ST	STE 121	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
151115	Fee-for-Service	1831382662	1831382662	1	1	PERKINS TIFT, KATHRYN C MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104909	20	Orthopedic Surgery	0	In state provider	None	11160 WARNER AVE	STE 311	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
151145	Fee-for-Service	1427519552	1427519552	1	1	PATEL, SAMIR MD	11/22/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	177071	45	Nephrology (Renal-Kidney)	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 211	GARDEN GROVE	CA	92843	1916	30	06059	33.77450141	-117.9123364	Orange County
151158	Fee-for-Service	1982865333	1982865333	1	1	PENA, YANIRA LMFT	9/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
151172	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	5/2/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
151224	Fee-for-Service	1154716157	1154716157	1	1	PANG, JONATHAN K MD	5/15/2019	207L00000X	NA	Other	026	PHYSICIANS	145287	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
151241	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	9/16/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
151250	Fee-for-Service	1134482367	1134482367	1	1	PARHAMI, IMAN MD	3/18/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	131928	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
151269	Fee-for-Service	1528268109	1528268109	1	1	PRIEST, LORAL P	6/6/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
151270	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	1/30/2017	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151279	Fee-for-Service	1285699793	1285699793	1	1	PENINSULA PATHOLOGISTS	9/30/1996	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	3205	41	06081	37.592811	-122.382351	San Mateo County
151328	Fee-for-Service	1356443485	1356443485	1	1	PHUNG, HENRY Q MD	8/13/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83987	08	Family Practice	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
151343	Fee-for-Service	1033139951	1033139951	1	1	PIETZ, JEFFREY T MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51784	01	General Practice	0	In state provider	None	2629 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78784949	-117.8254935	Orange County
151412	Fee-for-Service	1780165860	1780165860	1	1	PAPENBROOK, SHAUNA L PHD	11/26/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
151434	Fee-for-Service	1629240544	1629240544	1	1	PAZOUKI, FATEMEH, MD APC	7/31/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	102778	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1801 COLORADO AVE	STE 210	TURLOCK	CA	95382	2707	50	06099	37.50941613	-120.8353105	Stanislaus County
151439	Fee-for-Service	1467578625	1467578625	1	1	PUTNEY, CHRISTOPHER A DPM	2/3/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
151458	Fee-for-Service	1922269760	1922269760	1	1	PATEL, CHIRAG R MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122718	18	Ophthalmology	0	In state provider	None	420 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4908	01	06001	37.72618723	-122.1516684	Alameda County
151462	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	10/31/1994	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
151499	Fee-for-Service	1184665952	1184665952	1	1	PAJESTKA, CHARLES R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 HUDSPETH ST	STE A	SONORA	TX	76950	8004	00	None	30.562191	-100.6363665	Sutton County
151525	Fee-for-Service	1811296288	1811296288	1	1	PRINCE, JENNIFER L DO	11/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14479	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
151527	Fee-for-Service	1194824722	1194824722	1	1	PETERS, JACOB K MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	33404	40	Pediatrics	0	In state provider	None	750 G ST	None	REEDLEY	CA	93654	2622	10	06019	36.59985426	-119.4544917	Fresno County
151528	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
151559	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	12/29/2018	207RA0201X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151590	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
151652	Fee-for-Service	1447765201	1447765201	1	1	PEREZ, KARINA LMFT	4/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3316 INDUSTRY DR	None	SIGNAL HILL	CA	90755	4016	19	06037	33.79849605	-118.1526578	Los Angeles County
151671	Fee-for-Service	1962825240	1962825240	1	1	PATEL, HASNA M MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30290	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	622 34TH ST	None	BAKERSFIELD	CA	93301	2208	15	06029	35.39051453	-119.009079	Kern County
151698	Fee-for-Service	1437375011	1437375011	1	1	PIMENTA, HAROLD G MD	7/2/2008	2085R0204X	NA	Other	026	PHYSICIANS	86252	30	Radiology	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
151748	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	10/15/2018	207RA0201X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
151775	Fee-for-Service	1023035672	1023035672	1	1	PARDO, ENRIQUE S MD	12/1/2003	174400000X	NA	Other	026	PHYSICIANS	79347	None	None	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
151810	Fee-for-Service	1225657273	1225657273	1	1	PATEL, DIVYA A MD	6/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185594	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
151815	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	2/8/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
151844	Fee-for-Service	1578594776	1578594776	1	1	PAIKAL, ELIAS MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	33719	41	Internal Medicine	0	In state provider	None	540 N CENTRAL AVE	STE 203	GLENDALE	CA	91203	3364	19	06037	34.15437	-118.257912	Los Angeles County
151849	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	12/19/2016	207RA0201X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151865	Fee-for-Service	1295807808	1295807808	1	1	PINNACLE ANESTHESIA MEDI	11/14/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
151877	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
151905	Fee-for-Service	1457438624	1457438624	1	1	POLOWAY, MARK D PHD	1/31/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2181 EL CAMINO REAL	SUITE 205	OCEANSIDE	CA	92054	6222	37	06073	33.18767693	-117.3284773	San Diego County
151922	Fee-for-Service	1699960666	1699960666	1	1	POTREBIC, GORDANA PHD	9/25/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	120 PLEASANT HILL AVE N	SUITE 340	SEBASTOPOL	CA	95472	3168	49	06097	38.39887847	-122.8397185	Sonoma County
151974	Fee-for-Service	1447337381	1447337381	1	1	PRASAD, CHAYA J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49047	22	Pathology (M.D. only)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	01	06001	34.1010559	-117.6369445	San Bernardino County
151983	Fee-for-Service	1437375011	1437375011	1	1	PIMENTA, HAROLD G MD	7/2/2008	2085R0204X	NA	Other	026	PHYSICIANS	86252	02	General Surgery	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
152023	Fee-for-Service	1073617064	1073617064	1	1	PERRY, WENDELL H DO	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	6869	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
152037	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	9/16/2019	207RA0201X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
152050	Fee-for-Service	1588752612	1588752612	1	1	PEDIATRIC PARTNERS	8/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MED PROFESSIONAL CORP	36320 INLAND VALLEY DR	STE 203	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
152060	Fee-for-Service	1225095631	1225095631	1	1	PHAM, CAO VAN MD	7/15/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	32951	41	Internal Medicine	0	In state provider	None	17742 BEACH BLVD	STE 230	HUNTINGTON BEACH	CA	92647	6835	30	06059	33.704487	-117.989061	Orange County
152074	Fee-for-Service	1154954303	1154954303	1	1	PSYCHOLOGICAL BEHAVIORAL HEA	6/21/2024	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	LTH INC.	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
152080	Fee-for-Service	1558820845	1558820845	1	1	PATEL, ANESH MD	3/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180140	None	None	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
152095	Fee-for-Service	1477909125	1477909125	1	1	PALMCREST GRAND HOME ASSISTE	4/11/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ASSISTED LIVING LLC	3503 CEDAR AVE	None	LONG BEACH	CA	90807	3809	19	06037	33.82093228	-118.1954159	Los Angeles County
152103	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
152134	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	3/5/2018	207RA0201X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
152136	Fee-for-Service	1578594776	1578594776	1	1	PAIKAL, ELIAS MD	12/31/1995	207R00000X	NA	Other	026	PHYSICIANS	33719	45	Nephrology (Renal-Kidney)	0	In state provider	None	540 N CENTRAL AVE	STE 203	GLENDALE	CA	91203	3364	19	06037	34.15437	-118.257912	Los Angeles County
152147	Fee-for-Service	1942861026	1942861026	1	1	PELAYO, JERALD L MD	11/1/2022	207R00000X	NA	Other	026	PHYSICIANS	176490	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
152166	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	8/2/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
152182	Fee-for-Service	1518521798	1518521798	1	1	PATEL, PRIYANKA P MD	10/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180052	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
152193	Fee-for-Service	1518321157	1518321157	1	1	PATTERSON, BRIAN C MD	9/2/2021	208600000X	NA	General Surgery	026	PHYSICIANS	156070	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	STE E425	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
152195	Fee-for-Service	1053420844	1053420844	2	1	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3 6TH ST	None	POINT REYES STATI	CA	94956	0841	21	06041	38.06926923	-122.8086302	Marin County
152292	Fee-for-Service	1114236064	1114236064	1	1	PONDEXTER, DENIA E	1/3/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	6507	00	None	34.480224	-114.3390555	Mohave County
152323	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	1/1/1979	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
152340	Fee-for-Service	1750468112	1750468112	1	1	PHAM, TRAM L OD	8/1/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	265 MERIDIAN AVE	STE 6	SAN JOSE	CA	95126	2906	43	06085	37.32417558	-121.9138045	Santa Clara County
152356	Fee-for-Service	1942644596	1942644596	1	1	PREMIER HEALTHCARE SERVICES	4/1/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	200 SOUTH MAIN ST	STE 120	CORONA	CA	92882	2212	33	06065	33.87907397	-117.5659408	Riverside County
152361	Fee-for-Service	1154954303	1154954303	1	1	PSYCHOLOGICAL BEHAVIORAL HEA	4/21/2022	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LTH INC.	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
152363	Fee-for-Service	1174638076	1174638076	1	1	PAKTER, DAVID L MD	11/20/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85184	08	Family Practice	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
152391	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	12/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
152417	Fee-for-Service	1831383637	1831383637	1	1	PLANNED PARENTHOOD OF THE	7/3/2006	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	4305 UNIVERSITY AVE	STE 350	SAN DIEGO	CA	92105	8602	37	06073	32.74957853	-117.101439	San Diego County
152422	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	4/24/2018	207RA0201X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
152430	Fee-for-Service	1881987162	1881987162	1	1	PENICK, CIMBERLY L DO	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11697	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
152439	Fee-for-Service	1740417187	1740417187	1	1	POWERS, THEODORE N MD	1/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110865	05	Anesthesiology	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
152455	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	4/27/2017	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
152481	Fee-for-Service	1053420844	1053420844	2	1	PETALUMA HEALTH CENTER INC	7/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3 6TH ST	None	POINT REYES STATI	CA	94956	0841	21	06041	38.06926923	-122.8086302	Marin County
152505	Fee-for-Service	1306220686	1306220686	1	1	PARK, HAYOUNG MD	7/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	144908	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
152523	Fee-for-Service	1962115733	1962115733	1	1	PATIENTS CHOICE CLINIC INC	11/17/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	816 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2831	19	06037	34.16503922	-118.3455811	Los Angeles County
152539	Fee-for-Service	1538368832	1538368832	1	1	PUROHIT, GIRDHARI S MD INC	12/1/1997	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1225 E LATHAM AVE	STE B	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
152542	Fee-for-Service	1124555735	1124555735	1	1	PHAM, JUSTIN MD	8/15/2022	207L00000X	NA	Other	026	PHYSICIANS	177454	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
152549	Fee-for-Service	1871962076	1871962076	1	5	PORTOLA MEDICAL SERVICES, PC	1/6/2025	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9025 WARNER AVE	SUITE B	FOUNTAIN VALLEY	CA	92708	2700	30	06059	33.71593747	-117.971451	Orange County
152571	Fee-for-Service	1598723587	1598723587	1	1	PACK, JOHN C	11/2/1991	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	850 S ATLANTIC BLVD	STE 301	MONTEREY PARK	CA	91754	4729	19	06037	34.05097684	-118.1379979	Los Angeles County
152612	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	2/11/2013	207RA0201X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
152615	Fee-for-Service	1396511481	1396511481	1	1	PERCHIK, ELAN A	1/16/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
152619	Fee-for-Service	1740410182	1740410182	1	8	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	255 TERRACINA BLVD	STE 205C	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
152649	Fee-for-Service	1154954303	1154954303	1	1	PSYCHOLOGICAL BEHAVIORAL HEA	4/21/2022	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	LTH INC.	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
152654	Fee-for-Service	1548794035	1548794035	1	1	PAULINO, RAPHAEL E MD	7/19/2021	207L00000X	NA	Other	026	PHYSICIANS	161772	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
152666	Fee-for-Service	1184792079	1184792079	1	2	PRYOR,JONATHAN A MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62260	02	General Surgery	0	In state provider	None	3628 E IMPERIAL HWY	SUITE 204	LYNWOOD	CA	90262	2636	19	06037	33.93070837	-118.2044557	Los Angeles County
152680	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	10/14/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
152709	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	9/16/2019	207RA0201X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
152710	Fee-for-Service	1780188268	1780188268	1	1	PHILLIPS, ELISA M MD	6/15/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163885	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
152741	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
152743	Fee-for-Service	1033165899	1033165899	1	1	PARHAM, DAVID M MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
152812	Fee-for-Service	1962115733	1962115733	1	1	PATIENTS CHOICE CLINIC INC	11/17/2023	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	816 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2831	19	06037	34.16503922	-118.3455811	Los Angeles County
152883	Fee-for-Service	1295994440	1295994440	1	1	PARTIDA, RAMON A MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149275	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
152900	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
152907	Fee-for-Service	1740410182	1740410182	1	8	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	255 TERRACINA BLVD	STE 205C	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
152920	Fee-for-Service	1174981229	1174981229	1	1	PARK, KRISTEN CNM	1/25/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
152936	Fee-for-Service	1376591644	1376591644	1	1	PATEL, KOMAL D MD	7/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95869	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
152937	Fee-for-Service	1154954303	1154954303	1	1	PSYCHOLOGICAL BEHAVIORAL HEA	3/26/2023	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LTH INC.	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
152954	Fee-for-Service	1184792079	1184792079	1	2	PRYOR,JONATHAN A MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62260	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3628 E IMPERIAL HWY	SUITE 204	LYNWOOD	CA	90262	2636	19	06037	33.93070837	-118.2044557	Los Angeles County
152965	Fee-for-Service	1417554726	1417554726	1	1	PINK CORAL RESIDENCE LLC	12/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	40343 15TH ST. WEST	None	PALMDALE	CA	93551	3128	19	06037	34.61610153	-118.1566508	Los Angeles County
152968	Fee-for-Service	1336222397	1336222397	1	1	PERMANENTE MEDICAL GROUP INC	6/21/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
152983	Fee-for-Service	1851823504	1851823504	1	1	PARK, JOHN MD	9/17/2021	207R00000X	NA	Other	026	PHYSICIANS	157957	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
152992	Fee-for-Service	1376917369	1376917369	1	1	PELO, JENNIFER LPCC	11/29/2024	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
152997	Fee-for-Service	1336222397	1336222397	1	10	PERMANENTE MEDICAL GROUP INC	11/17/2015	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
153032	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	6/12/2017	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
153038	Fee-for-Service	1508982901	1508982901	1	1	PARODI, JACQUELINE N MSW LCS	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
153066	Fee-for-Service	1427317486	1427317486	1	1	PEABODY, CHRISTOPHER R MD	7/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121079	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
153077	Fee-for-Service	1770746653	1770746653	1	1	PRICE, JORDANA W MD	1/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	111903	None	None	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
153078	Fee-for-Service	1932574845	1932574845	1	1	PEDRO, DOROTHY L LCSW	3/22/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
153151	Fee-for-Service	1770888992	1770888992	1	1	PANOWICZ, VALERIE N LMFT	12/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
153173	Fee-for-Service	1821523168	1821523168	1	1	PAREKH, SEJAL N MD	8/6/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157958	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
153186	Fee-for-Service	1033859491	1033859491	1	1	PHAM, ALEXANDER T MD	3/21/2025	207R00000X	NA	Other	026	PHYSICIANS	187712	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
153187	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	3/9/2020	207RA0201X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
153190	Fee-for-Service	1063917375	1063917375	1	1	PETRIELLO, MARLA DO	3/26/2024	225XP0019X	NA	Other	026	PHYSICIANS	19887	None	None	0	In state provider	None	340 W EAST AVE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
153194	Fee-for-Service	1902151962	1902151962	1	1	PARIKH, RISHI M MD	6/16/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	132327	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
153203	Fee-for-Service	1831540632	1831540632	1	1	PYO, HOWARD C DO	11/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18709	None	None	0	In state provider	None	2000 E CHAPMAN AVE	100	FULLERTON	CA	92831	4103	30	06059	33.87415253	-117.895851	Orange County
153243	Fee-for-Service	1801871561	1801871561	1	1	PIMSTONE, NEVILLE R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33420	10	Gastroenterology (M.D. only)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
153274	Fee-for-Service	1104036565	1104036565	1	1	PEMBERTON, TERESA M LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47439	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4542	40	06079	35.27488974	-120.6468257	San Luis Obispo County
153286	Fee-for-Service	1346376894	1346376894	1	1	PATEL, SONAL R MD	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80378	None	None	0	In state provider	None	1701 CESAR E CHAVEZ AVE	STE 456 & 532	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
153290	Fee-for-Service	1093202566	1093202566	1	1	PREEFER, ZACHARY DO	11/14/2023	207L00000X	NA	Other	026	PHYSICIANS	21899	None	None	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
153294	Fee-for-Service	1659671600	1659671600	1	1	PLANNED PARENTHOOD SHASTA	4/11/2011	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ROSA CENTER	1140 SONOMA AVENUE	None	SANTA ROSA	CA	95405	4817	49	06097	38.440458	-122.699502	Sonoma County
153296	Fee-for-Service	1952786931	1952786931	1	1	PASADENA CARE CENTER LLC	4/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1640 N FAIR OAKS AVE	None	PASADENA	CA	91103	1615	19	06037	34.173909	-118.1507035	Los Angeles County
153317	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	4/9/2004	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
153356	Fee-for-Service	1376832519	1376832519	1	1	PARRY, DANIEL D MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130887	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
153385	Fee-for-Service	1033634373	1033634373	1	1	PREMIER FAMILY MEDICINE	3/6/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ASSOCIATES INC	2333 FOOTHILL BLVD	None	LA VERNE	CA	91750	3027	19	06037	34.11220804	-117.7613999	Los Angeles County
153395	Fee-for-Service	1497814099	1497814099	1	1	PHAM, THANG V DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7105	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
153440	Fee-for-Service	1619689304	1619689304	1	1	PINE MEDICAL TRANSPORT LLC	12/30/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4900 CALIFORNIA AVE	STE 210B	BAKERSFIELD	CA	93309	7024	15	06029	35.36440586	-119.0562732	Kern County
153452	Fee-for-Service	1982646154	1982646154	1	1	PATEL, ANIT B MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76092	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1200 B GAYLE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
153464	Fee-for-Service	1780911271	1780911271	1	1	PATEL, AMI N MD INC	11/28/2011	207R00000X	NA	Other	026	PHYSICIANS	88993	None	None	0	In state provider	None	1505 WILSON TERRACE	STE 155	GLENDALE	CA	91206	4032	19	06037	34.14960934	-118.2313491	Los Angeles County
153472	Fee-for-Service	1205038809	1205038809	1	1	PHAN, MONIQUE K DO	7/15/2008	207R00000X	NA	Other	026	PHYSICIANS	9739	41	Internal Medicine	0	In state provider	None	2601 W ALAMEDA AVE	#111	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
153474	Fee-for-Service	1508903352	1508903352	1	1	PALTER, LUBA LMFT	8/27/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
153478	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	7/14/2017	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
153480	Fee-for-Service	1740410182	1740410182	1	16	PACIFIC DERMATOLOGY INSTITUT	10/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	74090 EL PASEO	103	PALM DESERT	CA	92260	4135	33	06065	33.72028088	-116.3715055	Riverside County
153485	Fee-for-Service	1023110640	1023110640	1	1	PETERSON, LARS E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
153504	Fee-for-Service	1457468266	1457468266	1	1	PARADIS, DAVID R MD	11/1/2000	207P00000X	NA	Other	026	PHYSICIANS	65794	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
153517	Fee-for-Service	1871628149	1871628149	1	1	PARSH, NIKHIL MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82301	30	Radiology	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
153522	Fee-for-Service	1265750129	1265750129	1	1	PETROVA, EKATERINA N MD	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127080	40	Pediatrics	0	In state provider	None	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
153530	Fee-for-Service	1235721762	1235721762	1	1	PETERSON, SHELBY PT	8/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
153539	Fee-for-Service	1639242050	1639242050	1	1	PERLMAN, JEREMY S MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94930	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
153541	Fee-for-Service	1376743328	1376743328	1	1	PHUI, KHUONG C DO	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11007	08	Family Practice	0	In state provider	None	210 CANAL ST.	KING CITY	MONTEREY	CA	93930	0000	27	06053	36.20731142	-121.1325532	Monterey
153543	Fee-for-Service	1962030254	1962030254	1	1	PANDRAVADA, SASIREKHA DO	8/17/2023	207R00000X	NA	Other	026	PHYSICIANS	21057	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
153590	Fee-for-Service	1366530099	1366530099	1	1	PARNELL MEDICAL CORP	10/1/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1100 S ELISEO DR	STE 2	GREENBRAE	CA	94904	2017	21	06041	37.94358265	-122.5345035	Marin County
153602	Fee-for-Service	1861598922	1861598922	1	1	PHILLIPS, CHERYL L MD	7/21/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57920	08	Family Practice	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
153606	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	1/11/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
153623	Fee-for-Service	1639463391	1639463391	1	1	POTH, LUKE S MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
153661	Fee-for-Service	1508004086	1508004086	1	1	PROHEALTH PARTNERS A MEDICAL	10/13/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	6226 E SPRING ST	STE 240	LONG BEACH	CA	90815	1453	19	06037	33.81040053	-118.1102715	Los Angeles County
153680	Fee-for-Service	1497814099	1497814099	1	1	PHAM, THANG V DO	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7105	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
153739	Fee-for-Service	1982646154	1982646154	1	1	PATEL, ANIT B MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76092	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GAYLE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
153742	Fee-for-Service	1982079448	1982079448	1	1	PATEL, MONALI MD INC	2/16/2016	2084N0400X	NA	Neurology	026	PHYSICIANS	117320	13	Neurology (M.D. only)	0	In state provider	None	2400 E 24TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.66889426	-117.076872	San Diego County
153765	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	2/8/2020	207RA0201X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
153773	Fee-for-Service	1740410182	1740410182	1	11	PACIFIC DERMATOLOGY INSTITUT	9/12/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	11340 MOUNTAIN VIEW AVE.	B1	LOMA LINDA	CA	92354	3884	36	06071	34.04699925	-117.2436953	San Bernardino County
153810	Fee-for-Service	1326562257	1326562257	1	1	PAREDES, DANELVIS MD MPH	8/21/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	188606	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
153834	Fee-for-Service	1871642991	1871642991	1	1	PACIFIC SHORES MED GROUP	7/1/1998	207RX0202X	NA	Oncology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	222 W EULALIA ST	STE 100B	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
153863	Fee-for-Service	1285834440	1285834440	1	1	PHILLIPS, LARON MD	3/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	132048	None	None	0	In state provider	None	4199 FLAT ROCK DR	STE 148	RIVERSIDE	CA	92505	7115	33	06065	33.90364208	-117.4931242	Riverside County
153867	Fee-for-Service	1588860829	1588860829	1	1	PRESCOTT, DANIEL MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119629	18	Ophthalmology	0	In state provider	None	1360 E HERNDON	STE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
153868	Fee-for-Service	1710042965	1710042965	2	1	PATINO, ALFRED DPM	7/1/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1065 COLORADO AVE	STE 5	TURLOCK	CA	95380	2761	50	06099	37.50302546	-120.8353143	Stanislaus County
153879	Fee-for-Service	1366530099	1366530099	1	1	PARNELL MEDICAL CORP	10/1/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1100 S ELISEO DR	STE 2	GREENBRAE	CA	94904	2017	21	06041	37.94358265	-122.5345035	Marin County
153889	Fee-for-Service	1306473160	1306473160	1	1	PFEIL, SARAH K MD	12/4/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180825	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
153892	Fee-for-Service	1861598922	1861598922	1	1	PHILLIPS, CHERYL L MD	7/21/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57920	38	Geriatrics	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
153894	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
153942	Fee-for-Service	1508004086	1508004086	1	1	PROHEALTH PARTNERS A MEDICAL	10/13/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6226 E SPRING ST	STE 240	LONG BEACH	CA	90815	1453	19	06037	33.81040053	-118.1102715	Los Angeles County
153989	Fee-for-Service	1841723327	1841723327	1	4	PEACH TREE HEALTHCARE	11/23/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	120 5TH STREET	ROOM 1	MARYSVILLE	CA	95901	5734	58	06115	39.14056159	-121.5857045	Yuba County
153998	Fee-for-Service	1821011347	1821011347	1	1	POTTS, MATTHEW E MD	8/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85732	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
154028	Fee-for-Service	1982646154	1982646154	1	1	PATEL, ANIT B MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76092	41	Internal Medicine	0	In state provider	None	1200 B GAYLE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
154034	Fee-for-Service	1457391039	1457391039	1	1	PHAN, BINH A MD	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132255	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
154053	Fee-for-Service	1336222397	1336222397	1	3	PERMANENTE MEDICAL GROUP INC	6/21/2019	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
154058	Fee-for-Service	1740410182	1740410182	1	11	PACIFIC DERMATOLOGY INSTITUT	9/12/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	11340 MOUNTAIN VIEW AVE.	B1	LOMA LINDA	CA	92354	3884	36	06071	34.04699925	-117.2436953	San Bernardino County
154089	Fee-for-Service	1467463463	1467463463	1	1	PONGANIS, PAUL J MD	4/30/1982	207L00000X	NA	Other	026	PHYSICIANS	43095	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
154116	Fee-for-Service	1437308772	1437308772	1	1	PAHK, RAYMOND B MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152185	20	Orthopedic Surgery	0	In state provider	None	95 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00424149	-122.5538514	Marin County
154135	Fee-for-Service	1174055693	1174055693	1	1	PASSER, DEREK L MD	12/5/2022	207L00000X	NA	Other	026	PHYSICIANS	182607	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
154160	Fee-for-Service	1851651954	1851651954	1	1	PLEASANT DAY HOSPICE INC	5/24/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6737 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	1219	19	06037	34.193259	-118.4662185	Los Angeles County
154163	Fee-for-Service	1972819803	1972819803	1	2	PACIFIC KIDNEY & HYPERTENSIO	1/24/2011	193200000X	NA	Other	026	PHYSICIANS	104576	None	None	0	In state provider	HYPERTENSION, INC	1148 NORMAN DR	STE 4	MANTECA	CA	95336	5961	39	06077	37.79420383	-121.2001656	San Joaquin County
154181	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
154187	Fee-for-Service	1689146433	1689146433	1	1	PARADISE HOME HEALTH	12/7/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF LOS ANGELES INC	5530 CORBIN AVE	STE 220	TARZANA	CA	91356	2914	19	06037	34.171812	-118.5621935	Los Angeles County
154259	Fee-for-Service	1376632638	1376632638	1	1	PUPPALA, SHILPA MD	4/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54944	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
154271	Fee-for-Service	1730359159	1730359159	1	1	PAYNE, CARLA PSYD	7/12/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
154274	Fee-for-Service	1841723327	1841723327	1	4	PEACH TREE HEALTHCARE	11/23/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	120 5TH STREET	ROOM 1	MARYSVILLE	CA	95901	5734	58	06115	39.14056159	-121.5857045	Yuba County
154295	Fee-for-Service	1952882243	1952882243	1	1	PHYSICAL THERAPY & REHABILIT	7/23/2019	261QM1300X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	UTIONS	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
154334	Fee-for-Service	1427262252	1427262252	1	1	PAVLIN, EDWARD G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY PHYSICIANS	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
154335	Fee-for-Service	1972949709	1972949709	1	1	PETERS, CHRISTINE D	9/19/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6367	43	06085	37.36797679	-122.0297112	Santa Clara County
154344	Fee-for-Service	1740410182	1740410182	1	16	PACIFIC DERMATOLOGY INSTITUT	10/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	74090 EL PASEO	103	PALM DESERT	CA	92260	4135	33	06065	33.72028088	-116.3715055	Riverside County
154384	Fee-for-Service	1639110471	1639110471	1	1	PITTS, WILLIAM C MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51515	None	None	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
154386	Fee-for-Service	1518028497	1518028497	1	1	POSNER, CHRISTIAN J MD	12/12/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15258	None	None	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
154388	Fee-for-Service	1851692560	1851692560	1	3	PLANNED PARENTHOOD SHASTA	1/6/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	935 TRANCAS ST	UNIT 4D	NAPA	CA	94558	2947	28	06055	38.32367324	-122.294977	Napa County
154389	Fee-for-Service	1508173873	1508173873	1	1	PEACE, ROBYN A LCSW	9/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
154396	Fee-for-Service	1053634725	1053634725	1	1	PALM DRIVE HEALTH CARE DIST	3/9/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DEPARTMENT OF EKG	6800 PALM AVENUE	STE C-1	SEBASTOPOL	CA	95472	4215	49	06097	38.39602719	-122.8185446	Sonoma County
154407	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	4/24/2009	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
154408	Fee-for-Service	1487942835	1487942835	1	1	PARASHAR, PAVAN MD	7/10/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1875 S GRANT ST	None	SAN MATEO	CA	94402	2666	41	06081	37.55313	-122.302172	San Mateo County
154426	Fee-for-Service	1770236671	1770236671	1	1	PEDERSEN, ERICA A CCC-SLP	11/22/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39755 MURRIETA HOT SPRIN	STE F120	MURRIETA	CA	92563	9151	33	06065	33.55575954	-117.1627899	Riverside County
154438	Fee-for-Service	1881725406	1881725406	1	1	PURPUS, DEBBIE L MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41800	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
154448	Fee-for-Service	1851651954	1851651954	1	1	PLEASANT DAY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6737 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	1219	19	06037	34.193259	-118.4662185	Los Angeles County
154470	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	7/6/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
154509	Fee-for-Service	1982660544	1982660544	1	1	PETER C. H. WAI MD	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
154555	Fee-for-Service	1750860466	1750860466	1	1	PATATANYAN, MKRTICH DO	10/5/2021	207R00000X	NA	Other	026	PHYSICIANS	18882	None	None	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
154573	Fee-for-Service	1457422420	1457422420	1	1	PAREDES, JOSEPH P MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64061	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
154579	Fee-for-Service	1952882243	1952882243	1	1	PHYSICAL THERAPY & REHABILIT	7/23/2019	261QM1300X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	UTIONS	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
154605	Fee-for-Service	1891716551	1891716551	1	1	PILLSBURY, MATTHEW S MD	10/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105595	66	Emergency Medicine (Urgent Care)	0	In state provider	None	624 E ELDER STREET	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
154614	Fee-for-Service	1134673726	1134673726	1	1	PAGLIERO, CALEB PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
154623	Fee-for-Service	1033767215	1033767215	1	1	PARKSIDE VILLA INC	12/3/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	300 S 22ND ST	None	SAN JOSE	CA	95116	2727	43	06085	37.34155606	-121.8651215	Santa Clara County
154632	Fee-for-Service	1770922676	1770922676	1	1	PARK, BENJAMIN R DO	8/8/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19952	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
154665	Fee-for-Service	1104031327	1104031327	1	1	PERALEJO, BELLE M MD	3/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102716	03	Allergy	0	In state provider	None	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.84632065	-119.783885	Fresno County
154679	Fee-for-Service	1912384025	1912384025	1	1	PARK, ANNIE MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144866	41	Internal Medicine	0	In state provider	None	4077 FIFTH ST	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
154694	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	2/24/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
154726	Fee-for-Service	1326697814	1326697814	1	1	PSYCHOTHERAPY SERVICES BY LI	8/29/2020	225XM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SA STEIN, LMFT	7 4TH ST	STE 7	PETALUMA	CA	94952	3072	49	06097	38.23300765	-122.640298	Sonoma County
154731	Fee-for-Service	1649512054	1649512054	1	1	PRABHUSWAMY, ANJAN MD	4/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134629	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
154737	Fee-for-Service	1962535849	1962535849	1	1	PROHEALTH PARTNERS A MEDICAL	12/13/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	GROUP INC	3801 KATELLA AVE	SUITE 206	LOS ALAMITOS	CA	90720	3358	30	06059	33.80318951	-118.066068	Orange County
154758	Fee-for-Service	1639252604	1639252604	1	3	PERMANENTE MEDICAL GROUP INC	6/2/2004	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
154764	Fee-for-Service	1609960806	1609960806	1	1	PURVIS, GREGORY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4000 KRESGE WAY	None	LOUISVILLE	KY	40207	4605	00	None	38.23923389	-85.63896565	Jefferson County
154781	Fee-for-Service	1902833734	1902833734	1	1	PATEL, HITESH C MD	11/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50723	08	Family Practice	0	In state provider	None	7915 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75929551	-117.9903645	Orange County
154785	Fee-for-Service	1346959509	1346959509	1	1	PORTILLO, ANTHONY PT	11/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 BARRANCA ST.	SUITE 920	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
154787	Fee-for-Service	1417503830	1417503830	1	1	PARK, JOHN DO	7/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20967	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
154797	Fee-for-Service	1912352493	1912352493	1	2	PACIFIC CENTRAL COAST HEALTH	8/26/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3817	40	06079	35.11274104	-120.588873	San Luis Obispo County
154800	Fee-for-Service	1669933776	1669933776	1	1	PRAXIS INFECTIOUS DISEASES	12/16/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
154807	Fee-for-Service	1215705181	1215705181	1	1	PLAZO, ERICK PT	5/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
154820	Fee-for-Service	1407828429	1407828429	1	1	PASADENA HOSP ASSN, LTD	12/18/2007	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
154839	Fee-for-Service	1144212713	1144212713	1	1	PHUNG, STEVE D OD	4/1/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SPEX OPTOMETRY	11412 WASHINGTON BLVD	None	WHITTIER	CA	90606	3122	19	06037	33.97105838	-118.0681463	Los Angeles County
154842	Fee-for-Service	1619066065	1619066065	1	1	PAPAS, GEORGE T MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	29864	08	Family Practice	0	In state provider	None	2883 MEADE AVE	None	SAN DIEGO	CA	92116	4211	37	06073	32.7572405	-117.131724	San Diego County
154845	Fee-for-Service	1912132234	1912132234	1	1	PUPEIKIENE, JURGITA MD	7/21/2009	207R00000X	NA	Other	026	PHYSICIANS	107415	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
154852	Fee-for-Service	1275764417	1275764417	1	1	PREMIER HEALTHCARE SERVICES	3/31/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1601 RESPONSE RD	STE 250	SACRAMENTO	CA	95815	5258	34	06067	38.597769	-121.429548	Sacramento County
154857	Fee-for-Service	1447729280	1447729280	1	1	PENA, ALEXIS RCP	12/1/2023	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
154861	Fee-for-Service	1457422420	1457422420	1	1	PAREDES, JOSEPH P MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64061	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
154866	Fee-for-Service	1457568867	1457568867	1	1	PRICE, CHARLES N DC	4/27/2006	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	471 AINSLEY AVE	None	YUBA CITY	CA	95991	4105	51	06101	39.14416198	-121.6203058	Sutter County
154867	Fee-for-Service	1952882243	1952882243	1	1	PHYSICAL THERAPY & REHABILIT	7/23/2019	261QM1300X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	UTIONS	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
154868	Fee-for-Service	1659340743	1659340743	1	1	PATEL,MILAN C MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	82214	13	Neurology (M.D. only)	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
154874	Fee-for-Service	1043483597	1043483597	1	1	PERO, THOMAS MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102328	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
154882	Fee-for-Service	1285346809	1285346809	1	4	PAJARO VALLEY HEALTH CARE DI	3/31/2025	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	99 AIRPORT BLVD	None	FREEDOM	CA	95019	2917	44	06087	36.93884013	-121.7776254	Santa Cruz County
154905	Fee-for-Service	1518966902	1518966902	1	1	PUGH, PEGGY MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	57720	30	Radiology	0	In state provider	None	100 OCEANGATE	STE 1000	LONG BEACH	CA	90802	4347	19	06037	33.76655046	-118.1989306	Los Angeles County
154906	Fee-for-Service	1699703991	1699703991	1	1	PLAZA SURGICAL MEDICAL CENTE	8/8/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	R	850 S ATLANTIC BLVD	SUITE 201	MONTEREY PARK	CA	91754	4730	19	06037	34.05097684	-118.1379979	Los Angeles County
154911	Fee-for-Service	1336734078	1336734078	1	1	PEREYRA, SERGIO LMFT	5/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	410 W FALLBROOK AVE STE	None	FRESNO	CA	93711	6191	10	06019	36.84938752	-119.7995445	Fresno County
154924	Fee-for-Service	1083140560	1083140560	1	3	PROFICIO SPEECH THERAPY GROU	6/4/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P, INC.	1325 HOWE AVE	SUITE 207	SACRAMENTO	CA	95825	3364	34	06067	38.590191	-121.416624	Sacramento County
154934	Fee-for-Service	1508419029	1508419029	1	1	PRO ANGELS, INC	8/25/2023	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	401 S. MAIN STREET	103	POMONA	CA	91411	2357	19	06037	34.05572988	-117.7522895	Los Angeles County
154943	Fee-for-Service	1548643489	1548643489	1	1	PANCHAL, VINAYKUMAR R MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153124	41	Internal Medicine	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.741948	-121.848921	Butte County
154959	Fee-for-Service	1184940678	1184940678	1	1	PACSON, ELLEN C MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123136	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
154981	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	10/15/2018	152W00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
155002	Fee-for-Service	1285718262	1285718262	1	1	PECKLER, SETH MAINKER	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	66127	01	General Practice	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
155024	Fee-for-Service	1962535849	1962535849	1	1	PROHEALTH PARTNERS A MEDICAL	12/13/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	3801 KATELLA AVE	SUITE 206	LOS ALAMITOS	CA	90720	3358	30	06059	33.80318951	-118.066068	Orange County
155082	Fee-for-Service	1053327346	1053327346	1	1	PAYLESS DRUG STORE 6079	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1730 WATT AVE	None	SACRAMENTO	CA	95825	2140	34	06067	38.596662	-121.381668	Sacramento County
155109	Fee-for-Service	1407828429	1407828429	1	1	PASADENA HOSP ASSN, LTD	12/1/1979	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
155117	Fee-for-Service	1962778928	1962778928	1	1	PARSI, KORY K DO	1/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13033	07	Dermatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
155120	Fee-for-Service	1629570726	1629570726	1	1	PEREZ, MELINNA LMFT	7/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
155124	Fee-for-Service	1487807111	1487807111	1	1	PHAM, ALEXANDER D MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112936	41	Internal Medicine	0	In state provider	None	15400 NATIONAL AVENUE	STE 201	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
155131	Fee-for-Service	1619066065	1619066065	1	1	PAPAS, GEORGE T MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	29864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2883 MEADE AVE	None	SAN DIEGO	CA	92116	4211	37	06073	32.7572405	-117.131724	San Diego County
155151	Fee-for-Service	1841671591	1841671591	1	1	PHAM, DAVID V MD	10/21/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152624	None	None	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
155153	Fee-for-Service	1437679784	1437679784	1	1	POPP, MARGARET E LCSW	12/11/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
155154	Fee-for-Service	1659340743	1659340743	1	1	PATEL,MILAN C MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	82214	41	Internal Medicine	0	In state provider	None	1904 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07852627	-117.7481309	Los Angeles County
155156	Fee-for-Service	1144256355	1144256355	1	1	PERLMAN, MICHAEL W MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	85611	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
155161	Fee-for-Service	1669875563	1669875563	1	1	PORTSIDE HEALTHCARE INC	12/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3680 REYNARD WAY	None	SAN DIEGO	CA	92103	3847	37	06073	32.74480077	-117.1715646	San Diego County
155169	Fee-for-Service	1457377541	1457377541	1	1	PACIFIC PATHOLOGY INC	12/19/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	4945 MERCURY ST	None	SAN DIEGO	CA	92111	1703	37	06073	32.8316709	-117.1488624	San Diego County
155174	Fee-for-Service	1699833491	1699833491	1	1	PREDA, ADRIAN MD	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52180	36	Psychiatry	0	In state provider	None	101 THE CITY DRIVE SOUTH	BUILDING 3	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
155175	Fee-for-Service	1922176668	1922176668	1	1	PARRISH, DAVID N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
155183	Fee-for-Service	1992047575	1992047575	1	1	PATEL, MIHIR MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153627	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
155187	Fee-for-Service	1427032283	1427032283	1	1	PEDERSON,JUDITH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20010 CENTURY BLVD	STE 200	GERMANTOWN	MD	20874	0000	00	None	39.18560725	-77.25950536	Montgomery County
155249	Fee-for-Service	1184940678	1184940678	1	1	PACSON, ELLEN C MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123136	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
155270	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	8/20/2013	152W00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
155286	Fee-for-Service	1003830118	1003830118	1	1	PRINCE, JONATHAN MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90191	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
155292	Fee-for-Service	1891729109	1891729109	1	1	PETERSON, JOHN L MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	58431	07	Dermatology	0	In state provider	None	3883 AIRWAY DR	STE 165	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
155302	Fee-for-Service	1427145309	1427145309	1	1	PROFESSIONAL VILLAGE	3/11/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	1701 PROFESSIONAL DR	None	SACRAMENTO	CA	95825	2104	34	06067	38.596455	-121.387383	Sacramento County
155313	Fee-for-Service	1922482108	1922482108	1	1	PARDO, ROBERTO C NP	11/1/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
155329	Fee-for-Service	1982066734	1982066734	1	1	PARIKH, AMIT MD	8/5/2022	207R00000X	NA	Other	026	PHYSICIANS	161326	None	None	0	In state provider	None	1040 ELM AVE	STE 300	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
155353	Fee-for-Service	1972623007	1972623007	1	1	PDAP OF VENTURA COUNTY, INC	4/14/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1029 E SANTA PAULA ST	None	SANTA PAULA	CA	93060	2247	56	06111	34.35757427	-119.0610247	Ventura County
155397	Fee-for-Service	1407828429	1407828429	1	1	PASADENA HOSP ASSN, LTD	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	EILEEN KOONS	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
155413	Fee-for-Service	1962508135	1962508135	2	1	POPE, RICK S OD	6/12/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
155430	Fee-for-Service	1588742308	1588742308	1	1	PASTCAN, RICHARD G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30093	40	Pediatrics	0	In state provider	None	3284 JEFFERSON ST	None	NAPA	CA	94558	3436	28	06055	38.32147532	-122.2994954	Napa County
155451	Fee-for-Service	1174923684	1174923684	1	2	PLANNED PARENTHOOD MAR MONTE	12/18/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1400 BROADWAY	None	OAKLAND	CA	94621	2004	01	06001	37.80455747	-122.2710233	Alameda County
155471	Fee-for-Service	1073976353	1073976353	1	1	PETERSON, CATHERINE MD	4/6/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	168446	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
155472	Fee-for-Service	1861661373	1861661373	1	1	PHAM, NGUYEN S MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102823	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155476	Fee-for-Service	1861682189	1861682189	1	1	PARK, JASON L MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	112590	05	Anesthesiology	0	In state provider	None	9400 NO NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
155520	Fee-for-Service	1881993202	1881993202	1	1	PI, ALEXANDER C DO	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12644	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
155525	Fee-for-Service	1902260441	1902260441	1	1	PRAVDO, PIERS DO	12/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	15734	None	None	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
155538	Fee-for-Service	1366795106	1366795106	1	1	PARK, EDWARD J DO	8/5/2019	208800000X	NA	Other	026	PHYSICIANS	17227	34	Urology and Urological Surgery	0	In state provider	None	3771 KATELLA AVE	STE 210	LOS ALAMITOS	CA	90720	3118	30	06059	33.80319153	-118.067274	Orange County
155558	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	3/9/2020	152W00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
155572	Fee-for-Service	1295795672	1295795672	1	1	PETERSEN, SANDRA R MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51961	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	823 GATEWAY CENTER WAY	None	SAN DIEGO	CA	92102	4541	37	06073	32.71503452	-117.1134945	San Diego County
155577	Fee-for-Service	1346237971	1346237971	1	1	PEACE HEALTH	1/20/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
155591	Fee-for-Service	1467760108	1467760108	1	1	PACHECO, ALMA LMFT	1/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
155629	Fee-for-Service	1043713969	1043713969	1	1	POLY-MED PHARMACY INC	12/3/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17313 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	3901	19	06037	34.22114751	-118.510272	Los Angeles County
155648	Fee-for-Service	1164581740	1164581740	1	1	PAKANATI, ANURADHA R MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61691	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
155653	Fee-for-Service	1184901001	1184901001	1	1	PATEL, NIMISH G DO	5/30/2023	207R00000X	NA	Other	026	PHYSICIANS	18257	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
155716	Fee-for-Service	1366443525	1366443525	1	1	PRICE, STEVEN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 GLENN HENDREN DR	None	LIBERTY	MO	64068	9625	00	None	39.278767	-94.42102759	Clay County
155739	Fee-for-Service	1114184199	1114184199	1	1	PIERRE-LOUIS, ROSE-STELLA O	1/31/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	T	11151 SUN CENTER DR	C	RANCHO CORDOVA	CA	95670	6148	34	06067	38.596023	-121.2693075	Sacramento County
155759	Fee-for-Service	1376937656	1376937656	1	1	PATEL, SHRUTI P MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146173	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
155764	Fee-for-Service	1053625517	1053625517	1	1	PENCIU, OANA M MD	10/2/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	146855	None	None	0	In state provider	None	220 S 1ST ST	None	ALHAMBRA	CA	91801	3893	19	06037	34.09192598	-118.1259775	Los Angeles County
155774	Fee-for-Service	1295939346	1295939346	1	1	PAINTER, MYA T LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
155786	Fee-for-Service	1710997838	1710997838	1	1	POSTIGO, PEDRO J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34256	13	Neurology (M.D. only)	0	In state provider	None	665 CAMINO DEL LOS MARES	STE 200	SAN CLEMENTE	CA	92673	0000	30	06059	33.45730192	-117.6483252	Orange County
155792	Fee-for-Service	1124113915	1124113915	1	1	PENG, MEI Z MD	3/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84677	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
155813	Fee-for-Service	1790069235	1790069235	1	1	PREMIER ORTHOPEDIC SURGEON	1/23/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	HOSPITALISTS	1850 SULLIVAN AVE	SUITE 150	DALY CITY	CA	94015	2200	41	06081	37.68085904	-122.4728842	San Mateo County
155820	Fee-for-Service	1912232513	1912232513	1	1	PEJAVAR, SUNANDA M MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	103733	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
155846	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	2/12/2019	152W00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
155864	Fee-for-Service	1346237971	1346237971	1	1	PEACE HEALTH	1/20/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
155872	Fee-for-Service	1154860963	1154860963	1	1	POMONA COMMUNITY HEALTH	5/23/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	2680 E RIVERSIDE DR	None	ONTARIO	CA	91761	7307	36	06071	34.018722	-117.594603	San Bernardino County
155914	Fee-for-Service	1548598220	1548598220	1	1	PRUEITT, ASHLEY D PSYD	8/21/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
155943	Fee-for-Service	1194291294	1194291294	1	1	POOLSAAD FAMILY VISION OPTOM	4/28/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ETRY INC	7749 PAINTER AVE	None	WHITTIER	CA	90602	2411	19	06037	33.9703591	-118.0327069	Los Angeles County
156017	Fee-for-Service	1841600418	1841600418	1	1	PUING, ALFREDO G MD	4/23/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	161963	77	Infectious Disease	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
156041	Fee-for-Service	1881703593	1881703593	1	1	PORTERVILLE VALLEY PROMPTCAR	7/23/2012	193400000X	NA	Other	026	PHYSICIANS	40223	None	None	0	In state provider	MEDICAL CENTER, APC	876 W GRAND AVE	None	PORTERVILLE	CA	93257	2071	54	06107	36.07689277	-119.0370172	Tulare County
156065	Fee-for-Service	1396738993	1396738993	1	1	PATTERSON, JACK A MD	10/30/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	24768	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
156076	Fee-for-Service	1871607762	1871607762	1	84	PROVIDENCE MEDICAL FOUNDATIO	9/8/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3443 VILLA LANE	SUITE 2	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
156100	Fee-for-Service	1801287008	1801287008	1	1	PABAND MEDICAL CORP	7/8/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	SUITE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
156101	Fee-for-Service	1396300323	1396300323	1	1	PARK, STEVEN MD	8/4/2022	207R00000X	NA	Other	026	PHYSICIANS	178069	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
156110	Fee-for-Service	1912232513	1912232513	1	1	PEJAVAR, SUNANDA M MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	103733	78	Neoplastic Diseases/Oncology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
156134	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	9/16/2019	152W00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
156160	Fee-for-Service	1154860963	1154860963	1	1	POMONA COMMUNITY HEALTH	5/23/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	2680 E RIVERSIDE DR	None	ONTARIO	CA	91761	7307	36	06071	34.018722	-117.594603	San Bernardino County
156182	Fee-for-Service	1689871386	1689871386	1	1	PHILLIPS, MELINDA W MD	4/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96962	41	Internal Medicine	0	In state provider	None	625 S FAIR OAKS AVENUE	STE 245	PASADENA	CA	91105	2665	19	06037	34.134894	-118.1504155	Los Angeles County
156186	Fee-for-Service	1124026273	1124026273	2	1	PROVIDENCE SAINT JOHNS	3/1/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
156193	Fee-for-Service	1982789418	1982789418	1	1	POTTER, CHARLES A MD	8/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	56558	01	General Practice	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
156206	Fee-for-Service	1639193063	1639193063	1	1	PARKER, JAMES N MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69262	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
156208	Fee-for-Service	1922044940	1922044940	1	1	PHAM HUYEN Q MD	7/1/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70006	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
156216	Fee-for-Service	1871970541	1871970541	1	1	PARK, WAI K DO	6/11/2018	207SG0201X	NA	Other	026	PHYSICIANS	15213	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
156263	Fee-for-Service	1447516216	1447516216	1	1	PATRICK FLEEMAN	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
156275	Fee-for-Service	1568718401	1568718401	1	1	PURI, SIDDARTH MD	2/8/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	139447	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVE	1ST FLOOR	SAN LUIS OBISPO	CA	93401	4513	40	06079	35.27488974	-120.6468257	San Luis Obispo County
156305	Fee-for-Service	1841600418	1841600418	1	1	PUING, ALFREDO G MD	4/23/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	161963	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
156323	Fee-for-Service	1013104595	1013104595	1	1	PHAM, HIEN V DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11922 SEACREST DR	STE E	GARDEN GROVE	CA	92840	1937	30	06059	33.7894657	-117.9537811	Orange County
156344	Fee-for-Service	1851347272	1851347272	1	2	PALMS IMAGING MEDICAL GROUP	5/29/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4279 TIERRA REJADA	#3775 ROOM 13	MOORPARK	CA	93021	3775	56	06111	34.26903703	-118.898937	Ventura County
156358	Fee-for-Service	1194789271	1194789271	1	1	PAUL B GOOGE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 ERIN DR	None	KNOXVILLE	TN	37919	6202	00	None	35.92873617	-84.00304685	Knox County
156363	Fee-for-Service	1649360488	1649360488	1	1	PADILLA, DOROTHY J	12/7/2004	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2702 LOW CT	None	FAIRFIELD	CA	94534	9727	48	06095	38.23678474	-122.0847463	Solano County
156367	Fee-for-Service	1568942530	1568942530	1	1	POUNDS, VALERIE S RCP	10/22/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
156379	Fee-for-Service	1063622819	1063622819	1	1	PENA-RUIZ, MIGUEL A MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101128	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
156399	Fee-for-Service	1962255661	1962255661	1	1	PERIDOT HEALTH	12/9/2024	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	C	221 ELMO HWY	300	MC FARLAND	CA	93250	9528	15	06029	35.68880285	-119.2321901	Kern County
156422	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	152W00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
156450	Fee-for-Service	1154860963	1154860963	1	1	POMONA COMMUNITY HEALTH	12/8/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	2680 E RIVERSIDE DR	None	ONTARIO	CA	91761	7307	36	06071	34.018722	-117.594603	San Bernardino County
156451	Fee-for-Service	1114156775	1114156775	1	1	PATEL, AMAR P MD	7/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120364	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
156470	Fee-for-Service	1689871386	1689871386	1	1	PHILLIPS, MELINDA W MD	4/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96962	40	Pediatrics	0	In state provider	None	625 S FAIR OAKS AVENUE	STE 245	PASADENA	CA	91105	2665	19	06037	34.134894	-118.1504155	Los Angeles County
156475	Fee-for-Service	1124026273	1124026273	2	1	PROVIDENCE SAINT JOHNS	3/1/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
156479	Fee-for-Service	1053916965	1053916965	1	1	PEACOCK, REGINA J MSW LCSW	12/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16195 SISKIYOU ROAD	120B	APPLE VALLEY	CA	92307	1346	36	06071	34.54549098	-117.2671509	San Bernardino County
156516	Fee-for-Service	MSS00043F	None	1	1	PARTNERS IN CARE	4/1/2003	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION, INC	3621 E MLK BLVD	SUITE 8	LYNNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
156518	Fee-for-Service	1154713790	1154713790	1	2	PROACTIVE CARE NURSING, INC	8/28/2017	363LA2200X	NA	Nurse Practitioner	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	17822 BEACH BLVD	400	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
156523	Fee-for-Service	1295899888	1295899888	1	1	PODIATRY ASSOC OF SD CTY	7/3/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	3330 3RD AVE	STE 402	SAN DIEGO	CA	92103	5639	37	06073	32.74053588	-117.1622264	San Diego County
156536	Fee-for-Service	1457997835	1457997835	1	1	PROICON TRANSPORTATION LLC	6/19/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1799 BAYSHORE HWY	168E	BURLINGAME	CA	94010	1316	41	06081	37.6024946	-122.3720177	San Mateo County
156584	Fee-for-Service	1801225610	1801225610	1	1	PIRNIA, MANA DO	4/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13816	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
156596	Fee-for-Service	1730256827	1730256827	1	1	POLLACK, DAVID S PHD	8/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
156671	Fee-for-Service	1316572423	1316572423	1	1	PALACIOS, MICHELLE LPCC	2/2/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
156678	Fee-for-Service	1336248954	1336248954	1	1	PAUL, TRACI OD	6/26/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15333 CULVER DR	SUITE 690	IRVINE	CA	92604	7143	30	06059	33.69534179	-117.7972555	Orange County
156680	Fee-for-Service	1962942383	1962942383	1	1	PATEL, AVIK	10/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20778	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
156709	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
156728	Fee-for-Service	1497103766	1497103766	1	1	PATEL, SHIMONI K DO	9/29/2021	282N00000X	NA	Hospitals	026	PHYSICIANS	18786	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
156734	Fee-for-Service	1851301576	1851301576	1	1	POMONA VALLEY CARDIAC	6/20/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	SURGERY MEDICAL GROUP	160 E ARTESIA ST	STE 355	POMONA	CA	91767	2927	19	06037	34.07556833	-117.7507835	Los Angeles County
156737	Fee-for-Service	1235687245	1235687245	2	1	PALOMINO, YALINA LCSW	7/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	222E	RANCHO CUCAMONGA	CA	91730	1158	36	06071	34.12038413	-117.6160525	San Bernardino County
156766	Fee-for-Service	1770093734	1770093734	1	3	PROVIDENCE SAINT JOHN'S MEDI	2/9/2023	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ERS	2151 HARBOR BLVD	STE 3100	FULLERTON	CA	92835	3820	30	06059	33.89443025	-117.9288328	Orange County
156806	Fee-for-Service	1154713790	1154713790	1	2	PROACTIVE CARE NURSING, INC	8/28/2017	363LA2200X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	400	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
156818	Fee-for-Service	1063411460	1063411460	1	3	PALM IMAGING INSTITUTE A	11/22/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
156883	Fee-for-Service	1710024005	1710024005	1	1	PROVANCE, ARRON J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTIVIEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
156947	Fee-for-Service	1902291867	1902291867	1	1	PIERINI, JANICE	3/28/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3301 ARENA BLVD 87	None	SACRAMENTO	CA	95834	2518	34	06067	38.644092	-121.53393	Sacramento County
156954	Fee-for-Service	1962022012	1962022012	1	1	PASCUAL, ELIEL RCP	9/10/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
156959	Fee-for-Service	1467622209	1467622209	1	1	PEDROZA, MIGUEL A MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99833	08	Family Practice	0	In state provider	None	2240 E GONZALES RD	None	VENTURA	CA	93036	8210	56	06111	34.21873112	-119.1469396	Ventura
156972	Fee-for-Service	1912271743	1912271743	1	1	PADDA, BIKRAM S MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121446	10	Gastroenterology (M.D. only)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
156977	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	9/23/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
156999	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	4/24/2009	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
157025	Fee-for-Service	1831724970	1831724970	1	1	PAWIG, JOSEPH B NP	10/18/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
157054	Fee-for-Service	1770093734	1770093734	1	3	PROVIDENCE SAINT JOHN'S MEDI	10/25/2024	174400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	2151 HARBOR BLVD	STE 3100	FULLERTON	CA	92835	3820	30	06059	33.89443025	-117.9288328	Orange County
157060	Fee-for-Service	1386669224	1386669224	1	1	PUGLIESE-LOCKE, RANADA M	3/22/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
157108	Fee-for-Service	1063411460	1063411460	1	3	PALM IMAGING INSTITUTE A	11/22/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
157131	Fee-for-Service	1558925610	1558925610	1	1	PROGRESSIVE ANESTHESIA CONSU	11/5/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LTANTS OF CALIFORNIA PC	5176 HILL RD E.	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
157142	Fee-for-Service	1790798791	1790798791	1	1	PELAYO-GARCIA, JORGE MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56361	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
157164	Fee-for-Service	1043398100	1043398100	1	1	PIEHLER, MARK D MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68501	02	General Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
157178	Fee-for-Service	1972532034	1972532034	1	1	PELAYO, LETICIA	8/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89014	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
157201	Fee-for-Service	1760040406	1760040406	1	1	PATEL, SHRUTI P DO	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19524	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
157209	Fee-for-Service	1629601802	1629601802	1	1	PINNACLE HOME HEALTH &	6/1/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	2775 COTTAGE WAY	STE 19	SACRAMENTO	CA	95825	1220	34	06067	38.604078	-121.397769	Sacramento County
157217	Fee-for-Service	1669802922	1669802922	1	1	PEDROZA, MEGAN M LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
157228	Fee-for-Service	1861581043	1861581043	1	1	PLANNED PARENTHOOD	9/30/1986	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	HOLLYWOOD	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	2620	19	06037	34.0900257	-118.2916693	Los Angeles County
157231	Fee-for-Service	1225074826	1225074826	1	1	PAWAR, SHIWAJI D MD	4/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55014	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
157232	Fee-for-Service	1801076138	1801076138	1	1	PATEL, MANALI I MD	4/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	101063	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157234	Fee-for-Service	1902291867	1902291867	1	1	PIERINI, JANICE	3/28/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3301 ARENA BLVD 87	None	SACRAMENTO	CA	95834	2518	34	06067	38.644092	-121.53393	Sacramento County
157235	Fee-for-Service	1043843816	1043843816	1	1	PHAN, KIMMY OT	6/15/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
157259	Fee-for-Service	1912271743	1912271743	1	1	PADDA, BIKRAM S MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121446	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157266	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	2/8/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
157267	Fee-for-Service	1104213271	1104213271	1	1	PHELPS, JAZMA DO	8/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16990	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
157283	Fee-for-Service	1851480966	1851480966	1	1	PATEL, DILIPKUMAR C. MD	5/7/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	52224	01	General Practice	0	In state provider	None	3030 CHILDRENS WAY	STE 210	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
157285	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	2/8/2020	152W00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
157296	Fee-for-Service	1285061085	1285061085	1	1	PEPPERBUSH HOLDINGS LLC	4/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1201 S ORANGE AVE	None	EL CAJON	CA	92020	7521	37	06073	32.77914448	-116.9639444	San Diego County
157304	Fee-for-Service	1124573605	1124573605	1	1	PASSAGE, DONNA PSYD	10/16/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
157319	Fee-for-Service	1477680353	1477680353	1	1	PARK, EUN C MD	3/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50649	34	Urology and Urological Surgery	0	In state provider	None	1321 COTTONWOOD STREET	3RD FLOOR	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
157364	Fee-for-Service	1952507550	1952507550	1	1	POPE, YVETTE F LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
157395	Fee-for-Service	1063411460	1063411460	1	3	PALM IMAGING INSTITUTE A	11/22/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
157414	Fee-for-Service	1558925610	1558925610	1	1	PROGRESSIVE ANESTHESIA CONSU	6/22/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LTANTS OF CALIFORNIA PC	5176 HILL RD E.	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
157417	Fee-for-Service	1295848174	1295848174	1	1	PUVVULA, LAKSHIMI K MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88756	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	# 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
157439	Fee-for-Service	1528364809	1528364809	1	1	PIE, CYNTHIA P	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
157448	Fee-for-Service	1740410182	1740410182	1	19	PACIFIC DERMATOLOGY INSTITUT	2/3/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E INC.	16465 SIERRA LAKES PKWY	275	FONTANA	CA	92336	1263	36	06071	34.13805177	-117.4457839	San Bernardino County
157479	Fee-for-Service	1487281549	1487281549	1	1	PRITCHARD, RYAN C PSYD	10/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
157492	Fee-for-Service	1558595355	1558595355	1	1	PATEL, KEYUR A MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127311	41	Internal Medicine	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
157512	Fee-for-Service	1518910264	1518910264	1	1	PORTNOFF, VICKI J MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23464	None	None	0	In state provider	None	1151 N VIA MIRALESTE	None	PALM SPRINGS	CA	92262	4820	33	06065	33.83866232	-116.5413364	Riverside County
157544	Fee-for-Service	1073922910	1073922910	1	1	POWELL, CHERYL MD INC	3/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	58108	18	Ophthalmology	0	In state provider	None	231 W VERNON AVE	SUITE 104	LOS ANGELES	CA	90037	2778	19	06037	34.0038305	-118.2774195	Los Angeles County
157553	Fee-for-Service	1619928694	1619928694	1	1	POKOMO, RANDALL C MD	11/21/1978	207P00000X	NA	Other	026	PHYSICIANS	30095	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4640 ADMIRALTY WAY	FL 5	MARINA DEL REY	CA	90292	6636	19	06037	33.98120707	-118.4409729	Los Angeles County
157554	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	10/15/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
157562	Fee-for-Service	1720382690	1720382690	1	1	PARANJPE, PARAG W MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115358	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
157563	Fee-for-Service	1558585323	1558585323	1	1	PRASAD, RAJENDRA V MD	9/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	25178	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
157574	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	12/4/2020	152W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
157584	Fee-for-Service	1316097926	1316097926	1	1	PELLETIER, DANIEL MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69262	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
157600	Fee-for-Service	1578933149	1578933149	1	1	PROFESSIONAL HEALTHCARE	6/23/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	320 W BEDFORD AVE	SUITE 205	FRESNO	CA	93711	6078	10	06019	36.84585953	-119.797372	Fresno County
157602	Fee-for-Service	1891717385	1891717385	1	1	PEDDADA, CHITRA C MD	10/31/1995	207R00000X	NA	Other	026	PHYSICIANS	63174	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
157625	Fee-for-Service	1700230422	1700230422	1	1	PATEL, KAVITA MD	6/25/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156463	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
157632	Fee-for-Service	1518973122	1518973122	1	1	PARK, PERLA M MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	48406	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8162 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	4806	19	06037	34.219566	-118.4487405	Los Angeles County
157633	Fee-for-Service	1740201714	1740201714	1	1	PHAN HEALTHCARE INC	12/2/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FOOTHILL RANCH MEDICAL	26750 TOWNE CENTRE DR	STE C	FOOTHILL RANCH	CA	92610	2841	30	06059	33.67417453	-117.6625787	Orange County
157689	Fee-for-Service	1528211976	1528211976	1	1	PAK, YUN H MFT	1/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49697	-	NOT APPLICABLE	0	In state provider	None	3727 W 6TH STREET	SUITE 411	LOS ANGELES	CA	90020	5112	19	06037	34.06358655	-118.3037656	Los Angeles County
157698	Fee-for-Service	1588829006	1588829006	1	2	PIH HEALTH PHYSICIANS	2/9/2024	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
157734	Fee-for-Service	1740410182	1740410182	1	19	PACIFIC DERMATOLOGY INSTITUT	2/3/2025	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E INC.	16465 SIERRA LAKES PKWY	275	FONTANA	CA	92336	1263	36	06071	34.13805177	-117.4457839	San Bernardino County
157789	Fee-for-Service	1548556053	1548556053	1	1	POLYAKOV, MARK-ALLEN N MD	3/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132011	77	Infectious Disease	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
157798	Fee-for-Service	1003134107	1003134107	1	1	POWELL, MICHAEL MD	10/13/2023	207ZP0102X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1350 STARDUST ST	STE D	RENO	NV	89503	4264	00	None	39.52858204	-119.8347915	Washoe County
157799	Fee-for-Service	1033285010	1033285010	1	1	PUBLIC HOSPITAL DISTRICT	8/10/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NO 304	2000 HOSPITAL DR	None	SEDRO WOOLLEY	WA	98284	4327	00	None	48.49548051	-122.2760925	Skagit County
157809	Fee-for-Service	1629608229	1629608229	1	1	PAEZ, ANTHONY M LCSW	10/29/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23945 SUNNYMEAD BLVD.	3	MORENO VALLEY	CA	92553	3025	33	06065	33.93897472	-117.2450469	Riverside County
157819	Fee-for-Service	1225154347	1225154347	1	1	PEREZ, BELINDA M MD	12/19/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	90416	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157822	Fee-for-Service	1003116773	1003116773	1	1	PITTS, REBECCA M	4/20/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
157837	Fee-for-Service	1003077959	1003077959	1	1	PHO, JOANNE D PT	5/23/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
157838	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	2/24/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
157844	Fee-for-Service	1336316264	1336316264	1	1	PANG, JASON J MD INC	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69884	13	Neurology (M.D. only)	0	In state provider	None	11039 ACACIA PARKWAY	None	GARDEN GROVE	CA	92840	5126	30	06059	33.77607048	-117.940266	Orange County
157859	Fee-for-Service	1316971351	1316971351	1	1	PENINSULA PULMONARY	8/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL ASSOCIATES	3701 SKYPARK DR	STE 200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
157861	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	12/8/2015	152W00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
157986	Fee-for-Service	1588829006	1588829006	1	2	PIH HEALTH PHYSICIANS	11/28/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
158022	Fee-for-Service	1790973204	1790973204	1	1	PATEL, SAPNA P MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	56443	40	Pediatrics	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
158029	Fee-for-Service	1104290303	1104290303	1	1	PATEL PRITI INC	10/7/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1228 JEFFERSON ST	None	DELANO	CA	93215	9225	15	06029	35.7728983	-119.245138	Kern County
158088	Fee-for-Service	1033285010	1033285010	1	1	PUBLIC HOSPITAL DISTRICT	8/10/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NO 304	2000 HOSPITAL DR	None	SEDRO WOOLLEY	WA	98284	4327	00	None	48.49548051	-122.2760925	Skagit County
158089	Fee-for-Service	1740410182	1740410182	1	18	PACIFIC DERMATOLOGY INSTITUT	4/22/2024	207ND0900X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E INC.	101 REDLANDS BLVD	STE 284	REDLANDS	CA	92373	4721	36	06071	34.05731952	-117.181197	San Bernardino County
158094	Fee-for-Service	1588614226	1588614226	1	1	PARIWAT THAISETTHAWATKUL MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
158116	Fee-for-Service	1609881580	1609881580	1	1	PETROFF, HELEN MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90925	08	Family Practice	0	In state provider	None	825 N 10TH ST	EMERGENCY DEPT	SANTA PAULA	CA	93060	1309	56	06111	34.36574255	-119.0654422	Ventura County
158127	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	5/2/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
158134	Fee-for-Service	1851537708	1851537708	1	1	P K A MEDICAL CORPORATION	2/1/2022	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1610 W EDINGER AVE	STE B	SANTA ANA	CA	92704	4339	30	06059	33.72718149	-117.889506	Orange County
158147	Fee-for-Service	1316971351	1316971351	1	1	PENINSULA PULMONARY	8/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL ASSOCIATES	3701 SKYPARK DR	STE 200	TORRANCE	CA	90505	4749	19	06037	33.81114782	-118.349449	Los Angeles County
158150	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	10/26/2017	152W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
158161	Fee-for-Service	1518944396	1518944396	1	1	PATTERSON, DAVID R MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60485	01	General Practice	0	In state provider	None	2840 LONG BEACH BLVD	# 130	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
158166	Fee-for-Service	1306280607	1306280607	1	1	PROMER, KATHERINE MD	4/6/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	131952	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158206	Fee-for-Service	1457362394	1457362394	1	1	PANSE, MILIND P MD	7/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	51330	20	Orthopedic Surgery	0	In state provider	None	1225 E LATHAM AVE	SUITE #A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
158214	Fee-for-Service	1528301322	1528301322	1	1	POQUIZ, PATRICK H MD	3/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133708	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
158235	Fee-for-Service	1891500849	1891500849	1	1	PEDRO'S MARRIAGE & FAMILY CO	2/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	UNSELING INC.	647 VETERANS BLVD	A	REDWOOD CITY	CA	94063	1408	41	06081	37.49194933	-122.2312469	San Mateo County
158256	Fee-for-Service	1053324095	1053324095	1	1	PAUL, GREGORY M MD	10/26/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94621	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
158274	Fee-for-Service	1588829006	1588829006	1	2	PIH HEALTH PHYSICIANS	11/9/2023	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
158288	Fee-for-Service	1679849012	1679849012	1	1	POPPER, STEVEN T MD	1/30/2018	207R00000X	NA	Other	026	PHYSICIANS	127156	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158311	Fee-for-Service	1194052456	1194052456	1	1	PHELPS, TISHA Y NP	9/10/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
158356	Fee-for-Service	1891881421	1891881421	1	1	PENG, DAVID MD	5/25/2004	207N00000X	NA	Dermatology	026	PHYSICIANS	77579	07	Dermatology	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
158379	Fee-for-Service	1740410182	1740410182	1	18	PACIFIC DERMATOLOGY INSTITUT	4/22/2024	207ND0900X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E INC.	101 REDLANDS BLVD	STE 284	REDLANDS	CA	92373	4721	36	06071	34.05731952	-117.181197	San Bernardino County
158398	Fee-for-Service	1700089745	1700089745	1	1	PERP HM MED EQMT&SUP INC	3/27/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PERP HM EQMT&SUP INC	3018 BEVERLY BLVD	UNIT C	LOS ANGELES	CA	90057	1027	19	06037	34.07172187	-118.2820612	Los Angeles County
158409	Fee-for-Service	1770954471	1770954471	1	1	PRUDENT MEDICAL SUPPLIES INC	8/14/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5250 W CENTURY BOULEVARD	SUITE 216	LOS ANGELES	CA	90045	5918	19	06037	33.9451882	-118.371997	Los Angeles County
158415	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	10/14/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
158418	Fee-for-Service	1861580474	1861580474	1	3	PKQ NEUROLOGICAL ASSOCIATES	2/2/2024	2251N0400X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2250 HAYES ST	504	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
158438	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	152W00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
158510	Fee-for-Service	1649363433	1649363433	1	1	PETERS ANNA M RN	4/27/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
158513	Fee-for-Service	1184011363	1184011363	1	1	PHAM, ALISE K DO	9/9/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	18259	13	Neurology (M.D. only)	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
158568	Fee-for-Service	1588829006	1588829006	1	2	PIH HEALTH PHYSICIANS	7/26/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
158596	Fee-for-Service	1740234616	1740234616	1	1	PARKER, PAMELA D MD	5/15/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87822	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
158623	Fee-for-Service	1023286002	1023286002	1	1	PANIGRAHI, ARUN R MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151700	68	Hematology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
158654	Fee-for-Service	1053998013	1053998013	1	1	PAYTON, ETHAN R MD	3/18/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
158666	Fee-for-Service	1669403168	1669403168	1	1	PATEL, URMILA M MD	1/1/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50437	01	General Practice	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
158669	Fee-for-Service	1184364887	1184364887	1	1	PARK, CHRISTOPHER C CPO	7/11/2022	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1574 N BATAVIA ST	STE 4	ORANGE	CA	92867	3543	30	06059	33.8137854	-117.862488	Orange County
158705	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	12/29/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
158725	Fee-for-Service	1336222397	1336222397	1	9	PERMANENTE MEDICAL GROUP INC	12/29/2018	152W00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
158751	Fee-for-Service	1942628789	1942628789	1	1	PARMAR, MITALI M MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	154114	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
158757	Fee-for-Service	1407880719	1407880719	1	3	PULMONARY MEDICINE ASSOCIATE	1/1/1979	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES MEDICAL GROUP	6403 COYLE AVENUE	SUITE 450	CARMICHAEL	CA	95608	0361	34	06067	38.668347	-121.3148745	Sacramento County
158769	Fee-for-Service	1326370677	1326370677	1	1	PACIFIC COAST SURGICAL GROUP	3/26/2021	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4033 3RD AVE	SUITE 204	SAN DIEGO	CA	92103	2117	37	06073	32.75053781	-117.1627168	San Diego County
158797	Fee-for-Service	1972523769	1972523769	1	1	POKALA, SATHYA P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51070	41	Internal Medicine	0	In state provider	None	5555 RESERVOIR DR	STE 206	SAN DIEGO	CA	92120	5101	37	06073	32.77628471	-117.0563688	San Diego County
158832	Fee-for-Service	1215469606	1215469606	1	1	PASRICHA, MALINI V MD	7/30/2021	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	158453	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
158838	Fee-for-Service	1962990432	1962990432	1	1	PACIFIC VISION EYE INSTITUTE	7/20/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, A MEDICAL CORPORATION	711 VAN NESS AVE	260	SAN FRANCISCO	CA	94102	3244	38	06075	37.78218473	-122.4208156	San Francisco County
158840	Fee-for-Service	1457458630	1457458630	1	2	PHAM, DAVID N MD INC	5/31/2016	207RP1001X	NA	Pulmonology	026	PHYSICIANS	86094	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	14120 BEACH BLVD	STE 101	WESTMINSTER	CA	92683	4454	30	06059	33.757047	-117.989493	Orange County
158882	Fee-for-Service	1316261951	1316261951	1	1	PRAETEL, CLAUDIA MD	5/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98222	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
158884	Fee-for-Service	1740234616	1740234616	1	1	PARKER, PAMELA D MD	5/15/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87822	08	Family Practice	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
158890	Fee-for-Service	1053443473	1053443473	2	1	PORT CITY OPERATING COMPANY,	6/1/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	2510 N CALIFORNIA STREET	None	STOCKTON	CA	95204	5502	39	06077	37.97664117	-121.29149	San Joaquin County
158912	Fee-for-Service	1023286002	1023286002	1	1	PANIGRAHI, ARUN R MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151700	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
158916	Fee-for-Service	1891933081	1891933081	1	2	PRESTIGE HOME HEALTH SERVICE	1/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2236 LONGPORT CT	STE 100	ELK GROVE	CA	95758	7185	34	06067	38.425077	-121.4837865	Sacramento County
158919	Fee-for-Service	1013220359	1013220359	1	1	PETROFSKY, MARY L NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158923	Fee-for-Service	1609498591	1609498591	1	1	PATELL, SAATCHI K MD	10/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
158991	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
159018	Fee-for-Service	1033211438	1033211438	1	1	PASCUAL, HONESTO C MD	7/2/2018	207R00000X	NA	Other	026	PHYSICIANS	26232	41	Internal Medicine	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
159022	Fee-for-Service	1134262231	1134262231	1	1	PHAM, NGOC A MD	6/30/1991	207L00000X	NA	Other	026	PHYSICIANS	67054	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	None	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
159024	Fee-for-Service	1427127885	1427127885	1	1	PERAM, RADHA A MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88875	25	Physical Medicine and Rehabilitation	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
159045	Fee-for-Service	1407880719	1407880719	1	3	PULMONARY MEDICINE ASSOCIATE	4/10/2017	207RC0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES MEDICAL GROUP	6403 COYLE AVENUE	SUITE 450	CARMICHAEL	CA	95608	0361	34	06067	38.668347	-121.3148745	Sacramento County
159078	Fee-for-Service	1750468112	1750468112	1	2	PHAM, TRAM L OD	4/19/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	STORY OPTOMETRY	992 STORY RD	STE 40	SAN JOSE	CA	95122	2674	43	06085	37.33124622	-121.8556636	Santa Clara County
159079	Fee-for-Service	1770725368	1770725368	1	1	PETKOVSKA, IVA MD	1/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113555	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159086	Fee-for-Service	1972523769	1972523769	1	1	POKALA, SATHYA P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51070	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 RESERVOIR DR	STE 206	SAN DIEGO	CA	92120	5101	37	06073	32.77628471	-117.0563688	San Diego County
159115	Fee-for-Service	1508459397	1508459397	1	1	PILGRIM HOSPICE INC	8/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	125 S LOUISE ST	STE 120	GLENDALE	CA	91205	1024	19	06037	34.14566113	-118.252704	Los Angeles County
159125	Fee-for-Service	1962990432	1962990432	1	1	PACIFIC VISION EYE INSTITUTE	10/24/2018	207W00000X	NA	Ophthalmology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	, A MEDICAL CORPORATION	711 VAN NESS AVE	260	SAN FRANCISCO	CA	94102	3244	38	06075	37.78218473	-122.4208156	San Francisco County
159159	Fee-for-Service	1184714743	1184714743	1	1	PARTHAK,PRODHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 MARSHALL STREET	STE 653	LITTLE ROCK	AR	72202	0000	00	None	34.74346583	-92.29154425	Pulaski County
159181	Fee-for-Service	1053443473	1053443473	2	1	PORT CITY OPERATING COMPANY,	6/1/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	2510 N CALIFORNIA STREET	None	STOCKTON	CA	95204	5502	39	06077	37.97664117	-121.29149	San Joaquin County
159195	Fee-for-Service	1669407391	1669407391	1	1	PRYSTOWSKY, JASON J MD	5/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99035	None	None	0	In state provider	None	PUEBLO AT BATH	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
159200	Fee-for-Service	1023286002	1023286002	1	1	PANIGRAHI, ARUN R MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151700	78	Neoplastic Diseases/Oncology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
159228	Fee-for-Service	1659689198	1659689198	1	1	PARROTT, DAWN R LCSW	1/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159233	Fee-for-Service	1649201583	1649201583	1	1	PERNIA, MARIA L MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42808	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
159242	Fee-for-Service	1316031883	1316031883	1	1	PARK, SEAN S MD	4/18/2014	207R00000X	NA	Other	026	PHYSICIANS	70333	41	Internal Medicine	0	In state provider	None	85 SIERRA PARKS RD	None	MAMMOTH LAKES	CA	93546	2073	26	06051	37.64575895	-118.9638914	Mono County
159245	Fee-for-Service	1407529845	1407529845	1	1	PRIME HEALTHCARE ASC	3/24/2023	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTHRIDGE LLC	19331 BUSINESS CENTER DR	STE 102	NORTHRIDGE	CA	91324	3533	19	06037	34.23134428	-118.5551514	Los Angeles County
159282	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	2/12/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
159294	Fee-for-Service	1699017368	1699017368	1	1	PAN, HUBERT Y MD	11/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155171	78	Neoplastic Diseases/Oncology	0	In state provider	None	2800 L ST	STE 10	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
159308	Fee-for-Service	1235919424	1235919424	1	1	PORTILLO GARCIA, DINA	8/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
159329	Fee-for-Service	1275130742	1275130742	1	1	PRAYER HOSPICE CARE INC	9/9/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6741 VAN NUYS BLVD	SUITE 218	VAN NUYS	CA	91405	4630	19	06037	34.19331814	-118.4487786	Los Angeles County
159343	Fee-for-Service	1497822332	1497822332	1	1	POLIKOFF, JONATHAN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43519	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
159348	Fee-for-Service	1730248857	1730248857	1	1	PATOCK, MARY C PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2829 WATT AVE SUITE 150	None	SACRAMENTO	CA	95821	6200	34	06067	38.616264	-121.383558	Sacramento County
159374	Fee-for-Service	1972523769	1972523769	1	1	POKALA, SATHYA P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51070	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 RESERVOIR DR	STE 206	SAN DIEGO	CA	92120	5101	37	06073	32.77628471	-117.0563688	San Diego County
159396	Fee-for-Service	1821011347	1821011347	1	2	POTTS, MATTHEW E MD	2/7/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	85732	-	NOT APPLICABLE	0	In state provider	None	1260 E ARROW HIGHWAY	None	UPLAND	CA	91786	4982	36	06071	34.09953339	-117.6333297	San Bernardino County
159404	Fee-for-Service	1508459397	1508459397	1	1	PILGRIM HOSPICE INC	8/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	125 S LOUISE ST	STE 120	GLENDALE	CA	91205	1024	19	06037	34.14566113	-118.252704	Los Angeles County
159412	Fee-for-Service	1962990432	1962990432	1	1	PACIFIC VISION EYE INSTITUTE	1/14/2019	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	, A MEDICAL CORPORATION	711 VAN NESS AVE	260	SAN FRANCISCO	CA	94102	3244	38	06075	37.78218473	-122.4208156	San Francisco County
159418	Fee-for-Service	1922201508	1922201508	1	1	PIROUZ, SHAHRIAR MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107955	05	Anesthesiology	0	In state provider	None	1300 EAST CYPRESS STREET	STE E2	SANTA MARIA	CA	93454	4728	42	06083	34.95102551	-120.4164	Santa Barbara County
159518	Fee-for-Service	1073688719	1073688719	1	1	PAPA, FEROZ R MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72209	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159520	Fee-for-Service	1649201583	1649201583	1	1	PERNIA, MARIA L MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42808	40	Pediatrics	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
159522	Fee-for-Service	1699220509	1699220509	1	1	POLYUDHAPOOM, CHERYL L LCSW	12/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159559	Fee-for-Service	1841217726	1841217726	1	1	PRINCETON PHYSICIANS	9/4/1995	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES INC	500 N GARFIELD AVE	STE 308	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
159568	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	9/16/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
159574	Fee-for-Service	1043288574	1043288574	1	1	PONNUSAMY, NARAYANAN MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52112	02	General Surgery	0	In state provider	None	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
159591	Fee-for-Service	1457856502	1457856502	1	1	PREDUN, WILLIAM J MD	6/16/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
159619	Fee-for-Service	1275130742	1275130742	1	1	PRAYER HOSPICE CARE INC	9/9/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6741 VAN NUYS BLVD	SUITE 218	VAN NUYS	CA	91405	4630	19	06037	34.19331814	-118.4487786	Los Angeles County
159652	Fee-for-Service	1467589077	1467589077	1	1	PEDERSEN, RAYMOND F OD	7/6/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL	38069 MARTHA AVE	STE 200	FREMONT	CA	94536	3811	01	06001	37.55978715	-121.991892	Alameda County
159688	Fee-for-Service	1639990849	1639990849	1	1	PHIFER, DAMANY CCC-SLP	12/9/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
159745	Fee-for-Service	1417464389	1417464389	1	1	PAX HOME HEALTH	10/11/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9741 WHEATLAND AVE	STE 3	SUNLAND	CA	91040	1403	19	06037	34.24682102	-118.3574821	Los Angeles County
159753	Fee-for-Service	1770525016	1770525016	1	1	PREMIER HOSPITALIST OF	6/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	BAKERSFIELD INC	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
159778	Fee-for-Service	1346352267	1346352267	1	1	PARK VIEW MEDICAL PLAZA	8/11/1997	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	3975 JACKSON ST	STE 109	RIVERSIDE	CA	92503	3946	33	06065	33.92729721	-117.4413503	Riverside County
159798	Fee-for-Service	1538303722	1538303722	1	1	PORTILLO, DARIA O LMFT	8/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1139 N BRAND BLVD	SUITE A	GLENDALE	CA	91202	3012	19	06037	34.162839	-118.2550895	Los Angeles County
159806	Fee-for-Service	1073688719	1073688719	1	1	PAPA, FEROZ R MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72209	67	Endocrinology	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159857	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	9/11/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
159885	Fee-for-Service	1043558992	1043558992	1	1	PERSONAL GENOME DIAGNOSTICS	2/27/2015	207RX0202X	NA	Oncology	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	INC	2809 BOSTON STREET	SUITE 503	BALTIMORE	MD	21224	4814	00	None	39.27825499	-76.57586121	Baltimore city
159898	Fee-for-Service	1588125306	1588125306	1	1	PIERCE, COLIN J MD	7/28/2022	208M00000X	NA	Other	026	PHYSICIANS	178114	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
159903	Fee-for-Service	1598124869	1598124869	1	1	PEREZ, ROLANDO LCSW	9/19/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
159910	Fee-for-Service	1174749279	1174749279	1	1	POFFENBERGER, CORI A MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92390	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
159917	Fee-for-Service	1548647688	1548647688	1	1	PURUSOTHAMAN, VAISHNAVI MD	10/7/2022	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181309	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
159928	Fee-for-Service	1164426490	1164426490	1	1	PRICE, CHRISTOPHER A MD	10/25/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55084	08	Family Practice	0	In state provider	None	5030 J ST	STE 201	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
159946	Fee-for-Service	1407071087	1407071087	1	1	PONSONES, GIL R NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159975	Fee-for-Service	1487604419	1487604419	1	1	PHAM, HOA V MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80410	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
159988	Fee-for-Service	1700847621	1700847621	2	1	PLACERVILLE RADIOLOGY MEDICA	1/24/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	L GROUP, INC	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
159994	Fee-for-Service	1043268840	1043268840	1	1	PREMIERE SURGERY CENTER, INC	4/19/1991	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	700 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	3923	37	06073	33.14611822	-117.1023285	San Diego County
160005	Fee-for-Service	1811369721	1811369721	1	1	PACIFICA RADIOLOGY INC	5/17/2016	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44742	30	Radiology	0	In state provider	None	9449 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
160022	Fee-for-Service	1275750861	1275750861	1	1	PHAM, AHN TINA DO	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9235	41	Internal Medicine	0	In state provider	None	16415 COLORADO AVE	SUITE 207	PARAMOUNT	CA	90723	5054	19	06037	33.8853075	-118.1614695	Los Angeles County
160031	Fee-for-Service	1275546095	1275546095	1	1	PEDIATRIC MEDICAL ASSOC	1/24/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	OF TRI-CITY INC	2067 W VISTA WAY	STE 180	VISTA	CA	92083	6033	37	06073	33.18505594	-117.285958	San Diego County
160038	Fee-for-Service	1184120792	1184120792	1	1	PARK, AARON	7/14/2023	207R00000X	NA	Other	026	PHYSICIANS	174413	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
160052	Fee-for-Service	1720841182	1720841182	1	1	POPOVIC, MARKO MD	8/23/2024	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	622 W DUARTE RD	101	ARCADIA	CA	91007	7606	19	06037	34.12645266	-118.0521552	Los Angeles County
160102	Fee-for-Service	1265518781	1265518781	1	1	PAIGE, CAROL W MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	57540	41	Internal Medicine	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
160109	Fee-for-Service	1669906632	1669906632	1	1	PHILIPPONE, MICHAEL F DO	2/8/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
160123	Fee-for-Service	1932297710	1932297710	1	1	PARRAY, HAFIZ MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33111	41	Internal Medicine	0	In state provider	None	418 SAN FERNANDO MISSION	None	SAN FERNANDO	CA	91340	3530	19	06037	34.28283832	-118.4447463	Los Angeles County
160124	Fee-for-Service	1598869828	1598869828	1	1	PEDIATRIC PRACTICE ASSOC	8/14/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2809 OLIVE HWY	STE 330	OROVILLE	CA	95966	6135	04	06007	39.50386798	-121.5410203	Butte County
160145	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
160173	Fee-for-Service	1487121133	1487121133	1	1	PACIFIC HEALTH EDUCATION COG	7/28/2020	261QM0801X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	NITIVE CENTER, INC	5300 CALIFORNIA AVENUE	SUITE 220	BAKERSFIELD	CA	93309	1644	15	06029	35.35932416	-119.0610078	Kern County
160186	Fee-for-Service	1255347969	1255347969	1	1	PEGGY ANN BEELEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
160218	Fee-for-Service	1144389230	1144389230	1	3	PERINATAL DIAGNOSTIC CENTER	11/22/2023	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6850 SEPULVEDA BLVD	STE. 207	VAN NUYS	CA	91405	4444	19	06037	34.1955	-118.4661705	Los Angeles County
160242	Fee-for-Service	1558893784	1558893784	1	1	PAN, HAROLD H PT	8/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	120 S CHAPARRAL CT	150	ANAHEIM	CA	92808	2237	30	06059	33.86492127	-117.7445525	Orange County
160255	Fee-for-Service	1255548418	1255548418	1	1	POURATIAN, NADER MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109384	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
160257	Fee-for-Service	1730895293	1730895293	1	1	PARRY, ANGELA LPCC	3/10/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
160282	Fee-for-Service	1770673394	1770673394	1	1	PUGLIA, KATHLEEN H MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102977	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
160284	Fee-for-Service	1497051627	1497051627	1	3	PRODIGY HEALTHCARE, INC.	5/25/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	115 M ST	UNIT A	TULARE	CA	93274	4150	54	06107	36.20791413	-119.3434362	Tulare County
160298	Fee-for-Service	1144353020	1144353020	1	1	PROHEALTH PARTNERS	10/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MED GRP	2880 ATLANTIC AVE	STE 170	LONG BEACH	CA	90806	1715	19	06037	33.809382	-118.185001	Los Angeles County
160310	Fee-for-Service	1275750861	1275750861	1	1	PHAM, AHN TINA DO	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9235	45	Nephrology (Renal-Kidney)	0	In state provider	None	16415 COLORADO AVE	SUITE 207	PARAMOUNT	CA	90723	5054	19	06037	33.8853075	-118.1614695	Los Angeles County
160347	Fee-for-Service	1750406146	1750406146	1	1	PACIFIC MEMORIAL ANESTHESIA	11/20/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CARE INC	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
160350	Fee-for-Service	1194272286	1194272286	1	1	POZZESI, KADETH LMFT	7/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 WILLOW PASS RD	600	CONCORD	CA	94520	5292	07	06013	37.96879608	-122.0519798	Contra Costa County
160389	Fee-for-Service	1336553767	1336553767	1	1	PACIFIC CENTRAL COAST HEALTH	6/10/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	APCC	350 POSADA LANE	SUITE 202	TEMPLETON	CA	93465	4060	40	06079	35.55239522	-120.7215238	San Luis Obispo County
160413	Fee-for-Service	1598869828	1598869828	1	1	PEDIATRIC PRACTICE ASSOC	8/14/2002	282N00000X	NA	Hospitals	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2809 OLIVE HWY	STE 330	OROVILLE	CA	95966	6135	04	06007	39.50386798	-121.5410203	Butte County
160431	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	12/4/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
160439	Fee-for-Service	1316059231	1316059231	2	1	PRIMECARE PHARMACY INC	12/15/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 S. VERMONT AVE	104	LOS ANGELES	CA	90005	1567	19	06037	34.057458	-118.291676	Los Angeles County
160441	Fee-for-Service	1104296888	1104296888	1	1	PREMIUM URGENT CARE, INC.	1/19/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1415 BADGER FLAT RD	A	LOS BANOS	CA	93635	8600	24	06047	37.05576382	-120.8782498	Merced County
160474	Fee-for-Service	1497820344	1497820344	1	1	PEPITON, MORGAN B PHD	5/6/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
160502	Fee-for-Service	1104288562	1104288562	1	1	PHAN, LEAH DO	6/13/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15916	08	Family Practice	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
160528	Fee-for-Service	1356007793	1356007793	1	1	PHILIP, SHERLY CNP	12/6/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160532	Fee-for-Service	1346745262	1346745262	1	1	PATEL, ASHRUTA	12/18/2023	207R00000X	NA	Other	026	PHYSICIANS	18760	None	None	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
160539	Fee-for-Service	1063048064	1063048064	1	1	PATEL, DEEP MD	1/8/2025	390200000X	NA	Other	026	PHYSICIANS	188858	05	Anesthesiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
160558	Fee-for-Service	1235175787	1235175787	2	2	PHARMACA INTEGRATIVE PHARMAC	9/7/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y	734 MONTANA AVE	None	SANTA MONICA	CA	90403	1404	19	06037	34.02751911	-118.5008729	Los Angeles County
160634	Fee-for-Service	1750406146	1750406146	1	1	PACIFIC MEMORIAL ANESTHESIA	11/20/2018	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CARE INC	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
160642	Fee-for-Service	1265996771	1265996771	1	1	PRIMEMED HOME HEALTH CARE	9/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	8905 GLENOAKS BLVD	SUITE D	SUN VALLEY	CA	91352	2087	19	06037	34.23056548	-118.3672082	Los Angeles County
160661	Fee-for-Service	1407989379	1407989379	1	2	PROHEALTH PARTNERS	3/23/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1045 ATLANTIC AVENUE	SUITE 712	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
160686	Fee-for-Service	1871086512	1871086512	1	1	PARSI ACUPUNCTURE CLINIC, PC	5/31/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C.	22 ODYSSEY	240	IRVINE	CA	92618	3194	30	06059	33.66719598	-117.7642461	Orange County
160717	Fee-for-Service	1861969263	1861969263	1	1	PERFECT CARE HOSPICE INC	5/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6464 W SUNSET BLVD	STE # 870	LOS ANGELES	CA	90028	8041	19	06037	34.09796251	-118.3313115	Los Angeles County
160720	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	8/28/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
160721	Fee-for-Service	1811066285	1811066285	1	1	PATELL, SHIBANI MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40366	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5073	19	06037	33.81253631	-118.3435557	Los Angeles County
160743	Fee-for-Service	1104857598	1104857598	1	2	PETERS, WALTER JAMES MD	6/1/1999	207R00000X	NA	Other	026	PHYSICIANS	50476	41	Internal Medicine	0	In state provider	None	115 ODDSTAD DR	None	VALLEJO	CA	94589	2520	48	06095	38.13004488	-122.2406764	Solano County
160788	Fee-for-Service	1437550316	1437550316	1	1	PASEWALDT, JOSHUA LMFT	7/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
160795	Fee-for-Service	1750452637	1750452637	1	1	PARK, TIFFANY J MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56117	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
160805	Fee-for-Service	1386688588	1386688588	1	1	PADGET, RYAN G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12040 NE 128TH ST	None	KIRKLAND	WA	98034	3013	00	None	47.71493427	-122.1792761	King County
160810	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
160857	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	12/29/2018	1041C0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
160896	Fee-for-Service	1922053404	1922053404	1	1	PATEL, MAHENDRA MD INC	4/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	10515 BALBOA BLVD	STE 380	GRANADA HILLS	CA	91344	6383	19	06037	34.261497	-118.502318	Los Angeles County
160910	Fee-for-Service	1992171102	1992171102	1	1	PLACHY, TARYN	10/9/2019	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
160929	Fee-for-Service	1730365966	1730365966	1	1	PANELLA, DAN	1/31/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	STE 100	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
160945	Fee-for-Service	1316189186	1316189186	1	1	PANOPOULOS, MARINA MD	9/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143952	40	Pediatrics	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
160959	Fee-for-Service	1992920383	1992920383	1	2	PLAZA HOME CARE PHARMACY, IN	6/19/2018	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 S ARROYO PKWY	STE 150	PASADENA	CA	91105	3236	19	06037	34.12974595	-118.1471775	Los Angeles County
161006	Fee-for-Service	1861969263	1861969263	1	1	PERFECT CARE HOSPICE INC	5/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6464 W SUNSET BLVD	STE # 870	LOS ANGELES	CA	90028	8041	19	06037	34.09796251	-118.3313115	Los Angeles County
161009	Fee-for-Service	1336222397	1336222397	1	12	PERMANENTE MEDICAL GROUP INC	10/15/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
161024	Fee-for-Service	1083133953	1083133953	1	1	PEREZ, BERENICE LCSW	12/29/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14726 RAMONA AVE	#E10	CHINO	CA	91710	5730	36	06071	33.98583108	-117.7064762	San Bernardino County
161037	Fee-for-Service	1770997173	1770997173	1	1	PHOMMAHAXAY, KELLY MD	7/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174687	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
161055	Fee-for-Service	1295240893	1295240893	1	1	PAKOZDI-PAST, DORIS LMFT	3/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
161087	Fee-for-Service	1699987065	1699987065	1	1	PATEL, SHALINI R MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95870	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161088	Fee-for-Service	1952788192	1952788192	1	1	PROVDA, KIMBERLEE H LMFT	10/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	3233 MISSION OAKS BLVD	BUILDING C	CAMARILLO	CA	93012	5094	56	06111	34.219107	-119.026512	Ventura County
161100	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	2/12/2019	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
161101	Fee-for-Service	1639261951	1639261951	1	1	PHAM, SHERI A MD	11/16/2009	207R00000X	NA	Other	026	PHYSICIANS	69662	41	Internal Medicine	0	In state provider	None	158 W COLLEGE STREET	None	COVINA	CA	91723	2007	19	06037	34.08742904	-117.8917387	Los Angeles County
161134	Fee-for-Service	1750453502	1750453502	1	1	PARKER, MELANIE E MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76918	34	Urology and Urological Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
161136	Fee-for-Service	1659627180	1659627180	1	1	PRADO, ROSA	3/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
161139	Fee-for-Service	1053584128	1053584128	1	1	PERRIS UNION HIGH SD	6/24/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	155 E 4TH ST	None	PERRIS	CA	92570	2124	33	06065	33.78233952	-117.2273265	Riverside County
161145	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	2/26/2013	1041C0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
161161	Fee-for-Service	1578577490	1578577490	1	2	PIXLEY MEDICAL CLINIC	10/24/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	205 EAST DAVIS STREET	None	PIXLEY	CA	93256	1025	54	06107	35.96843541	-119.2923819	Tulare County
161167	Fee-for-Service	1023122918	1023122918	1	1	PANDEY, KIRAN MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131567	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
161183	Fee-for-Service	1922053404	1922053404	1	1	PATEL, MAHENDRA MD INC	4/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	10515 BALBOA BLVD	STE 380	GRANADA HILLS	CA	91344	6383	19	06037	34.261497	-118.502318	Los Angeles County
161199	Fee-for-Service	1134740541	1134740541	1	1	PEACEFUL HOSPICE INC	11/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 253	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
161211	Fee-for-Service	1235147562	1235147562	1	1	PARDINI, AARON W MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55620	67	Endocrinology	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
161235	Fee-for-Service	1841757309	1841757309	1	1	PIZANO, KARLA LCSW	1/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
161257	Fee-for-Service	1144783028	1144783028	1	1	PASSIAS, BRADEN J DO	7/8/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	22132	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
161259	Fee-for-Service	1659360139	1659360139	1	1	PATEL, SONYA S DO	11/14/2007	2084N0400X	NA	Neurology	026	PHYSICIANS	8045	13	Neurology (M.D. only)	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3704	43	06085	37.31809479	-121.9082315	Santa Clara County
161288	Fee-for-Service	1114420478	1114420478	1	1	PIER ANESTHESIA GROUP, INC.	9/21/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
161305	Fee-for-Service	1164661476	1164661476	1	1	PETRIGLIANO, FRANK A MD	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90515	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
161333	Fee-for-Service	1669493862	1669493862	1	2	POOLA, RAMAN S MD	4/15/2020	174400000X	NA	Other	026	PHYSICIANS	37636	10	Gastroenterology (M.D. only)	0	In state provider	None	18523 CORWIN RD	STE H	APPLE VALLEY	CA	92307	2300	36	06071	34.54095703	-117.2601143	San Bernardino County
161347	Fee-for-Service	1760017479	1760017479	1	1	PEREZ, FREDERICK CNP	4/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
161385	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	2/24/2019	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
161406	Fee-for-Service	1023136322	1023136322	1	1	PATEL, JIGNESH MD DO	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147694	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
161426	Fee-for-Service	1992396733	1992396733	1	1	POWER HOME HEALTH INC	6/17/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	183 NORTH HILL AVE	SUITE 201	PASADENA	CA	91106	1915	19	06037	34.149339	-118.1214055	Los Angeles County
161434	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	2/7/2018	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
161484	Fee-for-Service	1073625992	1073625992	1	1	PATEL, PRITI INC	8/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5925 TRUXTUN AVE	STE B	BAKERSFIELD	CA	93309	0434	15	06029	35.36335425	-119.070183	Kern County
161486	Fee-for-Service	1134740541	1134740541	1	1	PEACEFUL HOSPICE INC	11/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 253	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
161500	Fee-for-Service	1235147562	1235147562	1	1	PARDINI, AARON W MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55620	41	Internal Medicine	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
161568	Fee-for-Service	1780866574	1780866574	1	1	PAREKH, JUSTIN R MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98665	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
161595	Fee-for-Service	1174638076	1174638076	1	2	PAKTER, DAVID L MD	1/20/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	85184	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
161619	Fee-for-Service	1760492714	1760492714	1	3	POUDRE VALLEY HEALTH CARE IN	6/12/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1024 S LEMAY AVE	None	FORT COLLINS	CO	80524	3929	00	None	40.571712	-105.055668	Larimer County
161636	Fee-for-Service	1497196075	1497196075	1	1	PRINCIPLES INC	6/13/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1450 NORTH LAKE AVENUE	ROOM 218	PASADENA	CA	91104	2301	19	06037	34.17087521	-118.132138	Los Angeles County
161641	Fee-for-Service	1841362597	1841362597	1	1	PHAM,VANHANH T MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63119	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
161661	Fee-for-Service	1134650153	1134650153	1	1	PRABLEK, MARC MD	5/28/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161675	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	12/4/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
161692	Fee-for-Service	1043255797	1043255797	1	1	PHILIP, STEPHANUS R MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87363	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
161714	Fee-for-Service	1225116874	1225116874	1	1	PHAM, TIEN Q MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59203	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
161717	Fee-for-Service	1538572680	1538572680	1	1	PARK, STEVEN Y MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145667	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
161720	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	2/2/2017	1041C0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
161750	Fee-for-Service	1487062998	1487062998	1	1	PREMIER CARE RX INC	3/28/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13703 BURBANK BLVD	None	VAN NUYS	CA	91401	5040	19	06037	34.17216148	-118.431585	Los Angeles County
161772	Fee-for-Service	1114459542	1114459542	1	1	PEARSON, PHILLIP M MD	8/1/2022	207L00000X	NA	Other	026	PHYSICIANS	157057	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
161777	Fee-for-Service	1174127583	1174127583	1	1	PRO-MED HEALTH HOSPICE, INC	5/5/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	STE 200A	LOS ANGELES	CA	90039	1536	19	06037	34.12369709	-118.2682266	Los Angeles County
161783	Fee-for-Service	1063160984	1063160984	1	1	PHONGPRATEEP, KIMBERLY K	8/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
161788	Fee-for-Service	1700171246	1700171246	1	1	PIANTEDOSI, AMANDA	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
161828	Fee-for-Service	1881789436	1881789436	1	1	POWERS, REGINA M NP	2/19/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	651 1ST STREET WEST	STE H	SONOMA	CA	95476	7046	49	06097	38.28938482	-122.4593996	Sonoma County
161864	Fee-for-Service	1578577490	1578577490	1	1	PIXLEY MEDICAL CLINIC	11/27/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX Y	205 E DAVIS	None	PIXLEY	CA	93256	1025	54	06107	35.96843541	-119.2923819	Tulare County
161906	Fee-for-Service	1760492714	1760492714	1	3	POUDRE VALLEY HEALTH CARE IN	6/12/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1024 S LEMAY AVE	None	FORT COLLINS	CO	80524	3929	00	None	40.571712	-105.055668	Larimer County
161925	Fee-for-Service	1619984895	1619984895	1	1	PRODROMOU, ANDREW S MD	9/1/2000	207R00000X	NA	Other	026	PHYSICIANS	67715	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
161956	Fee-for-Service	1285320176	1285320176	1	1	PARK, SEHYUK	5/26/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
161962	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	12/29/2018	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
161999	Fee-for-Service	1225116874	1225116874	1	1	PHAM, TIEN Q MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59203	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
162000	Fee-for-Service	1952325268	1952325268	1	1	PERSSELIN, JAY E MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	44398	83	Rheumatology	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
162007	Fee-for-Service	1437475993	1437475993	1	1	PATEE, ALLEN L MD	7/1/2013	207P00000X	NA	Other	026	PHYSICIANS	125192	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
162009	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162037	Fee-for-Service	1346454501	1346454501	1	1	PENNER, KRISTINE R MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98880	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
162065	Fee-for-Service	1174127583	1174127583	1	1	PRO-MED HEALTH HOSPICE, INC	5/5/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	STE 200A	LOS ANGELES	CA	90039	1536	19	06037	34.12369709	-118.2682266	Los Angeles County
162067	Fee-for-Service	1851425060	1851425060	1	1	PAWAR, ANJALI MD	3/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119535	30	Radiology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
162122	Fee-for-Service	1225019698	1225019698	1	1	PARIKH, AMAN K MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85875	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
162139	Fee-for-Service	1225657513	1225657513	1	1	POLLACK, JOHN H MD	10/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181533	None	None	0	In state provider	None	455 OCONNOR DR	SUITE 210	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
162153	Fee-for-Service	1578577490	1578577490	1	1	PIXLEY MEDICAL CLINIC	11/27/2000	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PO BOX Y	205 E DAVIS	None	PIXLEY	CA	93256	1025	54	06107	35.96843541	-119.2923819	Tulare County
162157	Fee-for-Service	1841226990	1841226990	1	13	PHYSICIAN FOUNDATION	2/18/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ASSOCIATES	1350 S ELISEO DR	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
162171	Fee-for-Service	1629441308	1629441308	1	1	PALM HOUSE INC	3/27/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2515 E JEFFERSON ST	None	CARSON	CA	90810	1519	19	06037	33.83403995	-118.2243577	Los Angeles County
162249	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	10/14/2019	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
162254	Fee-for-Service	1679621692	1679621692	1	1	PUVVULA, JAYASHREE MD	1/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81824	41	Internal Medicine	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
162292	Fee-for-Service	1487684809	1487684809	1	1	PHILIP E PUTNAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
162295	Fee-for-Service	1518266329	1518266329	1	1	PESIK, MICHELE A CRNA	2/8/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
162298	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	10/16/2012	1041C0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162312	Fee-for-Service	1700893815	1700893815	1	1	PINZONE, JOSEPH J MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89034	67	Endocrinology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
162384	Fee-for-Service	1346415247	1346415247	1	1	PARK, JACQUELINE J MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109036	10	Gastroenterology (M.D. only)	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162401	Fee-for-Service	1881629186	1881629186	1	1	PAMELA GORDON MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
162405	Fee-for-Service	1972580868	1972580868	1	1	PHAM, PETER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86169	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
162411	Fee-for-Service	1225410970	1225410970	1	1	PENNA, ELLIOTT J MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	153882	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
162425	Fee-for-Service	1154358661	1154358661	1	1	PAQUETTE, JUSTIN D MD	7/9/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	91868	None	None	0	In state provider	None	7777 GREENBACK LANE	STE 103	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
162439	Fee-for-Service	1134532203	1134532203	1	1	PETERFREUND, GREGORY L MD	8/22/2019	207L00000X	NA	Other	026	PHYSICIANS	153364	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
162444	Fee-for-Service	1841226990	1841226990	1	13	PHYSICIAN FOUNDATION	2/18/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	ASSOCIATES	1350 S ELISEO DR	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
162489	Fee-for-Service	1356636138	1356636138	1	1	PALMER, CHRISTINA M MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122592	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
162497	Fee-for-Service	1811159411	1811159411	1	1	PARK, SUSAN K MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111901	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 TACHEVAH DR	2E107	PALM SPRINGS	CA	92282	5752	33	06065	33.83753681	-116.5424435	Riverside County
162517	Fee-for-Service	1649628926	1649628926	1	1	PRASAD, SHALVIN DO	9/10/2020	207R00000X	NA	Other	026	PHYSICIANS	16573	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
162520	Fee-for-Service	1265869481	1265869481	1	1	PREFERRED SLEEP SOLUTIONS, L	1/25/2022	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	LC	100 LAGUNA RD	205	FULLERTON	CA	92835	3633	30	06059	33.89264089	-117.9298746	Orange County
162537	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	9/16/2019	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
162552	Fee-for-Service	1487734349	1487734349	1	1	PRIORITY ONE MEDICAL	2/5/1997	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORT INC	740 S ROCHESTER	STE E	ONTARIO	CA	91761	8179	36	06071	34.05640834	-117.5469139	San Bernardino County
162566	Fee-for-Service	1265423610	1265423610	1	1	PHILAPIL, ROCHELLE A MD	2/1/2000	207P00000X	NA	Other	026	PHYSICIANS	61510	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
162580	Fee-for-Service	1104844810	1104844810	1	1	PATEL, RASIK A MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	48849	41	Internal Medicine	0	In state provider	None	1600 CREEKSIDE DR	STE 2800	FOLSOM	CA	95630	3486	34	06067	38.669994	-121.147488	Sacramento County
162584	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	12/9/2016	1041C0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162630	Fee-for-Service	1700975927	1700975927	1	1	PLANNED PARENTHOOD WORLD	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	EL MONTE	4786 PECK RD	None	EL MONTE	CA	91732	1349	19	06037	34.0907378	-118.0144392	Los Angeles County
162650	Fee-for-Service	1245563030	1245563030	1	1	PATEL, HEMANT D MD INC	3/15/2011	207R00000X	NA	Other	026	PHYSICIANS	41383	41	Internal Medicine	0	In state provider	None	2333 MOWRY AVE	SUITE 200	FREMONT	CA	94538	1622	01	06001	37.55614438	-121.9822469	Alameda County
162667	Fee-for-Service	1922057173	1922057173	1	1	POURZIAEE, BOBBY DPM INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10884 SANTA MONICA BLVD	STE 301	LOS ANGELES	CA	90025	7639	19	06037	34.04943699	-118.4375804	Los Angeles County
162670	Fee-for-Service	1942596853	1942596853	1	1	POTTI, TOMMY A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141756	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
162672	Fee-for-Service	1346415247	1346415247	1	1	PARK, JACQUELINE J MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109036	41	Internal Medicine	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162688	Fee-for-Service	1609848076	1609848076	1	1	PAULSON, ERIC P MD	3/20/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	95370	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
162689	Fee-for-Service	1215210083	1215210083	1	1	PADILLA, RACHELLE D MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118371	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09817553	-118.293237	Los Angeles County
162732	Fee-for-Service	1841226990	1841226990	1	13	PHYSICIAN FOUNDATION	2/18/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ASSOCIATES	1350 S ELISEO DR	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
162741	Fee-for-Service	1932598521	1932598521	1	1	PACIFIC CENTRAL COAST HEALTH	8/10/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	5920 WEST MALL	None	ATASCADERO	CA	93422	4232	40	06079	35.48946251	-120.6679881	San Luis Obispo County
162759	Fee-for-Service	1700409943	1700409943	1	1	PACILLAS, AMANDA M NP	9/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1633 S COURT ST	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
162773	Fee-for-Service	1073538385	1073538385	1	1	PATEL, DEREK R MD	8/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69111	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
162793	Fee-for-Service	1013907716	1013907716	1	1	PLOTNIK, JAMES L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
162795	Fee-for-Service	1114318151	1114318151	1	1	PHONG, CECILIA MD	12/15/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139142	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 SAN BERNARDINO ROAD	SUITE 201	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
162802	Fee-for-Service	1972295749	1972295749	1	1	PAROCUA, ALFONSO	7/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
162824	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2018	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
162830	Fee-for-Service	1891883955	1891883955	1	1	PONHOLD, SIEGHART H MD	7/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35148	01	General Practice	0	In state provider	None	13132 STUDEBAKER BLVD	SUITE 7	NORWALK	CA	90650	2557	19	06037	33.911874	-118.099151	Los Angeles County
162834	Fee-for-Service	1245578988	1245578988	1	1	PATEL, SHILPA K MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125474	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLD	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
162848	Fee-for-Service	1548945272	1548945272	1	1	PARADISE RESIDENTIAL HOME	12/27/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	546 N WRIGHTWOOD DRIVE	None	ORANGE	CA	92869	2666	30	06059	33.79591674	-117.8087641	Orange County
162871	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	6/15/2017	1041C0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
162872	Fee-for-Service	1720736473	1720736473	1	1	PROGRESSIVE MOVEMENT INC.	12/2/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	18484 HIGHWAY 18	#210	APPLE VALLEY	CA	92307	1331	36	06071	34.53970843	-117.2611301	San Bernardino County
162874	Fee-for-Service	1760988786	1760988786	1	1	PAL, RIA MD	4/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	164035	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
162878	Fee-for-Service	1225298110	1225298110	1	1	POURSARTIP, MARYAM MD	8/2/2022	207R00000X	NA	Other	026	PHYSICIANS	115362	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
162883	Fee-for-Service	1851458764	1851458764	1	1	PALO ALTO FIRE DEPT	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	250 HAMILTON AVE	None	PALO ALTO	CA	94301	2531	43	06085	37.44477695	-122.1606485	Santa Clara County
162898	Fee-for-Service	1235367186	1235367186	2	1	PUNDI, KAVITHA N MD	8/14/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169267	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
162930	Fee-for-Service	1396842472	1396842472	1	1	PATHOLOGY ARTS INC	3/14/2011	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	549 QUEENSLAND CIR	STE 101	CORONA	CA	92879	1397	33	06065	33.88363072	-117.5595658	Riverside County
162953	Fee-for-Service	1427610674	1427610674	1	1	PRO-GENEX LABORATORIES INCOR	7/10/2020	207ZP0007X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	PORATED	999 CHESTNUT ST SE	16	GAINESVILLE	GA	30501	6963	00	None	34.28899663	-83.81417899	Hall County
162983	Fee-for-Service	1275564874	1275564874	1	1	POP, SIMONA C MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	91844	08	Family Practice	0	In state provider	None	2095 W VISTA WAY	STE 218	VISTA	CA	92083	6010	37	06073	33.18438885	-117.2876725	San Diego County
163017	Fee-for-Service	1649372053	1649372053	2	1	PHI PHNOM PHARMACY INC	4/30/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 E ANAHEIM ST	STE A	LONG BEACH	CA	90804	3419	19	06037	33.7825725	-118.1663865	Los Angeles County
163019	Fee-for-Service	1578691655	1578691655	1	1	POWELL, JENNIFER S LMFT	12/16/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	791 8TH ST. SUITE S	None	ARCATA	CA	95521	6319	12	06023	40.86820448	-124.0869718	Humboldt County
163053	Fee-for-Service	1417957051	1417957051	1	1	PRINCE, LOLA M PHD	6/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	19	06037	33.98867148	-118.3837334	Los Angeles County
163061	Fee-for-Service	1538329693	1538329693	1	1	PENCIU, CRISTIAN MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145670	36	Psychiatry	0	In state provider	None	1560 E CHEVY CHASE DR	STE 130	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
163062	Fee-for-Service	1073538385	1073538385	1	1	PATEL, DEREK R MD	8/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69111	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
163091	Fee-for-Service	1104817840	1104817840	1	1	PHAN, HAI T	7/31/1986	207RN0300X	NA	Nephrology	026	PHYSICIANS	41679	41	Internal Medicine	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
163114	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	2/8/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
163152	Fee-for-Service	1922123355	1922123355	1	1	PAZDRAL, SUSANNAH L DO	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10811	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
163156	Fee-for-Service	1467457879	1467457879	1	1	PIMENTEL, CARLOS X. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 E RIDGE RD	STE 300	MCALLEN	TX	78503	1508	00	None	26.18505492	-98.21802943	Hidalgo County
163159	Fee-for-Service	1720736473	1720736473	1	1	PROGRESSIVE MOVEMENT INC.	12/2/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	18484 HIGHWAY 18	#210	APPLE VALLEY	CA	92307	1331	36	06071	34.53970843	-117.2611301	San Bernardino County
163160	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
163181	Fee-for-Service	1235662511	1235662511	1	1	PERRIS, HEATHER L NP	7/22/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 112	LONG BEACH	CA	90815	1100	19	06037	33.805692	-118.1251805	Los Angeles County
163254	Fee-for-Service	1982715348	1982715348	1	1	PARKER, RICHARD A DO	3/1/1993	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	5181	08	Family Practice	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
163257	Fee-for-Service	1922480946	1922480946	1	2	PIETRZAK, JOHN PSYD	7/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2599 E 28TH ST	STE 206	SIGNAL HILL	CA	90755	2139	19	06037	33.80808345	-118.160964	Los Angeles County
163261	Fee-for-Service	1871607762	1871607762	1	134	PROVIDENCE MEDICAL FOUNDATIO	12/4/2018	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2773 HARRIS STREET	SUITE B	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
163266	Fee-for-Service	1982137519	1982137519	1	1	PARK, ANDREW C MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	160795	None	None	0	In state provider	None	23653 EL TORO RD	STE B	LAKE FOREST	CA	92630	8614	30	06059	33.617891	-117.7039747	Orange County
163275	Fee-for-Service	1871607762	1871607762	1	115	PROVIDENCE MEDICAL FOUNDATIO	2/27/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19582 BEACH BLVD	SUITE 180	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
163283	Fee-for-Service	1194169953	1194169953	1	1	PRUITT, LAURA N MD	6/21/2018	390200000X	NA	Other	026	PHYSICIANS	135583	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
163286	Fee-for-Service	1023171469	1023171469	1	1	PEARCE, JENICA B LCSW	4/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
163307	Fee-for-Service	1619261054	1619261054	1	1	PRANJEL PATEL MD, INC	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116600	01	General Practice	0	In state provider	None	1530 BESSIE AVE	#105	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
163353	Fee-for-Service	1447437686	1447437686	1	1	PARK, DONALD MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122092	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
163380	Fee-for-Service	1104817840	1104817840	1	1	PHAN, HAI T	7/31/1986	207RN0300X	NA	Nephrology	026	PHYSICIANS	41679	45	Nephrology (Renal-Kidney)	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
163395	Fee-for-Service	1215012505	1215012505	1	1	PLATZ, ELIZABETH A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55758	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
163402	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	6/21/2019	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
163412	Fee-for-Service	1629242201	1629242201	1	1	PRIME HEALTHCARE SERVICES	7/1/2010	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
163419	Fee-for-Service	1801865381	1801865381	1	1	PERLEY, JULES M MD	12/31/1989	208800000X	NA	Other	026	PHYSICIANS	22223	34	Urology and Urological Surgery	0	In state provider	None	1045 ATLANTIC AVE	STE 915	LONG BEACH	CA	90813	3427	19	06037	33.780267	-118.1850795	Los Angeles County
163448	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	2/2/2017	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
163456	Fee-for-Service	1295257269	1295257269	1	1	PLAXCO, JAMIE L CNP	7/6/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
163463	Fee-for-Service	1164601589	1164601589	1	1	PATINO, RENE MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101064	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163476	Fee-for-Service	1124641071	1124641071	1	1	PETERSON, JONATHAN M MD	7/8/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
163484	Fee-for-Service	1629173778	1629173778	1	1	POLITO, LAURA E MD	8/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83844	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
163513	Fee-for-Service	1407880719	1407880719	1	2	PULMONARY MEDICINE ASSOCIATE	4/30/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DISEASE & CRITICAL CARE	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
163519	Fee-for-Service	1376071282	1376071282	1	1	PACIFIC UNITED ANESTHESIA AN	12/5/2017	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	D CRITICAL CARE ASSOCIAT	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
163544	Fee-for-Service	1760029847	1760029847	1	1	PANNU, MANPREET K CNP	8/5/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
163545	Fee-for-Service	1427344951	1427344951	1	1	PARK, MARGARET S MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124443	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
163591	Fee-for-Service	1851419907	1851419907	1	1	PETERSON, JOHN F MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109303	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2608	43	06085	37.313433	-121.9318385	Santa Clara County
163675	Fee-for-Service	1003054420	1003054420	1	1	PEDIATRIC SUBSPECIALTY	12/22/2009	2080P0203X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FACULTY INC	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
163691	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	1/1/1990	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
163722	Fee-for-Service	1174056402	1174056402	1	1	PARSONS, KAYLEE R DO	8/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16740	40	Pediatrics	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 713	GARDEN GROVE	CA	92843	1921	30	06059	33.77450141	-117.9123364	Orange County
163734	Fee-for-Service	1477796795	1477796795	1	1	PRIMO MEDICAL SUPPLIES, INC	5/28/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PRIMO MEDICAL SUPPLIES	17337 VENTURA BLVD	SUITE 220	ENCINO	CA	91316	4039	19	06037	34.16102943	-118.5108514	Los Angeles County
163738	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	9/16/2019	1041C0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
163761	Fee-for-Service	1598798498	1598798498	1	1	PAUL CANNON MORGAN, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1512 12TH AVE RD	None	NAMPA	ID	83686	6008	00	None	43.55346193	-116.5727785	Canyon County
163770	Fee-for-Service	1316494677	1316494677	1	1	PATEL, BIANCA K MD	9/16/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172986	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
163796	Fee-for-Service	1407880719	1407880719	1	2	PULMONARY MEDICINE ASSOCIATE	4/10/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DISEASE & CRITICAL CARE	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
163847	Fee-for-Service	1295924470	1295924470	1	1	PACIFIC REDWOOD MEDICAL SERV	1/14/2008	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERVICES INCORPORATED	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
163907	Fee-for-Service	1245356757	1245356757	1	1	PUSATERI, TONI L MD	10/9/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	99220	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
163959	Fee-for-Service	1306248240	1306248240	1	11	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	18811 FLORIDA STREET	None	HUNTINGTON BEACH	CA	92648	1920	30	06059	33.689025	-117.991069	Orange County
163965	Fee-for-Service	1447813654	1447813654	1	1	PREDDY, VIKA PT	4/19/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
163974	Fee-for-Service	1447448378	1447448378	1	1	PURNELL, MICHAEL B MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	45481	20	Orthopedic Surgery	0	In state provider	INC	1335 COFFEE RD	STE 100	MODESTO	CA	95355	3192	50	06099	37.66291854	-120.9756994	Stanislaus County
163976	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	9/25/2018	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
163980	Fee-for-Service	1982648374	1982648374	1	1	PHAM, LOY A MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45904	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8500 FLORENCE AVE	2ND FLOOR	DOWNEY	CA	90240	4056	19	06037	33.94970699	-118.1216339	Los Angeles County
163989	Fee-for-Service	1508891714	1508891714	1	1	PREMIER MEDICAL	7/1/2001	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION, INC	575 MAPLE CT	None	COLTON	CA	92324	3209	36	06071	34.05903709	-117.3328531	San Bernardino County
163997	Fee-for-Service	1023255262	1023255262	1	1	PHILLIPS, WALTER H LMFT	6/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 BEL MARIN KEYS	C-5	NOVATO	CA	94949	5727	21	06041	38.06937851	-122.5353192	Marin County
164021	Fee-for-Service	1063698553	1063698553	1	1	PARRA-SALAZ, JANIE LMFT	3/26/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
164025	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	1/1/1979	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
164031	Fee-for-Service	1356768485	1356768485	1	1	PAINTER, CAITLYN E DO MD	10/18/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14328	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
164033	Fee-for-Service	1003990219	1003990219	1	1	PACIFIC SURGICAL INSTITUTE	6/1/2000	208600000X	NA	General Surgery	026	PHYSICIANS	74789	02	General Surgery	0	In state provider	MEDICAL CORPORATION	1141 W REDONDO BEACH BLV	#300	GARDENA	CA	90247	3583	19	06037	33.89247036	-118.2941482	Los Angeles County
164058	Fee-for-Service	1043605090	1043605090	1	1	PHILIPSON, DANIEL J MD	5/25/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	148164	None	None	0	In state provider	None	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
164061	Fee-for-Service	1265629992	1265629992	1	1	PASCASIO, JOEY L MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111368	38	Geriatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
164068	Fee-for-Service	1710077698	1710077698	1	1	PAPADAKIS, EMMANUEL J MD	1/6/2015	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	47908	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
164132	Fee-for-Service	1720468804	1720468804	1	1	PEDIATRIC & FAMILY MEDICAL	12/15/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1513 S GRAND AVE	STE 220 & 250	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
164244	Fee-for-Service	1376591685	1376591685	1	1	PIATT, BRADFORD M MD	4/25/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	59447	30	Radiology	0	In state provider	UCD PROF BILLING GROUP	798 S WINCHESTER BLVD	None	SAN JOSE	CA	95128	2928	43	06085	37.313361	-121.9499825	Santa Clara County
164267	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2018	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
164271	Fee-for-Service	1174544787	1174544787	1	1	POP, ANDREIA R MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE B13	RENO	NV	89509	6102	00	None	39.47672552	-119.796471	Washoe County
164313	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	6/15/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
164390	Fee-for-Service	1225047590	1225047590	1	1	PARRISH, RICHARD M MD	5/1/1983	174400000X	NA	Other	026	PHYSICIANS	36581	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2505 SAMARITAN DR	STE 309	SAN JOSE	CA	95124	4011	43	06085	37.25111447	-121.9483395	Santa Clara County
164406	Fee-for-Service	1891246153	1891246153	1	1	PACIFIC INFECTIOUS DISEASES	2/22/2017	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	138814	77	Infectious Disease	0	In state provider	INC	1429 COLLEGE AVENUE	SUITE L	MODESTO	CA	95350	4046	50	06099	37.6654086	-121.0076479	Stanislaus County
164419	Fee-for-Service	1891787008	1891787008	1	1	PARK, EDWARD J MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137010	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
164420	Fee-for-Service	1720468804	1720468804	1	1	PEDIATRIC & FAMILY MEDICAL	7/28/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1513 S GRAND AVE	STE 220 & 250	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
164460	Fee-for-Service	1114229531	1114229531	1	1	PATEL, JESSICA S PHD	9/1/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
164498	Fee-for-Service	1790913770	1790913770	1	1	PEDERSEN, BRIAN A MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117531	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
164519	Fee-for-Service	1063571008	1063571008	1	1	PROEKTOR, LYUDMILA	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	FRAMES, LENSES, ETC.	6336 W 3RD ST	None	LOS ANGELES	CA	90036	3155	19	06037	34.07132833	-118.360324	Los Angeles County
164539	Fee-for-Service	1710034251	1710034251	1	1	PETERSEN, SCOTT J MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66975	01	General Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
164556	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	10/15/2018	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
164562	Fee-for-Service	1164945051	1164945051	1	1	PETRIELLO, ANGELO PT	6/12/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
164563	Fee-for-Service	1710183132	1710183132	1	1	PATEL, NEHA R DO	3/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11401	41	Internal Medicine	0	In state provider	None	147 NORTH BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
164592	Fee-for-Service	1720297294	1720297294	1	1	PHLIPPE, MARC T MD	7/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132667	41	Internal Medicine	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
164599	Fee-for-Service	1184636508	1184636508	1	1	PEPITONE, MICHELLE M MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	65400	40	Pediatrics	0	In state provider	None	3490 CALIFORNIA STREET	STE 200	SAN FRANCISCO	CA	94118	1892	38	06075	37.78668333	-122.4514243	San Francisco County
164602	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	3/25/2020	1041C0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
164626	Fee-for-Service	1104485887	1104485887	1	1	PMD WELLNESS CENTER INC	10/6/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1187 E ANAHEIM ST	None	LONG BEACH	CA	90813	3662	19	06037	33.78263353	-118.177209	Los Angeles County
164663	Fee-for-Service	1831222009	1831222009	1	1	PAE, JEANNE S MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120432	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
164707	Fee-for-Service	1720468804	1720468804	1	1	PEDIATRIC & FAMILY MEDICAL	7/28/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1513 S GRAND AVE	STE 220 & 250	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
164718	Fee-for-Service	1184034159	1184034159	1	1	PASION, JARIEL J MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 EAST LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
164738	Fee-for-Service	1568877314	1568877314	1	1	PAREKH, PUJA M OD	12/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	318 E COMPTON BLVD	None	COMPTON	CA	90221	3206	19	06037	33.89597324	-118.2191747	Los Angeles County
164762	Fee-for-Service	1083622120	1083622120	1	1	PRIME HEALTHCARE	9/30/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BEACH LLC	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
164817	Fee-for-Service	1871607762	1871607762	1	79	PROVIDENCE MEDICAL FOUNDATIO	8/4/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	N	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
164830	Fee-for-Service	1275979759	1275979759	1	1	PEREZ, BRITTANY	6/1/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
164842	Fee-for-Service	1336222397	1336222397	1	6	PERMANENTE MEDICAL GROUP INC	9/23/2019	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
164884	Fee-for-Service	1659609089	1659609089	1	1	POWERS, MICHELLE	10/22/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86994	-	NOT APPLICABLE	0	In state provider	None	1341 N ESCONDIDO BLVD	None	ESCONDIDO	CA	92026	2507	37	06073	33.14046993	-117.0924096	San Diego County
164885	Fee-for-Service	1760527055	1760527055	1	1	PEDROZA, VICTOR M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51722	41	Internal Medicine	0	In state provider	AMAVI, A PROF CORP	2705 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1441	19	06037	34.03264707	-118.2117851	Los Angeles County
164891	Fee-for-Service	1336222397	1336222397	1	5	PERMANENTE MEDICAL GROUP INC	12/27/2016	1041C0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SAN RAFAEL	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
164894	Fee-for-Service	1811049612	1811049612	1	1	PATEL, RITA MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67426	30	Radiology	0	In state provider	None	1001 POTRERO AVE	# 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
164928	Fee-for-Service	1013176999	1013176999	1	1	PATEL, NEEL C DO	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13933	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
164971	Fee-for-Service	1346713617	1346713617	1	1	PRINGLE, ANTHONY W NP	2/6/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
165001	Fee-for-Service	1689257974	1689257974	1	1	PACALDO LLC	9/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	130 VALE ST	None	DALY CITY	CA	94014	2516	41	06081	37.69157559	-122.4684814	San Mateo County
165020	Fee-for-Service	1518361815	1518361815	1	1	PATINO-AYALA, MONICA LMFT	9/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
165051	Fee-for-Service	1174570485	1174570485	1	1	PEARCE, JOHN G MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	30766	30	Radiology	0	In state provider	None	11222 INGLEWOOD AVE	None	INGLEWOOD	CA	90304	0000	19	06037	33.9309843	-118.3612799	Los Angeles County
165084	Fee-for-Service	1568767960	1568767960	1	2	PAKULA, ANDREA M MD	12/3/2018	208600000X	NA	General Surgery	026	PHYSICIANS	114029	02	General Surgery	0	In state provider	None	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	5908	42	06083	34.95019447	-120.4147816	Santa Barbara County
165091	Fee-for-Service	1649591215	1649591215	1	1	PONDER, KATHRYN L MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118561	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	43	06085	37.83734639	-122.2672128	Alameda County
165093	Fee-for-Service	1144775719	1144775719	1	1	PARKER, KIZZY M NP	9/9/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
165098	Fee-for-Service	1962602193	1962602193	1	1	PORENSKY, PAUL N MD	5/28/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	162608	14	Neurological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
165103	Fee-for-Service	1871607762	1871607762	1	79	PROVIDENCE MEDICAL FOUNDATIO	8/4/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	N	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
165113	Fee-for-Service	1316581812	1316581812	1	1	POON, KELVIN	5/13/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	158 C AVE	None	CORONADO	CA	92118	1420	37	06073	32.69718763	-117.1718102	San Diego County
165124	Fee-for-Service	1447887351	1447887351	1	1	PLANT, AMBER F MD	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176994	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
165147	Fee-for-Service	1669957114	1669957114	1	1	PENINSULA OBGYN INTEGRATIVE	9/18/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	101 S SAN MATEO DR	111	SAN MATEO	CA	94401	3819	41	06081	37.56590481	-122.325549	San Mateo County
165172	Fee-for-Service	1760527055	1760527055	1	1	PEDROZA, VICTOR M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51722	01	General Practice	0	In state provider	AMAVI, A PROF CORP	2705 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1441	19	06037	34.03264707	-118.2117851	Los Angeles County
165208	Fee-for-Service	1164658951	1164658951	1	1	PARWANI, PURVI J MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142244	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON STREET	SUITE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
165213	Fee-for-Service	1740296607	1740296607	1	1	PEREZ, MARCO V MD	4/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86952	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
165306	Fee-for-Service	1598906521	1598906521	1	1	PEDIATRIC HEART CENTER INC	10/6/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 OLD RIVER ROAD	SUITE 105	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
165317	Fee-for-Service	1104041086	1104041086	1	1	PALACIOS, ANGELA	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	BUENA VISTA OPTICAL	9061 WOODMAN AVE	None	ARLETA	CA	91331	6404	19	06037	34.23446751	-118.4398288	Los Angeles County
165349	Fee-for-Service	1154544773	1154544773	1	1	POPTELECAN, CARRIE M	1/13/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10850 ARROW ROUTE	None	RANCHO CUCAMONGA	CA	91730	4833	36	06071	34.0991609	-117.5680267	San Bernardino County
165352	Fee-for-Service	1578927208	1578927208	1	1	PAGE, MICHAEL S MD	11/15/2019	207P00000X	NA	Other	026	PHYSICIANS	151976	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
165365	Fee-for-Service	1609070945	1609070945	1	1	PATEL, MITESH MD	9/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	116106	30	Radiology	0	In state provider	None	12490 BUSINESS CENTER DR	200	VICTORVILLE	CA	92395	5833	36	06071	34.47770869	-117.2869719	San Bernardino County
165384	Fee-for-Service	1922462845	1922462845	1	1	PHAM, MICHAEL D DO	10/5/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	19100	None	None	0	In state provider	None	9190 HAVEN AVE	SUITE 200	RANCHO CUCAMONGA	CA	91730	5431	36	06071	34.086816	-117.5758865	San Bernardino County
165385	Fee-for-Service	1831464981	1831464981	1	1	PULL, SONJA K	5/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	43112 N 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
165390	Fee-for-Service	1871607762	1871607762	1	79	PROVIDENCE MEDICAL FOUNDATIO	8/4/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
165405	Fee-for-Service	1184673923	1184673923	1	1	PREMIER EMERGENCY	8/7/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS OF CA MED GRP	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
165410	Fee-for-Service	1225409238	1225409238	2	1	PHARMEDQUEST PHARMACY SERVIC	10/22/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6801 COLDWATER CANYON AV	None	NORTH HOLLYWOOD	CA	91605	5162	19	06037	34.194447	-118.4138285	Los Angeles County
165466	Fee-for-Service	1265728570	1265728570	1	1	PHAM, HESPER H N OD	9/4/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9061 BOLSA AVE	STE 105	WESTMINSTER	CA	92683	5558	30	06059	33.74494462	-117.9711164	Orange County
165486	Fee-for-Service	1386007128	1386007128	1	1	PAULSEN, JONATHAN N MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	161512	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
165526	Fee-for-Service	1053178806	1053178806	1	1	PATTERSON, SADE LCSW	3/12/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
165533	Fee-for-Service	1336250836	1336250836	2	1	PHAN, KENNETH T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77173	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	150 N JACKSON AVENUE	STE 209	SAN JOSE	CA	95116	1908	43	06085	37.36190683	-121.8468659	Santa Clara County
165537	Fee-for-Service	1043381940	1043381940	1	1	PEARCE, CHERYL D CNM	12/16/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5 CENTERPOINTE DRIVE	STE 200	LA PALMA	CA	90623	1050	30	06059	33.86168254	-118.0308375	Orange County
165540	Fee-for-Service	1194286534	1194286534	1	1	PREVICH, LAUREN E MD	7/26/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
165587	Fee-for-Service	1598906521	1598906521	1	1	PEDIATRIC HEART CENTER INC	10/6/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	500 OLD RIVER ROAD	SUITE 105	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
165604	Fee-for-Service	1245348820	1245348820	1	4	PRIMARY CARE ASSOCIATES	1/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	REDWOOD EMPIRE MED GROUP	1144 SONOMA AVE	STE 119	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
165614	Fee-for-Service	1942452941	1942452941	1	1	PICHA, PAUL T DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1905 FRANKLIN ST	None	OAKLAND	CA	94612	2905	01	06001	37.80762338	-122.2676664	Alameda County
165653	Fee-for-Service	1346331725	1346331725	1	1	PALOMA MEDICAL GROUP INC	1/23/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
165667	Fee-for-Service	1861060733	1861060733	1	1	PAIN CLINICS OF CENTRAL CALI	10/20/2021	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	FORNIA, INC.	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
165678	Fee-for-Service	1871607762	1871607762	1	36	PROVIDENCE MEDICAL FOUNDATIO	5/20/2013	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	1100 TRANCAS ST	STE 209	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
165699	Fee-for-Service	1710171434	1710171434	1	1	PATEL, GITANE MD	10/23/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	108603	18	Ophthalmology	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
165700	Fee-for-Service	1336977693	1336977693	1	1	PACINOS, ANABELLE R PT	9/18/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1191 N. STATE	#D	SAN JACINTO	CA	92583	0000	33	06065	33.802677	-116.972033	Riverside County
165720	Fee-for-Service	1629140405	1629140405	1	1	PATHWAY PHARMACEUTICALS	12/7/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	FIRESIDE PHARMACY	73847 HIGHWAY 111	None	PALM DESERT	CA	92260	4005	33	06065	33.72103904	-116.3765047	Riverside County
165785	Fee-for-Service	1619051687	1619051687	1	1	PARNES, MICHAEL D MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84742	02	General Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
165873	Fee-for-Service	1386088698	1386088698	1	1	PARKER, JOHN A MD	7/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133060	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
165914	Fee-for-Service	1184341950	1184341950	1	2	PRO RIDE INC	7/6/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD,	STE 352	GLENDALE	CA	91203	4427	19	06037	34.151958	-118.255149	Los Angeles County
165921	Fee-for-Service	1063771889	1063771889	1	1	PANOSIAN, JILL S MD	6/12/2017	390200000X	NA	Other	026	PHYSICIANS	147451	30	Radiology	0	In state provider	None	1001 POTRERO AVE	ROOM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
165939	Fee-for-Service	1447760814	1447760814	1	1	P4 CLINICAL LLC	3/29/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	25 RIVERSIDE DR	UNIT 10	PINE BROOK	NJ	07058	9391	00	None	40.85438079	-74.3404033	Morris County
165940	Fee-for-Service	1598837312	1598837312	1	1	PAVY, MAUREEN MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60333	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
165944	Fee-for-Service	1346331725	1346331725	1	1	PALOMA MEDICAL GROUP INC	1/23/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
165958	Fee-for-Service	1861060733	1861060733	1	1	PAIN CLINICS OF CENTRAL CALI	10/20/2021	208VP0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FORNIA, INC.	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
165999	Fee-for-Service	1447621412	1447621412	1	1	PADUA, CHERRY ANN PT	1/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
166001	Fee-for-Service	1023438637	1023438637	1	1	PARIZO, JUSTIN T MD	9/21/2021	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139952	None	None	0	In state provider	None	3131 BERGER AVE	None	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
166010	Fee-for-Service	1740447945	1740447945	1	1	PRIME HEALTHCARE SERVICES	7/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIMAS, LLC	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
166032	Fee-for-Service	1568837532	1568837532	1	1	PRESTOSA, JASON L PT	1/21/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
166056	Fee-for-Service	1760489389	1760489389	1	1	PAIK-NICELY, TIMOTHY C MD	5/29/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44510	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2505 LUCAS ST	SUITE B	EUREKA	CA	95501	3340	12	06023	40.79130448	-124.139304	Humboldt County
166109	Fee-for-Service	1740410182	1740410182	1	10	PACIFIC DERMATOLOGY INSTITUT	4/26/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	None	1801 E TAHQUITZ CANYON W	103	PALM SPRINGS	CA	92262	7120	33	06065	33.82303451	-116.5265775	Riverside County
166136	Fee-for-Service	1740551563	1740551563	1	1	PSYCHIATRIC MEDICAL PRACTITI	6/9/2020	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ONERS, INC.	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
166161	Fee-for-Service	1871086512	1871086512	1	3	PARSI ACUPUNCTURE CLINIC, PC	12/27/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C.	1520 BROOKHOLLOW DRIVE	37	SANTA ANA	CA	92705	5429	30	06059	33.7145683	-117.8475378	Orange County
166183	Fee-for-Service	1376310516	1376310516	1	1	PROFESSIONAL MEDICAL GROUP I	5/13/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	20054 HAWTHORNE BLVD	None	TORRANCE	CA	90503	1518	19	06037	33.849909	-118.353614	Los Angeles County
166201	Fee-for-Service	1437136389	1437136389	1	1	PRICE O PAUL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT P.C	2550 S PARKER RD	STE 206	AURORA	CO	80014	1679	00	None	39.670515	-104.8642785	Arapahoe County
166209	Fee-for-Service	1881217453	1881217453	1	1	POURIAN, JESSICA J MD	7/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	188048	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
166226	Fee-for-Service	1871766469	1871766469	1	1	POUDEL, REGINA MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128647	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
166231	Fee-for-Service	1346331725	1346331725	1	1	PALOMA MEDICAL GROUP INC	1/23/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
166245	Fee-for-Service	1639215452	1639215452	1	1	PAMPOLINA, CELESTE T PT	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	700 EAST CALAVERAS BLVD	None	MILPITAS	CA	95035	5439	43	06085	37.43308793	-121.8951311	Santa Clara County
166246	Fee-for-Service	1144363102	1144363102	1	1	PALICA, JOANNA J MD	12/13/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	92228	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
166248	Fee-for-Service	1861060733	1861060733	1	1	PAIN CLINICS OF CENTRAL CALI	10/20/2021	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	FORNIA, INC.	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
166261	Fee-for-Service	1326157785	1326157785	1	1	PAYLESS DRUG STORE 5922	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	3848 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	4502	01	06001	37.6935276	-122.0674111	Alameda County
166277	Fee-for-Service	1225745508	1225745508	1	1	PRIME RX WEST COVINA INC	12/13/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1523 E AMAR RD	None	WEST COVINA	CA	91792	1619	19	06037	34.03086099	-117.9135255	Los Angeles County
166293	Fee-for-Service	1750447322	1750447322	1	1	PERRY, CHRIS LMFT	11/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
166343	Fee-for-Service	1760489389	1760489389	1	1	PAIK-NICELY, TIMOTHY C MD	5/29/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44510	08	Family Practice	0	In state provider	None	2505 LUCAS ST	SUITE B	EUREKA	CA	95501	3340	12	06023	40.79130448	-124.139304	Humboldt County
166380	Fee-for-Service	1861792244	1861792244	1	1	PRASAD, PRIYA MD	7/2/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	143405	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
166390	Fee-for-Service	1174289490	1174289490	1	1	PACULBA, ASHLEY LMFT	9/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35070 ORCHARD CREST CT	None	WINCHESTER	CA	92596	8418	33	06065	33.61517732	-117.096033	Riverside County
166401	Fee-for-Service	1740410182	1740410182	1	10	PACIFIC DERMATOLOGY INSTITUT	4/26/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1801 E TAHQUITZ CANYON W	103	PALM SPRINGS	CA	92262	7120	33	06065	33.82303451	-116.5265775	Riverside County
166403	Fee-for-Service	1447447248	1447447248	1	3	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	890 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3137	41	06081	37.63037357	-122.4174484	San Mateo County
166406	Fee-for-Service	1629173984	1629173984	1	1	PHILIP, BRIDGET M MD	7/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75791	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166422	Fee-for-Service	1891786018	1891786018	1	1	PROFESSIONAL UNITED DIALYSIS	8/20/1996	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	7403 HELLMAN AVE	None	ROSEMEAD	CA	91770	2213	19	06037	34.06986966	-118.1078052	Los Angeles County
166424	Fee-for-Service	1740551563	1740551563	1	1	PSYCHIATRIC MEDICAL PRACTITI	6/9/2020	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ONERS, INC.	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
166431	Fee-for-Service	1871607762	1871607762	1	81	PROVIDENCE MEDICAL FOUNDATIO	8/25/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	1950 SUNNYCREST DR	None	FULLERTON	CA	92835	3644	30	06059	33.89240507	-117.9313904	Orange County
166443	Fee-for-Service	1447440573	1447440573	1	1	PATEL, SAURABH D MD	1/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152872	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
166459	Fee-for-Service	1720215486	1720215486	1	1	PARK, JONATHAN K MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113114	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
166488	Fee-for-Service	1073902672	1073902672	1	1	POMERADO OPERATIONS LLC	1/20/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12696 MONTE VISTA RD	None	POWAY	CA	92064	2500	37	06073	32.99449954	-117.0541688	San Diego County
166511	Fee-for-Service	1154375970	1154375970	1	1	PANDE, SANGEETA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12303 DEPAUL DR	None	BRIDGETON	MO	63044	0000	00	None	38.750967	-90.4336785	St. Louis County
166513	Fee-for-Service	1629089669	1629089669	1	1	PARKER, JENNY MD	8/4/1988	207L00000X	NA	Other	026	PHYSICIANS	42667	05	Anesthesiology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
166537	Fee-for-Service	1194958256	1194958256	1	1	PATEL, REENA R	10/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109224	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
166540	Fee-for-Service	1396782272	1396782272	1	1	PANKE, ROLF K. DO	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 3RD ST	STE 1	DAVENPORT	WA	99122	5008	00	None	47.656755	-118.1447295	Lincoln County
166586	Fee-for-Service	1851820112	1851820112	1	1	PATTISON, HUNTER M MD	6/29/2020	390200000X	NA	Other	026	PHYSICIANS	157699	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
166588	Fee-for-Service	1396817052	1396817052	1	1	PETERS, ALFRED G MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19127	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6183 N FRESNO ST	STE 101	FRESNO	CA	93710	8611	10	06019	36.82625378	-119.7814317	Fresno County
166598	Fee-for-Service	1346942695	1346942695	1	1	PEBBLE BEACH HOLDINGS LLC	5/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22103 REDWOOD ROAD	None	CASTRO VALLEY	CA	94546	7107	01	06001	37.68644367	-122.0735881	Alameda County
166601	Fee-for-Service	1093960254	1093960254	1	1	POULSON, CARRIE L LCSW	5/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
166606	Fee-for-Service	1588977375	1588977375	1	1	PILLAI, SANGITA S MD	3/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109474	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
166623	Fee-for-Service	1417434077	1417434077	1	1	PFIZENMAYER, PATRICK MD	10/5/2023	208800000X	NA	Other	026	PHYSICIANS	189923	None	None	0	In state provider	None	1541 FLORIDA AVE	STE 100	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
166628	Fee-for-Service	1053791442	1053791442	1	1	PATKI, SWATI S MD	6/12/2020	390200000X	NA	Other	026	PHYSICIANS	157540	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
166630	Fee-for-Service	1760489389	1760489389	1	1	PAIK-NICELY, TIMOTHY C MD	5/29/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44510	01	General Practice	0	In state provider	None	2505 LUCAS ST	SUITE B	EUREKA	CA	95501	3340	12	06023	40.79130448	-124.139304	Humboldt County
166637	Fee-for-Service	1013903947	1013903947	1	1	PAULIKS, LINDA B MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148807	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1010 W LA VETA AVE	STE 575	ORANGE	CA	92868	4305	30	06059	33.78028244	-117.8635552	Orange County
166644	Fee-for-Service	1912703539	1912703539	1	1	PRIME CONSULT AND CARE INC	4/1/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1945 PALO VERDE AVE	STE 207	LONG BEACH	CA	90815	3445	19	06037	33.791634	-118.1080175	Los Angeles County
166688	Fee-for-Service	1447447248	1447447248	1	3	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	890 EL CAMINO REAL	None	SAN BRUNO	CA	94066	3137	41	06081	37.63037357	-122.4174484	San Mateo County
166689	Fee-for-Service	1003952151	1003952151	1	1	PHILLIPS, TANYANIKA L MD	10/24/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	157739	41	Internal Medicine	0	In state provider	None	44151 15TH ST WEST	STE 409	LANCASTER	CA	93534	5504	19	06037	34.68551775	-118.1568686	Los Angeles County
166693	Fee-for-Service	1336477611	1336477611	1	1	PEREZ, ANA M G MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111723	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166726	Fee-for-Service	1871607762	1871607762	1	170	PROVIDENCE MEDICAL FOUNDATIO	8/23/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	558 3RD ST W	None	SONOMA	CA	95476	6502	49	06097	38.29133791	-122.4636079	Sonoma County
166772	Fee-for-Service	1215208913	1215208913	1	1	PREMJI, RESMI MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138848	67	Endocrinology	0	In state provider	None	275 CROSSROADS	SUITE A	CARMEL	CA	93923	8684	27	06053	36.53645751	-121.9089649	Monterey County
166795	Fee-for-Service	1336643030	1336643030	1	1	PATEL, UMABEN	4/14/2020	390200000X	NA	Other	026	PHYSICIANS	165818	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
166823	Fee-for-Service	1801931878	1801931878	1	1	PROGRESS HOUSE, INC	4/21/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5607 MOUNT MURPHY ROAD	None	GARDEN VALLEY	CA	95633	9701	09	06017	38.83620772	-120.8759529	El Dorado County
166876	Fee-for-Service	1154304103	1154304103	1	1	PENG, RICK Y MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61449	01	General Practice	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
166902	Fee-for-Service	1902236169	1902236169	1	1	PATTERSON URGENT CARE INC	4/3/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1010 SPERRY AVE	SUITE D	PATTERSON	CA	95363	9297	50	06099	37.46429354	-121.1415615	Stanislaus County
166903	Fee-for-Service	1922711209	1922711209	1	1	PATEL, KRINA NP	1/8/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8590 RIO SAN DIEGO DR	SUITE 111	SAN DIEGO	CA	92108	5507	37	06073	32.77472926	-117.1448295	San Diego County
166915	Fee-for-Service	1548328750	1548328750	1	1	PACIFICA OF THE VALLEY	6/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
166968	Fee-for-Service	1306144209	1306144209	1	1	PENINSULA GASTROINTESTINAL S	2/25/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	PECIALISTS, INC.	100 S ELLSWORTH AVE	SUITE 507	SAN MATEO	CA	94401	3939	41	06081	37.56665635	-122.3247743	San Mateo County
166979	Fee-for-Service	1003952151	1003952151	1	1	PHILLIPS, TANYANIKA L MD	10/24/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	157739	68	Hematology	0	In state provider	None	44151 15TH ST WEST	STE 409	LANCASTER	CA	93534	5504	19	06037	34.68551775	-118.1568686	Los Angeles County
167005	Fee-for-Service	1952642597	1952642597	1	1	PALESH, OXANA G PHD	5/2/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167021	Fee-for-Service	1326109190	1326109190	1	1	PEREZ, MARVIN J PHD	10/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
167052	Fee-for-Service	1427402320	1427402320	1	1	PERALTA, JENNIFER B	12/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	171458	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
167065	Fee-for-Service	1982635256	1982635256	1	1	PANTELL, ROBERT H MD	1/1/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	27056	40	Pediatrics	0	In state provider	U C S F	400 PARNASSUS AVE	# A206	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
167066	Fee-for-Service	1164719399	1164719399	1	1	PARK, EILEEN A MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114574	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
167098	Fee-for-Service	1245307123	1245307123	1	1	PENG, SUSY C MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	69153	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
167164	Fee-for-Service	1154304103	1154304103	1	1	PENG, RICK Y MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61449	33	Thoracic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
167167	Fee-for-Service	1578169249	1578169249	1	1	PACIFIC CREST HOSPICE OF	1/19/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	VENTURA COUNTY LLC	2300 ALESSANDRO DR	STE 120	VENTURA	CA	93001	3783	56	06111	34.2662422	-119.2690302	Ventura County
167194	Fee-for-Service	1366579658	1366579658	1	1	PERRY, CAROLYN A PA	9/25/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11037	-	NOT APPLICABLE	0	In state provider	None	2080 CENTURY PARK E	STE 1210	CENTURY CITY	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
167197	Fee-for-Service	1548328750	1548328750	1	1	PACIFICA OF THE VALLEY	6/1/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
167215	Fee-for-Service	1326073818	1326073818	1	1	PAONER, JOEL D CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
167374	Fee-for-Service	1851007256	1851007256	1	1	PATHWAY FAMILY SERVICES	10/11/2024	253J00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	2600 G ST	None	BAKERSFIELD	CA	93301	2814	15	06029	35.38311669	-119.0222975	Kern County
167386	Fee-for-Service	1245307123	1245307123	1	1	PENG, SUSY C MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	69153	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
167396	Fee-for-Service	1679527089	1679527089	1	1	PAUL BLACKBURN, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
167449	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	1/3/2024	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
167453	Fee-for-Service	1699550400	1699550400	1	1	PARADISE PHARMACY, INC.	9/15/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3940 4TH AVE	STE 150	SAN DIEGO	CA	92103	3193	37	06073	32.74912549	-117.161641	San Diego County
167454	Fee-for-Service	1306026562	1306026562	1	1	PATEL, SHAIVAL M MD	4/20/2015	207L00000X	NA	Other	026	PHYSICIANS	101983	05	Anesthesiology	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
167455	Fee-for-Service	1578169249	1578169249	1	1	PACIFIC CREST HOSPICE OF	1/19/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	VENTURA COUNTY LLC	2300 ALESSANDRO DR	STE 120	VENTURA	CA	93001	3783	56	06111	34.2662422	-119.2690302	Ventura County
167459	Fee-for-Service	1659455632	1659455632	1	1	PATEL, MOLINA S DO	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8241	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
167487	Fee-for-Service	1548328750	1548328750	1	1	PACIFICA OF THE VALLEY	6/1/2008	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
167490	Fee-for-Service	1346351608	1346351608	1	1	POLNER, PORTIA PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2255 MORELLO AVE	STE 119	PLEASANT HILL	CA	94523	1855	07	06013	37.961784	-122.081391	Contra Costa County
167498	Fee-for-Service	1164535779	1164535779	1	1	PAULETT, KELLY E OD	5/16/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	162 W D STREET	None	LEMOORE	CA	93245	2938	16	06031	36.302089	-119.7831008	Kings County
167504	Fee-for-Service	1801828256	1801828256	1	1	PIETSCHKER, DARLA J	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
167512	Fee-for-Service	1144368747	1144368747	2	1	PARK, SANG W	12/12/2014	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	945 S WESTERN AVE	STE 203	LOS ANGELES	CA	90006	1008	19	06037	34.054218	-118.3091085	Los Angeles County
167590	Fee-for-Service	1053546945	1053546945	1	1	POTTATHIL, VIJAY R MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147576	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167637	Fee-for-Service	1205922440	1205922440	1	1	PEZZANI, MICHELLE E MD	7/31/1996	207R00000X	NA	Other	026	PHYSICIANS	83953	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
167661	Fee-for-Service	1528736766	1528736766	1	1	PHAN, VU T NP	1/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25470 MEDICAL CENTER DR	SUITE 201	MURRIETA	CA	92562	4900	33	06065	33.55723646	-117.1859554	Riverside County
167669	Fee-for-Service	1942920939	1942920939	1	1	PEREZ, LESLIE OD	7/6/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 110B	SAN DIMAS	CA	91773	2541	19	06037	34.10669347	-117.814932	Los Angeles County
167674	Fee-for-Service	1285680785	1285680785	1	1	PAVEL BRAUNSHTEIN	2/6/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6428 1/2 COLDWATER CYN	AVE	NORTH HOLLYWOOD	CA	91606	1159	19	06037	34.18757276	-118.4137803	Los Angeles County
167704	Fee-for-Service	1346250701	1346250701	1	1	PAYANDEH, FARAMARZ M.D.	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	52895	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
167737	Fee-for-Service	1942417340	1942417340	1	1	PLEASANT VALLEY PEDIATRI	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GRP	2486 N PONDEROSA DR	STE D211	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
167738	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	2/23/2024	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
167789	Fee-for-Service	1780751545	1780751545	1	1	PHAM, LUAN H DPM	5/27/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
167829	Fee-for-Service	1598816563	1598816563	1	1	PAUSHTER, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60675	0001	00	None	41.788431	-87.60489252	Cook County
167838	Fee-for-Service	1407485972	1407485972	1	1	PATEL, YATINDRA H MD	4/5/2024	207R00000X	NA	Other	026	PHYSICIANS	187180	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
167856	Fee-for-Service	1801201025	1801201025	1	1	PAUL, PRITIKANTA MD	9/9/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	187641	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
167886	Fee-for-Service	1558641936	1558641936	1	1	PASCUCCI, ANABELLA MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113352	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 450, 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
167926	Fee-for-Service	1174184238	1174184238	1	1	PURCELL, VALERIE J LCSW	9/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13075 BLACKBIRD ST	None	GARDEN GROVE	CA	92843	2902	30	06059	33.77353611	-117.9130729	Orange County
167928	Fee-for-Service	1821268434	1821268434	1	1	POOLE, RENEE M MD	2/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	129318	08	Family Practice	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
167936	Fee-for-Service	1750151429	1750151429	1	1	PAULOS, RIVA CRNA	4/24/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
168024	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	5/21/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
168028	Fee-for-Service	1508037300	1508037300	1	1	PASCASIO, MARY P MD	12/3/2010	390200000X	NA	Other	026	PHYSICIANS	113048	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91188	0001	19	06037	34.17030266	-118.5881699	Los Angeles County
168029	Fee-for-Service	1326133448	1326133448	1	1	PACIFIC RENAL CARE	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL CORP	11180 WARNER AVE	STE 463	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
168052	Fee-for-Service	1679640536	1679640536	1	1	PYNE, JOHN WILLIAM MD	4/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	74301	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
168076	Fee-for-Service	1336268796	1336268796	1	1	PECK-SOBOLEWSKI, REGINA C LM	3/31/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	680 LANGSDORF DR STE	219	FULLERTON	CA	92831	3702	30	06059	33.87673088	-117.8824577	Orange County
168127	Fee-for-Service	1285346809	1285346809	1	3	PAJARO VALLEY HEALTH CARE DI	3/4/2024	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	65 NIELSON ST	STE 125	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
168134	Fee-for-Service	1508872243	1508872243	1	1	PARK, JUNG M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52223	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3010 W ORANGE AVE	STE 202	ANAHEIM	CA	92804	3171	30	06059	33.82472315	-117.994133	Orange County
168136	Fee-for-Service	1720345895	1720345895	1	1	POSNER, DAVID A MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126918	01	General Practice	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95620	6217	57	06113	38.56287659	-121.7715536	Yolo County
168163	Fee-for-Service	1730265497	1730265497	1	1	PARAMSOTHY, PATHMAJA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
168182	Fee-for-Service	1871607762	1871607762	1	48	PROVIDENCE MEDICAL FOUNDATIO	5/13/2014	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	27871 MEDICAL CENTER RD	STE 240	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
168183	Fee-for-Service	1407337108	1407337108	1	1	PAVLOV, ANNA LMFT	7/9/2024	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
168192	Fee-for-Service	1699215400	1699215400	1	1	PATEL, DIXI DO	2/19/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18622	None	None	0	In state provider	None	2880 ATLANTIC AVE	SUITE 170	LONG BEACH	CA	90806	1715	19	06037	33.809382	-118.185001	Los Angeles County
168205	Fee-for-Service	1992055263	1992055263	1	1	PERMENTER, LAUREN	1/20/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
168232	Fee-for-Service	1386631901	1386631901	1	1	PATEL, RAVINDRANATH	3/28/1996	174400000X	NA	Other	026	PHYSICIANS	42045	68	Hematology	0	In state provider	None	4100 TRUXTUN AVE	STE 200	BAKERSFIELD	CA	93309	0656	15	06029	35.37322685	-119.0458325	Kern County
168263	Fee-for-Service	1811204340	1811204340	1	1	PATEL, PREMAL M MD	6/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116444	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
168294	Fee-for-Service	1972694792	1972694792	2	1	PADILLA, WILLIAM J A	8/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	43091	08	Family Practice	0	In state provider	MEDICAL CORPORATION	263 CHURCH AVE	None	CHULA VISTA	CA	91910	2728	37	06073	32.64292218	-117.0793772	San Diego County
168307	Fee-for-Service	1669520128	1669520128	1	1	PAYNE, DENISE E LMFT	11/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
168314	Fee-for-Service	1326133448	1326133448	1	1	PACIFIC RENAL CARE	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL CORP	11180 WARNER AVE	STE 463	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
168316	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	1/3/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
168325	Fee-for-Service	1497195267	1497195267	1	1	PATHAN, MOHAMMAD F MD	1/21/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	163060	18	Ophthalmology	0	In state provider	None	255 E WEBER AVE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
168326	Fee-for-Service	1225234982	1225234982	1	1	PETTUS, JEREMY H MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106382	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168337	Fee-for-Service	1235774175	1235774175	1	1	POWELL, FANNY NP	12/30/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
168339	Fee-for-Service	1679640536	1679640536	1	1	PYNE, JOHN WILLIAM MD	4/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	74301	10	Gastroenterology (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
168356	Fee-for-Service	1093765901	1093765901	1	1	PORT, JAMES E MD	7/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87271	None	None	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
168387	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	11/26/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
168416	Fee-for-Service	1841279973	1841279973	1	1	PAUL HUNT M.D.	2/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
168488	Fee-for-Service	1285642439	1285642439	1	1	PAUL, SATNAM MD	2/1/2023	207L00000X	NA	Other	026	PHYSICIANS	176017	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
168490	Fee-for-Service	1336432376	1336432376	1	1	PRIEB, JULIA MARIE CO	9/22/2011	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 S ELLSWORTH AVE	#203	SAN MATEO	CA	94401	3932	41	06081	37.56665635	-122.3247743	San Mateo County
168492	Fee-for-Service	1942888136	1942888136	1	1	PATHAKOTA, REDDY MD	6/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
168554	Fee-for-Service	1871607762	1871607762	1	180	PROVIDENCE MEDICAL FOUNDATIO	6/10/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	363 MAIN ST	110, 170, 345	ORANGE	CA	92868	3813	30	06059	33.782787	-117.8672715	Orange County
168566	Fee-for-Service	1467436055	1467436055	1	1	PHADKE, JAYANT G MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56221	13	Neurology (M.D. only)	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
168587	Fee-for-Service	1851797880	1851797880	1	1	PACIFIC BIOMEDICAL EQUIPMENT	12/6/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	3140 GOLD CAMP DRIVE	STE 90	RANCHO CORDOVA	CA	95670	6054	34	06067	38.592477	-121.2745095	Sacramento County
168595	Fee-for-Service	1447205505	1447205505	1	1	PETROVA, ANNA A MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52536	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
168601	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	6/24/2024	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
168611	Fee-for-Service	1194967653	1194967653	1	1	PANDIT, DIPIKA R MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117290	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
168650	Fee-for-Service	1275545493	1275545493	1	1	POTTURI, LATA MD	1/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91943	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
168676	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	9/5/2017	207Q00000X	NA	Adult Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
168698	Fee-for-Service	1306248240	1306248240	1	4	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	25652 OLD TRABUCO ROAD	None	LAKE FOREST	CA	92630	2776	30	06059	33.64531866	-117.6831748	Orange County
168785	Fee-for-Service	1740360163	1740360163	1	1	PIENIAZEK, JOHN J MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
168787	Fee-for-Service	1003543786	1003543786	1	1	PADILLA PHYSICAL THERAPY & F	9/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ITNESS INC	1420 7TH ST	None	WASCO	CA	93280	1735	15	06029	35.5943138	-119.3418761	Kern County
168793	Fee-for-Service	1982653598	1982653598	1	1	PACIFIC NETWORK IMAGING, INC	6/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	50566	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 SO SAN MATEO DR	STE 303	SAN MATEO	CA	94401	3844	41	06081	37.56590481	-122.325549	San Mateo County
168795	Fee-for-Service	1982853305	1982853305	1	1	PEACE-IT-TOGETHER	11/27/2024	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
168796	Fee-for-Service	1326798695	1326798695	1	1	PHONG, BRANDON C MD	8/23/2024	207P00000X	NA	Other	026	PHYSICIANS	189152	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
168809	Fee-for-Service	1720598451	1720598451	1	1	PETALUMA CITY SCHOOLS	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	200 DOUGLAS STREET	None	PETALUMA	CA	94952	2567	49	06097	38.22900363	-122.6435653	Sonoma County
168833	Fee-for-Service	1457803470	1457803470	1	1	PAPPAS, CARISSA A LMFT	2/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
168834	Fee-for-Service	1588822241	1588822241	1	2	PAUL, SHEILA A LMFT	2/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9800 MESA LINDA ST	APT 262	HESPERIA	CA	92345	0110	36	06071	34.42932536	-117.3926994	San Bernardino County
168835	Fee-for-Service	1952515553	1952515553	1	1	PALMER, ERIC W MD	7/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	842 EAST MAIN STREET	None	MEDFORD	OR	97208	2947	00	None	42.32787853	-122.863311	Jackson County
168841	Fee-for-Service	1871607762	1871607762	1	180	PROVIDENCE MEDICAL FOUNDATIO	6/10/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	363 MAIN ST	110, 170, 345	ORANGE	CA	92868	3813	30	06059	33.782787	-117.8672715	Orange County
168845	Fee-for-Service	1528087483	1528087483	1	1	PROCARE HOSPICE, LLC	10/21/1999	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	42442 10TH ST W	STE E	LANCASTER	CA	93534	7067	19	06037	34.65427909	-118.147575	Los Angeles County
168848	Fee-for-Service	1033746078	1033746078	1	1	PATEL, NIHAR U MD	6/7/2024	207R00000X	NA	Other	026	PHYSICIANS	178775	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
168863	Fee-for-Service	1477586279	1477586279	1	1	POMPAN, DONALD C MD	4/10/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	64818	20	Orthopedic Surgery	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
168877	Fee-for-Service	1871607762	1871607762	1	64	PROVIDENCE MEDICAL FOUNDATIO	12/1/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	30131 TOWN CENTER DR	STE 135	LAGUNA NIGUEL	CA	92677	2010	30	06059	33.52530096	-117.7148334	Orange County
168887	Fee-for-Service	1093708679	1093708679	1	1	PROVIDENCE HEALTH SERVICES	11/10/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WACO	6901 MEDICAL PKWY	None	WACO	TX	76712	7910	00	None	31.51396064	-97.19823392	McLennan County
168888	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	2/9/2023	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
168899	Fee-for-Service	1134802119	1134802119	1	1	PEREZ, VANESA M PHD	11/18/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
168963	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	4/5/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
168968	Fee-for-Service	1639747116	1639747116	1	1	PROGRESSIVE PHYSICAL THERAPY	10/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	OF SAN DIEGO INC	681 MOLLISON	None	EL CAJON	CA	92020	6908	37	06073	32.78816936	-116.9509395	San Diego County
168992	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	3/9/2020	207RA0201X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
169008	Fee-for-Service	1225490295	1225490295	1	1	PHAM, CINDY MD	9/18/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	167343	39	Preventive (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
169024	Fee-for-Service	1548656499	1548656499	1	2	PAK, EMILY	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144172	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
169044	Fee-for-Service	1619383502	1619383502	1	1	PULLIZZI, AMY CNP	11/19/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9730 MISSION GORGE RD	None	SANTEE	CA	92071	3808	37	06073	32.83879131	-116.9848056	San Diego County
169053	Fee-for-Service	1760440101	1760440101	1	1	PARSONS, JOHN K MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91156	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
169072	Fee-for-Service	1841715471	1841715471	1	2	PACGENOMICS	6/27/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	28222 AGOURA RD	STE 200/201	AGOURA HILLS	CA	91301	2411	19	06037	34.14076955	-118.7417477	Los Angeles County
169079	Fee-for-Service	1982653598	1982653598	1	1	PACIFIC NETWORK IMAGING, INC	6/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	50566	42	Nuclear Medicine	0	In state provider	None	101 SO SAN MATEO DR	STE 303	SAN MATEO	CA	94401	3844	41	06081	37.56590481	-122.325549	San Mateo County
169084	Fee-for-Service	1982853305	1982853305	1	1	PEACE-IT-TOGETHER	1/22/2025	No Taxonomy Provided	NA	None	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
169091	Fee-for-Service	1225277866	1225277866	1	1	PON, DOUGLAS A CRNA	5/20/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
169095	Fee-for-Service	1114420478	1114420478	1	2	PIER ANESTHESIA GROUP, INC.	9/21/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
169119	Fee-for-Service	1922159482	1922159482	1	1	PIONEER DIAGNOSTICS	4/28/2014	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	AND RESEARCH CORP	5720 STONERIDGE MALL RD	SUITE 288	PLEASANTON	CA	94588	2828	01	06001	37.69247085	-121.9301884	Alameda County
169128	Fee-for-Service	1568875987	1568875987	1	1	PERRONE, MICHAEL A MD	9/1/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161143	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
169133	Fee-for-Service	1528087483	1528087483	1	1	PROCARE HOSPICE, LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	42442 10TH ST W	STE E	LANCASTER	CA	93534	7067	19	06037	34.65427909	-118.147575	Los Angeles County
169144	Fee-for-Service	1922079458	1922079458	1	1	PUERCO VALLEY AMBULANCE	1/17/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1/2 MILE SOUTH HWY 191	None	SANDERS	AZ	86512	0000	00	None	35.19098422	-109.3343381	Apache County
169149	Fee-for-Service	1942235940	1942235940	1	1	PENA, JORGE A MD	2/28/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	29890	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	600 N GARFIELD AVE	STE 311	MONTEREY PARK	CA	91754	1171	19	06037	34.06820797	-118.1228835	Los Angeles County
169151	Fee-for-Service	1790992998	1790992998	1	1	PARK-SIGAL, JENNIFER J MD	1/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103213	67	Endocrinology	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
169155	Fee-for-Service	1770989121	1770989121	1	1	PITSAVAS, NICOLE PSYD	5/13/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	308 W STATE ST	STE 3D	REDLANDS	CA	92373	4653	36	06071	34.05649746	-117.18603	San Bernardino County
169156	Fee-for-Service	1639205255	1639205255	1	1	PENN, MARK W MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131027	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
169158	Fee-for-Service	1790865111	1790865111	1	1	PHILLIPS,WILLIAM A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6621 FANNIN ST	None	HOUSTON	TX	77030	0000	00	None	29.70724683	-95.4026169	Harris County
169164	Fee-for-Service	1609037688	1609037688	1	1	PALOMERA, VANESSA LMFT	9/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
169166	Fee-for-Service	1407119852	1407119852	1	1	PHAM, KEVIN G DO	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO BLVD	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
169174	Fee-for-Service	1093708679	1093708679	1	1	PROVIDENCE HEALTH SERVICES	8/30/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WACO	6901 MEDICAL PKWY	None	WACO	TX	76712	7910	00	None	31.51396064	-97.19823392	McLennan County
169176	Fee-for-Service	1770093734	1770093734	1	1	PROVIDENCE SAINT JOHNS MEDI	2/9/2023	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERS	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
169184	Fee-for-Service	1104546365	1104546365	1	1	PACOIMA RX PHARMACY INC	1/19/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13630 VAN NUYS BLVD	STE 101	PACOIMA	CA	91331	3655	19	06037	34.26033707	-118.429957	Los Angeles County
169228	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
169250	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	2/9/2024	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
169280	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	2/12/2019	207RA0201X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
169283	Fee-for-Service	1275879801	1275879801	1	1	PROVIDENT HEALTH CARE INC	5/3/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1553 TAMARACK AVE	None	ATWATER	CA	95301	2743	24	06047	37.35880322	-120.6095628	Merced County
169301	Fee-for-Service	1336714294	1336714294	1	1	PACIFIC COAST REHABILITATION	10/9/2023	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	2181 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
169308	Fee-for-Service	1235231770	1235231770	1	1	PUNIANI, TRILOK S MD	2/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45790	13	Neurology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
169354	Fee-for-Service	1659399202	1659399202	1	1	PACIFIC WOUND CENTER MEDICAL	2/15/2011	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	4722 QUAIL LAKES DR	STE A	STOCKTON	CA	95207	5256	39	06077	37.98644944	-121.3399768	San Joaquin County
169359	Fee-for-Service	1558603860	1558603860	1	1	PAN, STEPHANIE J MD	9/11/2019	207L00000X	NA	Other	026	PHYSICIANS	161045	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
169372	Fee-for-Service	1467428656	1467428656	1	1	PETERSEN, MICHAEL S MD	3/1/1999	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	49302	20	Orthopedic Surgery	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
169374	Fee-for-Service	1982853305	1982853305	1	1	PEACE-IT-TOGETHER	6/15/2015	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	M/B 10, SUITE B	SANTA CLARA	CA	95050	4721	43	06085	37.34637328	-121.9509049	Santa Clara County
169388	Fee-for-Service	1356641955	1356641955	1	1	PHILLIPS, DOUGLAS A LCSW	10/2/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
169400	Fee-for-Service	1235299033	1235299033	1	1	PAZIRANDEH, ARYAN OD	5/26/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	991 E MONTE VISTA AVE	None	TURLOCK	CA	95382	0403	50	06099	37.52188647	-120.83769	Stanislaus County
169413	Fee-for-Service	1437590809	1437590809	1	1	PIPER HOWER	1/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4505 NW FIELDING RD	None	TOPEKA	KS	66618	2651	00	None	39.12882174	-95.71425266	Shawnee County
169415	Fee-for-Service	1326066671	1326066671	1	1	PEAK, SCOTT J MD	7/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79065	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
169423	Fee-for-Service	1851548366	1851548366	1	1	PALMER, KAROLYN M LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
169511	Fee-for-Service	1154515294	1154515294	1	1	PULITZER, STEVEN MD	2/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	189041	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
169512	Fee-for-Service	1124313820	1124313820	1	1	PATEL, ARPAN A MD	8/31/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	130484	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
169515	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	9/23/2019	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
169538	Fee-for-Service	1245348820	1245348820	1	3	PRIMARY CARE ASSOCIATES	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	REDWOOD EMPIRE MED GROUP	255 FARMERS LN	None	SANTA ROSA	CA	95405	4721	49	06097	38.447901	-122.6884725	Sonoma County
169539	Fee-for-Service	1487812236	1487812236	1	1	PARK, HAROLD S MD	2/17/2020	2085R0204X	NA	Other	026	PHYSICIANS	133522	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
169542	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	11/28/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
169554	Fee-for-Service	1316368590	1316368590	1	1	PLATINUM PHARMACY INC	1/26/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1175 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1403	19	06037	34.05510581	-118.3837417	Los Angeles County
169558	Fee-for-Service	1972506442	1972506442	1	1	PETERSEN, JOHN L MD INC	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74917	41	Internal Medicine	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
169571	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
169575	Fee-for-Service	1427314178	1427314178	1	1	PATEL, ARPNA S MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	128199	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
169579	Fee-for-Service	1326240219	1326240219	1	2	POKHAREL, SAJAL S MD	11/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150168	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
169588	Fee-for-Service	1336714294	1336714294	1	1	PACIFIC COAST REHABILITATION	6/10/2024	208100000X	NA	Physical Medicine and Rehabilitation	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2181 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.11995854	-117.1204723	San Diego County
169619	Fee-for-Service	1790312783	1790312783	1	1	PENTAGULIO, CELENA D MD	10/31/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178633	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
169632	Fee-for-Service	1316195886	1316195886	1	1	POWERS, CHRISTOPHER V MFT	6/28/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80901	-	NOT APPLICABLE	0	In state provider	None	470 CASTRO STREET	None	SAN FRANCISCO	CA	94114	2482	38	06075	37.76132744	-122.4350734	San Francisco County
169638	Fee-for-Service	1760912729	1760912729	1	1	PEZESHKI, BRYAN B MD	7/6/2020	207P00000X	NA	Other	026	PHYSICIANS	167480	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
169659	Fee-for-Service	1053829473	1053829473	1	1	PETERSON, REINA	9/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
169670	Fee-for-Service	1417165309	1417165309	1	1	PATEL, RAJAN CORPORATION	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91395	20	Orthopedic Surgery	0	In state provider	None	6330 SAN VINCENTE BLVD	SUITE 310	LOS ANGELES	CA	90048	5425	19	06037	34.06129173	-118.3678359	Los Angeles County
169728	Fee-for-Service	1548379316	1548379316	1	1	PURVIS, JANEY M MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2801 DAGGET AVE	None	KLAMATH	OR	97601	1106	00	None	42.25271647	-121.787181	Klamath
169732	Fee-for-Service	1275572828	1275572828	1	1	PATEL, RAVI J MD	9/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92623	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
169738	Fee-for-Service	1134170533	1134170533	1	1	PARK, NAM H MD	9/15/2008	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
169739	Fee-for-Service	1699236380	1699236380	1	1	PHAM, HOANG MD	8/11/2023	207P00000X	NA	Other	026	PHYSICIANS	181904	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
169800	Fee-for-Service	1275071458	1275071458	1	1	POWERS, DAVID LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 JEWELL ST	None	SANTA CRUZ	CA	95060	1717	44	06087	36.9882732	-122.025701	Santa Cruz County
169801	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	10/15/2018	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
169802	Fee-for-Service	1124313820	1124313820	1	1	PATEL, ARPAN A MD	8/31/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	130484	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
169806	Fee-for-Service	1275791931	1275791931	1	1	PAUL, RAINA M MD	1/1/2022	207PP0204X	NA	Other	026	PHYSICIANS	175858	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
169818	Fee-for-Service	1548280571	1548280571	1	1	PATEL, ROSHNI V MD	4/20/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168194	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
169823	Fee-for-Service	1407813660	1407813660	1	2	POMONA VALLEY HOSPITAL	4/23/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2333 FOOTHILL BLVD	SUITE C	LAVERNE	CA	91750	3027	19	06037	34.11220804	-117.7613999	Los Angeles County
169828	Fee-for-Service	1588829006	1588829006	1	1	PIH HEALTH PHYSICIANS	11/7/2024	207Q00000X	NA	Adult Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	PIH	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
169846	Fee-for-Service	1972506442	1972506442	1	1	PETERSEN, JOHN L MD INC	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74917	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
169857	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	12/4/2020	207RA0201X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
169878	Fee-for-Service	1053549998	1053549998	1	1	PARVEEN, SHAHIDA MD	11/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106558	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
169884	Fee-for-Service	1073995817	1073995817	1	1	PETROSSIAN, EMELIA OD	2/22/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
169892	Fee-for-Service	1871607762	1871607762	1	16	PROVIDENCE MEDICAL FOUNDATIO	8/20/2012	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1144 SONOMA AVE	STE 113	SANTA ROSA	CA	95405	4812	49	06097	38.441097	-122.6989755	Sonoma County
169923	Fee-for-Service	1841723327	1841723327	1	5	PEACH TREE HEALTHCARE	2/27/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4446 OLIVE AVENUE	BUILDING P-5	OLIVEHURST	CA	95961	4738	58	06115	39.083526	-121.538421	Yuba County
169934	Fee-for-Service	1912085515	1912085515	1	1	PARK, EUN-HA MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72015	18	Ophthalmology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
169954	Fee-for-Service	1275021743	1275021743	1	1	PERERA, YOHAN R MD	3/25/2020	390200000X	NA	Other	026	PHYSICIANS	164043	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
169980	Fee-for-Service	1003978719	1003978719	1	1	PEROS, JAMES N MD	11/26/2007	207R00000X	NA	Other	026	PHYSICIANS	100167	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
169989	Fee-for-Service	1265663488	1265663488	1	1	PUNTHAKEE, XERXES D MD	10/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109106	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
169990	Fee-for-Service	1245254127	1245254127	1	1	PARK, IL-LYUCK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10450 W MCDOWELL RD	STE 101	AVONDALE	AZ	85392	4802	00	None	33.465087	-112.2863085	Maricopa County
170015	Fee-for-Service	1306103510	1306103510	1	1	PHULL, HARDEEP S MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123404	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
170030	Fee-for-Service	1912383886	1912383886	1	1	PFEIFLE, GINA B PHD	11/28/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
170056	Fee-for-Service	1861441925	1861441925	1	1	POWELL, WES J MD	7/31/1991	208600000X	NA	General Surgery	026	PHYSICIANS	46628	02	General Surgery	0	In state provider	None	50 BELLEFONTAINE ST	STE 404	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
170085	Fee-for-Service	1104986462	1104986462	1	1	PANWALA, ALPA OD	9/10/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10502 KATELLA AVE	None	ANAHEIM	CA	92804	6528	30	06059	33.80291728	-117.9500175	Orange County
170087	Fee-for-Service	1245348820	1245348820	1	2	PRIMARY CARE ASSOCIATES	4/11/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	REDWOOD EMPIRE MED GROUP	1450 MEDICAL CENTER DR	STE 3	ROHNERT PARK	CA	94928	2933	49	06097	38.34758366	-122.6816633	Sonoma County
170090	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	9/25/2018	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
170116	Fee-for-Service	1285945287	1285945287	1	1	PATEL, NEELAM M LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
170145	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	10/15/2018	207RA0201X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
170164	Fee-for-Service	1942245717	1942245717	1	1	PARSI, VIDA K MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78950	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
170165	Fee-for-Service	1285961896	1285961896	1	1	POPA, PATRICK G MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117147	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3033 WEST ORANGE AVE	None	ANAHEIM	CA	92804	3183	30	06059	33.82476552	-117.994914	Orange County
170206	Fee-for-Service	1366201337	1366201337	1	1	PRICE, JOEL NP	8/27/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
170212	Fee-for-Service	1841723327	1841723327	1	5	PEACH TREE HEALTHCARE	2/27/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4446 OLIVE AVENUE	BUILDING P-5	OLIVEHURST	CA	95961	4738	58	06115	39.083526	-121.538421	Yuba County
170239	Fee-for-Service	1871607762	1871607762	1	67	PROVIDENCE MEDICAL FOUNDATIO	1/27/2015	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	17073 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41987484	-117.2906045	San Bernardino County
170242	Fee-for-Service	1003979162	1003979162	1	1	PEREZ, MARK A MD INC	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67514	08	Family Practice	0	In state provider	None	1350 W 6TH ST	None	SAN PEDRO	CA	90732	3544	19	06037	33.7388545	-118.306602	Los Angeles County
170274	Fee-for-Service	1962508820	1962508820	1	1	PAPILLON, LUCY C PHD	10/29/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2309 PACIFIC COAST HWY	SUITE 101	HERMOSA BEACH	CA	90254	2309	19	06037	33.87101437	-118.3948248	Los Angeles County
170281	Fee-for-Service	1407963044	1407963044	1	1	PRATT, STEVEN G MD	11/30/1983	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32379	18	Ophthalmology	0	In state provider	None	9850 GENESEE AVE	STE 310	LA JOLLA	CA	92037	1208	37	06073	32.882913	-117.226341	San Diego County
170308	Fee-for-Service	1306103510	1306103510	1	1	PHULL, HARDEEP S MD	7/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123404	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
170323	Fee-for-Service	1851460240	1851460240	1	1	PARK ANAHEIM HEALTH CARE	4/1/1995	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER	3435 W BALL RD	None	ANAHEIM	CA	92804	3708	30	06059	33.81728953	-118.010232	Orange County
170355	Fee-for-Service	1457420622	1457420622	1	1	PATEL, SHIRISH C MD INC	12/1/2003	208600000X	NA	General Surgery	026	PHYSICIANS	30379	02	General Surgery	0	In state provider	None	1027 E MAIN ST	None	ALHAMBRA	CA	91801	4154	19	06037	34.10028787	-118.1161362	Los Angeles County
170372	Fee-for-Service	1982165247	1982165247	1	1	PARK, NATHAN K MD	7/1/2022	207R00000X	NA	Other	026	PHYSICIANS	178989	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
170374	Fee-for-Service	1750398533	1750398533	1	1	PERAINO, ALEXIS M MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90924	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
170377	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	6/21/2019	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
170396	Fee-for-Service	1417097098	1417097098	1	1	PARAG, AMIT MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97392	40	Pediatrics	0	In state provider	None	657 CAMINO DE LOS MARES	STE 243	SAN CLEMENTE	CA	92673	2811	30	06059	33.4575611	-117.6492697	Orange County
170411	Fee-for-Service	1669408571	1669408571	1	1	PARK, CHARLES J MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51947	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
170432	Fee-for-Service	1396797338	1396797338	1	1	PIERRE, JOSEPH M MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64683	13	Neurology (M.D. only)	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
170436	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	9/16/2019	207RA0201X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
170460	Fee-for-Service	1871607762	1871607762	1	145	PROVIDENCE MEDICAL FOUNDATIO	2/19/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1100 TRANCAS ST	SUITE 201	NAPA	CA	94558	2904	28	06055	38.32316569	-122.2981938	Napa County
170497	Fee-for-Service	1639632078	1639632078	1	1	PRIMARY CARE HOMEHEALTHCARE	7/3/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14545 FRIAR ST	SUITE 203-2	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
170521	Fee-for-Service	1326290339	1326290339	1	1	PATEL, MONALI S MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117320	36	Psychiatry	0	In state provider	None	655 EUCLID AVENUE	SUITE 408	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
170523	Fee-for-Service	1699176644	1699176644	1	1	PETERSON, ADRIENNE L PT	3/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
170527	Fee-for-Service	1659470789	1659470789	1	1	PUNO, MARIA ADELMA S MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55803	01	General Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
170530	Fee-for-Service	1003979162	1003979162	1	1	PEREZ, MARK A MD INC	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67514	01	General Practice	0	In state provider	None	1350 W 6TH ST	None	SAN PEDRO	CA	90732	3544	19	06037	33.7388545	-118.306602	Los Angeles County
170569	Fee-for-Service	1407963044	1407963044	1	1	PRATT, STEVEN G MD	11/30/1983	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9850 GENESEE AVE	STE 310	LA JOLLA	CA	92037	1208	37	06073	32.882913	-117.226341	San Diego County
170604	Fee-for-Service	1871971937	1871971937	1	1	POON, MARY M Y PSYD	5/24/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
170649	Fee-for-Service	1265870646	1265870646	1	1	PARFYONOVA, ANNA LMFT	6/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
170668	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	10/14/2019	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
170691	Fee-for-Service	1942799416	1942799416	1	1	PATEL, TARAL	7/3/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PARKWA	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
170718	Fee-for-Service	1396797338	1396797338	1	1	PIERRE, JOSEPH M MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64683	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
170722	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	2/8/2020	207RA0201X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
170729	Fee-for-Service	1366424095	1366424095	1	1	POLIDORE, THOMAS M MD	7/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83054	02	General Surgery	0	In state provider	None	1225 MARSHALL ST	STE 24	CRESCENT CITY	CA	95531	2281	08	06015	41.76776596	-124.2003274	Del Norte County
170730	Fee-for-Service	1063483121	1063483121	1	1	PHIRIPES, CONSTANTINE E	10/12/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56470	41	Internal Medicine	0	In state provider	None	255 W BULLARD AVE	STE 124	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
170745	Fee-for-Service	1548797160	1548797160	1	1	PARET, MATAN MD	4/1/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	163718	40	Pediatrics	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
170769	Fee-for-Service	1841724721	1841724721	1	1	PRICE, AARON	4/13/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
170798	Fee-for-Service	1972829224	1972829224	1	1	PEDIATRIC INPATIENT	6/21/2010	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALISTS PC	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
170816	Fee-for-Service	1972819803	1972819803	1	1	PACIFIC KIDNEY & HYPERTENSIO	1/24/2011	193200000X	NA	Other	026	PHYSICIANS	104576	None	None	0	In state provider	N	1805 N CALIFORNIA	STE 303	STOCKTON	CA	95204	6033	39	06077	37.9711691	-121.2894221	San Joaquin County
170819	Fee-for-Service	1982049821	1982049821	1	1	PATZEK, SOPHIE M MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131954	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
170836	Fee-for-Service	1346947462	1346947462	1	1	PACIFIC MEDICAL, INC.	6/14/2024	335E00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2901 K ST	170	SACRAMENTO	CA	95816	5124	34	06067	38.572497	-121.468059	Sacramento County
170850	Fee-for-Service	1598934960	1598934960	1	1	PATEL, PRASHANT	10/7/2008	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	101004	None	None	0	In state provider	None	655 EUCLID AVENUE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
170869	Fee-for-Service	1396952941	1396952941	1	1	PUSEY, ELIZABETH MD INC	4/11/2016	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50236	None	None	0	In state provider	None	361 HOSPITAL RD	STE 528	NEWPORT BEACH	CA	92663	3526	30	06059	33.62579141	-117.9299554	Orange County
170908	Fee-for-Service	1053713552	1053713552	1	1	PHILIP R MILL OD AND MICHAEL	9/25/2015	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	D SUTTON OD INC	3715 RAILROAD AVE	SUITE C	PITTSBURG	CA	94565	5236	07	06013	38.00653723	-121.8932341	Contra Costa County
170909	Fee-for-Service	1205162013	1205162013	1	1	POWERPLAY LYDIE HAZAN MD INC	11/6/2000	133VN1004X	NA	Other	026	PHYSICIANS	53116	40	Pediatrics	0	In state provider	None	5800 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	4501	19	06037	34.06241847	-118.3552875	Los Angeles County
170937	Fee-for-Service	1356683833	1356683833	1	1	PINCHBECK, CARRIE A MD	8/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148415	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
170940	Fee-for-Service	1174907273	1174907273	1	1	PHAN, KEVIN OD	9/27/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
170943	Fee-for-Service	1245244755	1245244755	1	1	PRICE, JAMES E MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	24686	41	Internal Medicine	0	In state provider	None	558 3RD ST W	None	SONOMA	CA	95476	6502	49	06097	38.29133791	-122.4636079	Sonoma County
170958	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	12/29/2018	207N00000X	NA	Dermatology	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
170962	Fee-for-Service	1275649386	1275649386	1	1	PARTH MEDICAL GROUP INC	8/3/2009	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18092 WIKA RD	SUITE 220	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
170964	Fee-for-Service	1124407150	1124407150	1	1	PUZZO, CARLO J MD DO	5/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19256	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
171007	Fee-for-Service	1841308558	1841308558	1	1	PRASAD, KEDAR C MD	3/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67149	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
171010	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	6/1/1984	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
171019	Fee-for-Service	1265764674	1265764674	1	1	PERSHALL, LAUREL A NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171034	Fee-for-Service	1992149504	1992149504	1	1	POURMOUSSA, ANDREW M MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138261	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
171076	Fee-for-Service	1255566063	1255566063	1	1	PATEL, SHWETA MD	11/9/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	133003	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
171088	Fee-for-Service	1265440234	1265440234	1	1	PERFORMANCE PROSTHETIC	7/1/1996	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTIC CENTER INC	2820 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2410	19	06037	34.035228	-118.4718221	Los Angeles County
171115	Fee-for-Service	1437483518	1437483518	1	1	PACK, NATHANIEL M PSYD	2/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
171183	Fee-for-Service	1659448322	1659448322	1	1	PANDYA, SNEHAL J	7/18/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
171197	Fee-for-Service	1205162013	1205162013	1	1	POWERPLAY LYDIE HAZAN MD INC	11/6/2000	133VN1004X	NA	Other	026	PHYSICIANS	53116	01	General Practice	0	In state provider	None	5800 WILSHIRE BLVD	None	LOS ANGELES	CA	90036	4501	19	06037	34.06241847	-118.3552875	Los Angeles County
171216	Fee-for-Service	1457310450	1457310450	1	1	POPPLEWELL, LESLIE L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84546	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
171231	Fee-for-Service	1245244755	1245244755	1	1	PRICE, JAMES E MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	24686	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	558 3RD ST W	None	SONOMA	CA	95476	6502	49	06097	38.29133791	-122.4636079	Sonoma County
171243	Fee-for-Service	1306248240	1306248240	1	1	PACIFIC HOSPITALIST ASSOCIAT	9/9/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	340 VICTORIA STREET	None	COSTA MESA	CA	92627	1914	30	06059	33.65263167	-117.9138606	Orange County
171246	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	9/16/2019	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
171268	Fee-for-Service	1982132668	1982132668	1	1	PATEL, BHUMI B MD	4/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174614	None	None	0	In state provider	None	17051 SIERRA LAKES PKWY	STE 101	FONTANA	CA	92336	1274	36	06071	34.13797332	-117.4324372	San Bernardino County
171291	Fee-for-Service	1821379231	1821379231	2	1	PORTER, DORA L LCSW	9/24/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 E REDLANDS BLVD	170H	REDLANDS	CA	92373	4775	36	06071	34.05731952	-117.181197	San Bernardino County
171294	Fee-for-Service	1518354869	1518354869	1	1	PRODIGY HEALTHCARE, INC	5/4/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	13620 S KINCAID	P-1, 2, 3, 4, CO	CARUTHERS	CA	93609	8211	10	06019	36.53775218	-119.8404828	Fresno County
171298	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	9/25/2018	207RA0201X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
171308	Fee-for-Service	1649223983	1649223983	1	1	PRASAD, GANESH B MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74192	05	Anesthesiology	0	In state provider	None	1600 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
171330	Fee-for-Service	1689109878	1689109878	1	1	PETROSYAN, ROMELA MD	12/27/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	183119	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
171372	Fee-for-Service	1386802312	1386802312	1	1	PUNCH, GREGORY E MD	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121708	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171376	Fee-for-Service	1265440234	1265440234	1	1	PERFORMANCE PROSTHETIC	5/23/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTIC CENTER INC	2820 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2410	19	06037	34.035228	-118.4718221	Los Angeles County
171413	Fee-for-Service	1003122086	1003122086	1	1	POLLACK, AARON	10/19/2010	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	SERVICE	3637 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.18108911	-117.3086107	San Diego County
171437	Fee-for-Service	1235607318	1235607318	1	1	PRICE, KELSEY A OD	12/14/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 COTTAGE AVE	STE 102	MANTECA	CA	95336	4935	39	06077	37.79956104	-121.1982472	San Joaquin County
171455	Fee-for-Service	1942463377	1942463377	1	1	PAKBAZ, ZAHRA MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117499	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
171486	Fee-for-Service	1942826375	1942826375	1	1	PURKEYPILE, CLARISSA B NP	3/1/2022	390200000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
171497	Fee-for-Service	1154065787	1154065787	1	1	PATEL, SAUMIL	2/17/2025	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
171502	Fee-for-Service	1457310450	1457310450	1	1	POPPLEWELL, LESLIE L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84546	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
171509	Fee-for-Service	1356361893	1356361893	1	1	PARVIN SULTANA	2/26/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PARVIN MEDICAL SUPPLIES	324 S ALVARADO STREET	None	LOS ANGELES	CA	90057	2915	19	06037	34.06224493	-118.2731261	Los Angeles County
171528	Fee-for-Service	1902208507	1902208507	1	3	PREMIER PHYSICAL THERAPY & A	3/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SSOCIATES INC	1160 N VENTURA RD	None	OXNARD	CA	93030	3802	56	06111	34.2133887	-119.1943554	Ventura County
171530	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
171532	Fee-for-Service	1306248240	1306248240	1	7	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	24452 HEALTH CENTER DRIV	None	LAGUNA HILLS	CA	92653	3604	30	06059	33.60743243	-117.7081139	Orange County
171549	Fee-for-Service	1215461041	1215461041	1	1	PEPPER, MICHAEL A MD	7/15/2022	207ZP0102X	NA	Other	026	PHYSICIANS	158865	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
171558	Fee-for-Service	1144450487	1144450487	1	1	PHILLIP, JOHN W MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114261	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
171587	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	6/21/2019	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
171609	Fee-for-Service	1194789230	1194789230	1	1	PERELES, FREDERICK S MD	1/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87211	30	Radiology	0	In state provider	None	559 ABBOTT ST	None	SALINAS	CA	93901	4325	27	06053	36.66284132	-121.6420108	Monterey County
171636	Fee-for-Service	1417005760	1417005760	1	1	PRINCE WILLIAM HOSPITAL	5/14/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8700 SUDLEY RD	None	MANASSAS	VA	20110	4418	00	None	38.765322	-77.4724635	Manassas city
171688	Fee-for-Service	1477575843	1477575843	1	1	PRINGLE, DAVID	8/10/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	STE 100	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
171818	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	2/12/2019	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
171820	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	8/28/2009	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
171847	Fee-for-Service	1558588871	1558588871	1	1	PEDIATRIC ANESTHESIA	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
171873	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	12/29/2018	207RA0201X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
171896	Fee-for-Service	1427237858	1427237858	1	1	PATEL, TEJAL MD	1/16/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140227	30	Radiology	0	In state provider	None	1444 FLORIDA AVE	STE 101	MODESTO	CA	95350	4400	50	06099	37.66487562	-120.9961927	Stanislaus County
171898	Fee-for-Service	1790216182	1790216182	1	1	PATEL, SACHI R MD	7/14/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	170586	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171906	Fee-for-Service	1871607762	1871607762	1	26	PROVIDENCE MEDICAL FOUNDATIO	11/27/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	2141 N HARBOR BLVD	SUITE 35000	FULLERTON	CA	92835	3616	30	06059	33.89443025	-117.9288328	Orange County
171927	Fee-for-Service	1174749311	1174749311	1	1	PEG TAYLOR CTR FOR ADHC	7/1/1993	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	124 PARMAC RD	None	CHICO	CA	95926	2249	04	06007	39.75464603	-121.8503133	Butte County
171947	Fee-for-Service	1063014462	1063014462	1	1	PERENNIAL HOSPICE CARE LLC	3/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2319 WEST OLIVE AVE	SUITE B	BURBANK	CA	91506	2627	19	06037	34.16241128	-118.328344	Los Angeles County
171951	Fee-for-Service	1164453494	1164453494	1	1	PORTER, STEVEN J MD INC	9/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90374	20	Orthopedic Surgery	0	In state provider	None	263 PEARSON DR	STE 201	PORTERVILLE	CA	93257	3333	54	06107	36.07050297	-119.0277645	Tulare County
171964	Fee-for-Service	1306426093	1306426093	1	1	PATEL, SHIV P MD	5/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1131 WILSHIRE BLVD	SUITE 302	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
171974	Fee-for-Service	1952546103	1952546103	1	1	PARMAN, KORTNEY M NP	3/29/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
171979	Fee-for-Service	1427412048	1427412048	1	1	PAULLIN, WHITNEY MD	9/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157612	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
172038	Fee-for-Service	1780296384	1780296384	1	1	PORTILLO, MAYRA NP	1/16/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
172045	Fee-for-Service	1235283722	1235283722	1	1	PHOENIX HOUSES OF LOS ANGELE	2/28/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11600 ELDRIDGE AVENUE	None	LAKE VIEW TERRACE	CA	91342	6506	19	06037	34.28038404	-118.3838708	Los Angeles County
172103	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
172106	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	207N00000X	NA	Dermatology	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
172121	Fee-for-Service	1487095337	1487095337	1	1	PAYMAN P JOSEPH, MD, A	10/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7232 VAN NUYS BLVD	STE 101	VAN NUYS	CA	91405	2231	19	06037	34.202241	-118.4487235	Los Angeles County
172133	Fee-for-Service	1639139827	1639139827	1	1	PACIFIC HEART INSTITUTE	9/14/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 280W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
172135	Fee-for-Service	1710164736	1710164736	1	1	PHAN, ANDREW C MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102518	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
172136	Fee-for-Service	1275548943	1275548943	1	1	PRASAD, RAJEEV MD	11/28/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	128004	None	None	0	In state provider	None	65 NIELSON STREET	SUITE 102	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
172142	Fee-for-Service	1821152299	1821152299	1	1	PRADO, ANGELA LCSW	9/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2628 VICTOR AVE STE C	None	REDDING	CA	96002	1454	45	06089	40.56894199	-122.3392301	Shasta County
172146	Fee-for-Service	1700457496	1700457496	1	1	PRACTITIONERS CARE HOME	1/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH	2161 COLORADO BLVD	STE 204	LOS ANGELES	CA	90041	1251	19	06037	34.13915884	-118.2133958	Los Angeles County
172157	Fee-for-Service	1427563485	1427563485	1	1	PATRICIO PETRICH, JOSEPHINE	5/14/2019	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	F	577 E ELDER ST	H	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
172165	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
172193	Fee-for-Service	1871607762	1871607762	1	26	PROVIDENCE MEDICAL FOUNDATIO	12/5/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2141 N HARBOR BLVD	SUITE 35000	FULLERTON	CA	92835	3616	30	06059	33.89443025	-117.9288328	Orange County
172194	Fee-for-Service	1639213606	1639213606	1	1	PATEL, DIVYANG U	10/31/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2858 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1511	38	06075	37.72566124	-122.4028218	San Francisco County
172207	Fee-for-Service	1811128275	1811128275	1	1	PATEL, KIMBERLY B MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	106242	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
172213	Fee-for-Service	1215993738	1215993738	1	1	PROVENZANO, JOSEPH J DO	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	5427	08	Family Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
172242	Fee-for-Service	1689943243	1689943243	1	1	PROHEALTH HOME CARE INC	7/3/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2125 OAK GROVE ROAD	SUITE 124 A & B	WALNUT CREEK	CA	94598	2534	07	06013	37.930767	-122.0177917	Contra Costa County
172301	Fee-for-Service	1255387106	1255387106	1	1	PLANNED PARENTHOOD	9/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	430 N PALORA AVE	STE G	YUBA CITY	CA	95991	4707	51	06101	39.1281222	-121.633371	Sutter County
172306	Fee-for-Service	1841723327	1841723327	1	10	PEACH TREE HEALTHCARE	2/27/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PEACH TREE MOBILE UNIT	5600 LINDHURST AVE	None	MARYSVILLE	CA	95901	7109	58	06115	39.11547246	-121.5598518	Yuba County
172320	Fee-for-Service	1982377537	1982377537	1	1	PURPURA, LAURA LMFT	6/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
172322	Fee-for-Service	1861535718	1861535718	1	1	PATHOLOGY ASSOCIATES OF	4/9/2007	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ANAHEIM APC	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2538	30	06059	33.84718298	-117.933758	Orange County
172346	Fee-for-Service	1780645176	1780645176	1	1	POLANSKY, ANDREW D MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45468	30	Radiology	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
172359	Fee-for-Service	1609152503	1609152503	1	1	PARBST, MICHAEL PT	10/30/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	392 SIERRA ST	None	KINGSBURG	CA	93631	1706	10	06019	36.5178297	-119.5717648	Fresno County
172391	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	12/29/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
172393	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	2/8/2020	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
172425	Fee-for-Service	1215197470	1215197470	1	1	PASCUA, LUZON M PT	8/17/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
172438	Fee-for-Service	1831487461	1831487461	1	1	PATEL, MONALISA H MD	7/21/2017	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	129574	40	Pediatrics	0	In state provider	None	1711 ORANGE ST	None	REDLANDS	CA	92374	2254	36	06071	34.0796409	-117.1824145	San Bernardino County
172441	Fee-for-Service	1366496838	1366496838	1	1	PLANNED PARENTHOOD MAR MONTE	1/31/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	4555 PRECISSI LANE	None	STOCKTON	CA	95207	6239	39	06077	37.98919284	-121.3152121	San Joaquin County
172449	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	9/11/2012	207RA0201X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
172481	Fee-for-Service	1871607762	1871607762	1	103	PROVIDENCE MEDICAL FOUNDATIO	11/16/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19582 BEACH BLVD	SUITE 250	HUNTINGTON BEACH	CA	92648	5977	30	06059	33.67831649	-117.9885198	Orange County
172516	Fee-for-Service	1285321786	1285321786	1	1	PAYNE, MARISSA L NP	6/9/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23 UPPER RAGSDALE DR	STE 200	MONTEREY	CA	93940	5771	27	06053	36.57529358	-121.8101334	Monterey County
172531	Fee-for-Service	1689943243	1689943243	1	1	PROHEALTH HOME CARE INC	7/3/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2125 OAK GROVE ROAD	SUITE 124 A & B	WALNUT CREEK	CA	94598	2534	07	06013	37.930767	-122.0177917	Contra Costa County
172536	Fee-for-Service	1851019426	1851019426	1	1	PIHLMANN, STEPHANIE CNM	7/31/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	25880 TOURNAMENT RD	SUITE 109	VALENCIA	CA	91355	2384	19	06037	34.39184204	-118.5626441	Los Angeles County
172547	Fee-for-Service	1154507812	1154507812	1	1	PERLMUTTER, AARON M MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70055	77	Infectious Disease	0	In state provider	IN	8641 WILSHIRE BLVD	SUITE 100	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
172561	Fee-for-Service	1770841843	1770841843	1	1	PACIFICA FAMILY MATERNITY CE	6/2/2020	261QB0400X	NA	Freestanding Birth Center	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	NTER	3101 TELEGRAPH AVE	None	BERKELEY	CA	94705	1984	01	06001	37.85361291	-122.2600247	Alameda County
172567	Fee-for-Service	1598092462	1598092462	1	1	PHILLIPS, JUSTIN P LMFT	8/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114115	-	NOT APPLICABLE	0	In state provider	None	1630 10TH STREET	None	OAKLAND	CA	94607	1927	01	06001	37.80875282	-122.2969308	Alameda County
172577	Fee-for-Service	1356417752	1356417752	1	1	PHAM, TAM-NGUYEN T MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81625	05	Anesthesiology	0	In state provider	INC	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
172597	Fee-for-Service	1841723327	1841723327	1	10	PEACH TREE HEALTHCARE	9/19/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PEACH TREE MOBILE UNIT	5600 LINDHURST AVE	None	MARYSVILLE	CA	95901	7109	58	06115	39.11547246	-121.5598518	Yuba County
172612	Fee-for-Service	1700999463	1700999463	1	1	POPKE, KURT B MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78879	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
172635	Fee-for-Service	1659390391	1659390391	1	1	PIERCE, KATHRYN A	4/1/2003	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2015 S BROADWAY	STE B	SANTA MARIA	CA	93454	7809	42	06083	34.92342662	-120.4362114	Santa Barbara County
172636	Fee-for-Service	1477624401	1477624401	1	1	POLLACK, ALAN M MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40944	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
172652	Fee-for-Service	1407813660	1407813660	1	1	POMONA VALLEY HOSPITAL	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
172680	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	12/4/2020	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
172682	Fee-for-Service	1871607762	1871607762	1	43	PROVIDENCE MEDICAL FOUNDATIO	12/2/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1550A PROFESSIONAL DR	STE 200	PETALUMA	CA	94954	6628	49	06097	38.25596038	-122.6308056	Sonoma County
172684	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	12/4/2020	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
172685	Fee-for-Service	1205808334	1205808334	1	1	PRESCOTT-KIM, PAMELA T	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67192	None	None	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
172686	Fee-for-Service	1922447721	1922447721	1	1	PEREZ, PERLA I LCSW	10/22/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	10	06019	36.777735	-119.7815105	Fresno County
172711	Fee-for-Service	1013542687	1013542687	1	1	PRADO LUNA, GRISELL BIRTH D	6/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
172714	Fee-for-Service	1225081227	1225081227	1	1	PLANNED PARENTHOOD	7/1/1995	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	WESTSIDE	1119 PACIFIC AVE	STE 200	SANTA CRUZ	CA	95060	4464	44	06087	36.9722444	-122.0256836	Santa Cruz County
172736	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
172752	Fee-for-Service	1871607762	1871607762	1	93	PROVIDENCE MEDICAL FOUNDATIO	5/2/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	N	5150 HILL ROAD EAST	SUITE F	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
172753	Fee-for-Service	1841272218	1841272218	1	1	PATEL, MANOJ K MD	8/17/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52248	08	Family Practice	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
172779	Fee-for-Service	1487181749	1487181749	1	1	PURDY, AMANDA C MD	8/25/2020	208600000X	NA	General Surgery	026	PHYSICIANS	157674	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172820	Fee-for-Service	1689943243	1689943243	1	1	PROHEALTH HOME CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2125 OAK GROVE ROAD	SUITE 124 A & B	WALNUT CREEK	CA	94598	2534	07	06013	37.930767	-122.0177917	Contra Costa County
172847	Fee-for-Service	1770841843	1770841843	1	1	PACIFICA FAMILY MATERNITY CE	6/2/2020	261QB0400X	NA	Freestanding Birth Center	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	NTER	3101 TELEGRAPH AVE	None	BERKELEY	CA	94705	1984	01	06001	37.85361291	-122.2600247	Alameda County
172866	Fee-for-Service	1770061293	1770061293	1	1	PATEL, VASEAN K NP	6/25/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
172880	Fee-for-Service	1881821387	1881821387	1	1	PURISIMA FAMILY MEDICINE INC	8/12/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	575 KELLY STREET	None	HALF MOON BAY	CA	94019	1719	41	06081	37.46381401	-122.4307787	San Mateo County
172883	Fee-for-Service	1841723327	1841723327	1	10	PEACH TREE HEALTHCARE	9/19/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PEACH TREE MOBILE UNIT	5600 LINDHURST AVE	None	MARYSVILLE	CA	95901	7109	58	06115	39.11547246	-121.5598518	Yuba County
172885	Fee-for-Service	1730325010	1730325010	1	1	PATIL-SISODIA, KOMAL MD	10/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95640	67	Endocrinology	0	In state provider	None	8737 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
172889	Fee-for-Service	1629188990	1629188990	1	1	PHELPS, ROGER T MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	41095	41	Internal Medicine	0	In state provider	SOUTH BLDG	350 30TH ST	STE 511	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
172941	Fee-for-Service	1407813660	1407813660	1	1	POMONA VALLEY HOSPITAL	4/1/1983	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
172966	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	2/12/2019	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
172967	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	2/8/2020	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
172978	Fee-for-Service	1215015110	1215015110	1	1	PATEL,NEVILLE R MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75422	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
173024	Fee-for-Service	1336222397	1336222397	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2015	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
173046	Fee-for-Service	1043237530	1043237530	1	1	PATEL, BINDI P MD	7/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85233	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
173072	Fee-for-Service	1417232331	1417232331	1	1	PITROSS, ANGINEH LMFT	5/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
173107	Fee-for-Service	1427578392	1427578392	1	1	PMDTC LLC	12/22/2020	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	3745 W CALDWELL AVE	C	VISALIA	CA	93277	9230	54	06107	36.298116	-119.3323005	Tulare County
173157	Fee-for-Service	1104985928	1104985928	1	1	PETROVICH, MICHAEL PHD	2/26/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
173174	Fee-for-Service	1730325010	1730325010	1	1	PATIL-SISODIA, KOMAL MD	10/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95640	41	Internal Medicine	0	In state provider	None	8737 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
173177	Fee-for-Service	1629188990	1629188990	1	1	PHELPS, ROGER T MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	41095	77	Infectious Disease	0	In state provider	SOUTH BLDG	350 30TH ST	STE 511	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
173197	Fee-for-Service	1952961286	1952961286	1	1	PRIYAM, PRACHI MD	9/7/2022	208M00000X	NA	Other	026	PHYSICIANS	180175	None	None	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
173209	Fee-for-Service	1770872558	1770872558	1	1	PERRY ALAN MEIER	6/4/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8733 BEVERLY BLVD	SUITE 306	WEST HOLLYWOOD	CA	90048	1843	19	06037	34.07688048	-118.3815765	Los Angeles County
173213	Fee-for-Service	1922046135	1922046135	1	1	PRATT, ALAN G MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141710	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
173241	Fee-for-Service	1962455113	1962455113	1	1	PARSON, MARK R MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
173254	Fee-for-Service	1336222397	1336222397	1	13	PERMANENTE MEDICAL GROUP INC	2/24/2019	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	750 REDWOOD HWY FRONTAG	STE 1206	MILL VALLEY	CA	94912	2372	21	06041	37.89552879	-122.5159107	Marin County
173256	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
173270	Fee-for-Service	1730546490	1730546490	1	1	PERILLA, MARTHA	7/3/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12084 CUSTER ST	None	YUCAIPA	CA	92399	3975	36	06071	34.03422682	-117.032292	San Bernardino County
173278	Fee-for-Service	1245524867	1245524867	1	1	PHAM, CHRISTINA B MD	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129529	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173297	Fee-for-Service	1235179037	1235179037	2	1	PLAZA-TOWERS OBSTETRICS	3/30/2015	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 468W	SANTA MONICA	CA	90404	2180	19	06037	34.02891163	-118.4797466	Los Angeles County
173300	Fee-for-Service	1164531430	1164531430	1	1	PATEL, ARUN C MD	7/31/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	42740	18	Ophthalmology	0	In state provider	None	3939 J ST	STE 104	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
173350	Fee-for-Service	1871607762	1871607762	1	12	PROVIDENCE MEDICAL FOUNDATIO	1/23/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	500 DOYLE PARK DR	STE 100	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
173389	Fee-for-Service	1114109121	1114109121	1	1	PUBLIC HEALTH FOUNDATION ENT	2/12/2024	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
173391	Fee-for-Service	1992702708	1992702708	1	1	PALESTINE, ALAN G MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	18	Ophthalmology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
173405	Fee-for-Service	1316364284	1316364284	1	1	PHAM, MINH H PT	12/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1236 BROOKS ST	None	ONTARIO	CA	91762	3608	36	06071	34.062066	-117.6737715	San Bernardino County
173455	Fee-for-Service	1912387580	1912387580	1	1	PRIROMPRINTR, BRYANT MD	7/16/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	136711	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
173458	Fee-for-Service	1528394251	1528394251	1	1	PALACIOS, GILBERTO MD	10/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109853	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
173460	Fee-for-Service	1003037722	1003037722	1	1	PARADISE VALLEY MEDICAL	9/11/2007	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	655 EUCLID AVE	STE 408	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
173471	Fee-for-Service	1174848832	1174848832	1	1	PARO, RENEE M R MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117732	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
173482	Fee-for-Service	1922480946	1922480946	1	1	PIETRZAK, JOHN PSYD	2/1/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21838 ENCINA ROAD	None	TOPANGA	CA	90290	3527	19	06037	34.09263456	-118.6006323	Los Angeles County
173495	Fee-for-Service	1982808242	1982808242	1	1	PALIANI, RICHARD E LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
173503	Fee-for-Service	1003033580	1003033580	1	1	PENA, ANN MARIE MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77391	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
173513	Fee-for-Service	1194778894	1194778894	1	1	PETTY, LEONORA	5/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	38026	36	Psychiatry	0	In state provider	None	2102 BUSINESS CENTER DR	STE 250	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
173536	Fee-for-Service	1871607762	1871607762	1	20	PROVIDENCE MEDICAL FOUNDATIO	1/27/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
173546	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	10/14/2019	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
173553	Fee-for-Service	1871681767	1871681767	1	1	PRESTON, HENRY N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
173557	Fee-for-Service	1730546490	1730546490	1	1	PERILLA, MARTHA	7/3/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12084 CUSTER ST	None	YUCAIPA	CA	92399	3975	36	06071	34.03422682	-117.032292	San Bernardino County
173570	Fee-for-Service	1013209782	1013209782	1	1	POST, MARINA C MD	7/26/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122986	-	NOT APPLICABLE	0	In state provider	None	86 S 14TH ST	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
173629	Fee-for-Service	1538548755	1538548755	1	1	PATEL, VIRAAT M MD	1/4/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	175645	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	510	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
173636	Fee-for-Service	1700366713	1700366713	1	1	PATEL, SNEHA P OT	9/24/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1901 W LUGONIA AVE	SUITE 240	REDLANDS	CA	92374	9703	36	06071	34.07027851	-117.218421	San Bernardino County
173654	Fee-for-Service	1417019209	1417019209	1	1	POLK, CARYL A LCSW	12/8/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
173739	Fee-for-Service	1316442056	1316442056	1	1	POSTALCIOGLU, MERVE MD	7/25/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	173794	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173755	Fee-for-Service	1003037722	1003037722	1	1	PARADISE VALLEY MEDICAL	9/11/2007	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	655 EUCLID AVE	STE 408	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
173760	Fee-for-Service	1629427869	1629427869	1	1	PEREZ, GERARDO A DO	9/19/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18302	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
173771	Fee-for-Service	1952540908	1952540908	1	1	PARK, JUN K MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98074	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
173800	Fee-for-Service	1194778894	1194778894	1	1	PETTY, LEONORA	5/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	38026	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2102 BUSINESS CENTER DR	STE 250	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
173811	Fee-for-Service	1780871780	1780871780	1	1	PENG, JAMES S MD	8/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
173822	Fee-for-Service	1871607762	1871607762	1	20	PROVIDENCE MEDICAL FOUNDATIO	2/19/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
173834	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	8/28/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
173919	Fee-for-Service	1316987613	1316987613	1	1	PETERSON, LEE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84606	0000	00	None	40.248072	-111.6673905	Utah County
173935	Fee-for-Service	1871607762	1871607762	1	116	PROVIDENCE MEDICAL FOUNDATIO	6/16/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1496 PROFESSIONAL DR	SUITE 601	PETALUMA	CA	94954	6698	49	06097	38.25575122	-122.6329158	Sonoma County
173958	Fee-for-Service	1922158526	1922158526	1	1	PEARSON, JAMES M MD	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108195	04	Otology, Laryngology, Rhinology	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
173993	Fee-for-Service	1205049558	1205049558	1	1	PATHWAYS HOME HEALTH &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	333 HEGENBERGER RD	STE 700	OAKLAND	CA	94621	1463	01	06001	37.7350428	-122.1976624	Alameda County
174000	Fee-for-Service	1730594318	1730594318	1	1	PEREZ, EVAN B CRNA	7/31/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
174011	Fee-for-Service	1255480687	1255480687	1	1	PORTUGALL, SUSAN	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
174036	Fee-for-Service	1003037722	1003037722	1	1	PARADISE VALLEY MEDICAL	9/11/2007	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	655 EUCLID AVE	STE 408	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
174072	Fee-for-Service	1982073789	1982073789	1	1	PLATT, MONIQUE	3/7/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2606 BIRCH STREET	None	SAN BERNARDINO	CA	92410	1918	36	06071	34.0954895	-117.346473	San Bernardino County
174077	Fee-for-Service	1013043744	1013043744	1	1	PAVILIK, EMILY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 DALLAS ST	None	SAN ANTONIO	TX	78205	1201	00	None	29.43317376	-98.49236007	Bexar County
174084	Fee-for-Service	1215612197	1215612197	1	1	PAZAN, KATHRYN LMFT	1/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5290 OVERPASS RD	SUITE 106	SANTA BARBARA	CA	93111	2052	42	06083	34.43960012	-119.8079098	Santa Barbara County
174095	Fee-for-Service	1427443100	1427443100	1	1	PORTER, COURTNEY M	7/9/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
174107	Fee-for-Service	1497284145	1497284145	1	1	PROHEALTH HOME CARE, INC	6/19/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1375 EXPOSITION BLVD	SUITE 250B	SACRAMENTO	CA	95815	5101	34	06067	38.596554	-121.4393445	Sacramento County
174112	Fee-for-Service	1871607762	1871607762	1	20	PROVIDENCE MEDICAL FOUNDATIO	12/4/2012	207Q00000X	NA	Adult Primary Care	027	PODIATRISTS	-	None	None	0	In state provider	N	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
174119	Fee-for-Service	1396987392	1396987392	1	1	PALM SPRINGS TREATMENT CENTE	5/20/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ENTER	515 NORTH PALM CANYON DR	BLDG H	PALM SPRINGS	CA	92262	5543	33	06065	33.83073	-116.5468495	Riverside County
174120	Fee-for-Service	1386077485	1386077485	1	1	PIERRE, AMBER LMFT	1/3/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
174122	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	2/11/2013	367A00000X	NA	Certified Nurse Midwife	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
174149	Fee-for-Service	1427142777	1427142777	1	1	PIKE, ABIGAIL A CNM	5/2/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
174169	Fee-for-Service	1912931098	1912931098	1	1	PETERS, ALAN E MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	45138	36	Psychiatry	0	In state provider	None	101 HOSPITAL RD	None	SONORA	CA	95370	5227	55	06109	37.9744944	-120.3778743	Tuolumne County
174189	Fee-for-Service	1871936690	1871936690	1	1	PHAM, AN D MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148873	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
174224	Fee-for-Service	1467073676	1467073676	1	1	PATEL, KEENA R CNP	12/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
174229	Fee-for-Service	1366007635	1366007635	1	1	PINEROS, DWAN B MD	3/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178779	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
174233	Fee-for-Service	1174694079	1174694079	1	1	PATEL, NEHAL G	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75898	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
174239	Fee-for-Service	1447592969	1447592969	1	1	PAREDES, HAROLD MD	5/15/2019	207R00000X	NA	Other	026	PHYSICIANS	162122	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
174261	Fee-for-Service	1083773600	1083773600	1	1	PARK, LINDA C MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81594	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
174267	Fee-for-Service	1841221637	1841221637	1	1	PHAM, KHANH Q DO	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8578	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
174281	Fee-for-Service	1205049558	1205049558	1	1	PATHWAYS HOME HEALTH &	1/1/1999	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	333 HEGENBERGER RD	STE 700	OAKLAND	CA	94621	1463	01	06001	37.7350428	-122.1976624	Alameda County
174312	Fee-for-Service	1033103676	1033103676	1	5	PACIFIC REDWOOD MEDICAL GROU	11/22/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC.	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
174358	Fee-for-Service	1447543053	1447543053	1	1	PETROVICH, LAURA E MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125291	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
174362	Fee-for-Service	1982073789	1982073789	1	1	PLATT, MONIQUE	3/7/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2606 BIRCH STREET	None	SAN BERNARDINO	CA	92410	1918	36	06071	34.0954895	-117.346473	San Bernardino County
174395	Fee-for-Service	1497284145	1497284145	1	1	PROHEALTH HOME CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1375 EXPOSITION BLVD	SUITE 250B	SACRAMENTO	CA	95815	5101	34	06067	38.596554	-121.4393445	Sacramento County
174401	Fee-for-Service	1871607762	1871607762	1	20	PROVIDENCE MEDICAL FOUNDATIO	8/2/2021	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
174411	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	2/11/2013	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
174438	Fee-for-Service	1003251125	1003251125	1	1	PALVOLGYI, MICHELLE P MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134262	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
174451	Fee-for-Service	1124434972	1124434972	1	1	PROCTOR, LAURA J PHD	8/1/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4445 EASTGATE MALL	STE 200	SAN DIEGO	CA	92121	1979	37	06073	32.87856225	-117.2103399	San Diego County
174476	Fee-for-Service	1093126088	1093126088	1	1	PAPAZIAN, VARTAN D DO	1/7/2019	207R00000X	NA	Other	026	PHYSICIANS	15454	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
174492	Fee-for-Service	1205036423	1205036423	1	1	POBLETE, MARK R MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119375	05	Anesthesiology	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
174524	Fee-for-Service	1447592969	1447592969	1	1	PAREDES, HAROLD MD	5/15/2019	207R00000X	NA	Other	026	PHYSICIANS	162122	10	Gastroenterology (M.D. only)	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
174526	Fee-for-Service	1639313273	1639313273	1	1	PETTERSSON, DAVID R MD	10/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
174527	Fee-for-Service	1174691497	1174691497	1	1	PAIS, MARILYN J MD	11/16/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	38931	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
174547	Fee-for-Service	1235334129	1235334129	1	1	PAZOUKI, NARGES MD AMC	7/19/2004	193400000X	NA	Other	026	PHYSICIANS	86591	13	Neurology (M.D. only)	0	In state provider	None	1801 COLORADO AVE	STE 210	TURLOCK	CA	95382	2707	50	06099	37.50941613	-120.8353105	Stanislaus County
174553	Fee-for-Service	1063635563	1063635563	1	1	PETERSON, JERALEEN M LCSW	8/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CIVIC CENTER DR	SUITE 100-L	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
174561	Fee-for-Service	1992726020	1992726020	1	1	PABUSTAN, CESAR C MD	7/29/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36943	40	Pediatrics	0	In state provider	None	2333 N CALIFORNIA ST	None	STOCKTON	CA	95204	5531	39	06077	37.97483395	-121.2908171	San Joaquin County
174570	Fee-for-Service	1447818273	1447818273	1	1	PATEL, DIL V MD	8/8/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
174577	Fee-for-Service	1265708424	1265708424	1	1	PALACIOS, ALISON M MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11631	08	Family Practice	0	In state provider	None	HWY 96	None	WILLOW CREEK	CA	95573	1045	12	06023	40.99466457	-123.6316897	Humboldt County
174590	Fee-for-Service	1740410182	1740410182	1	7	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	9041 MAGNOLIA AVE	STE 206	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
174598	Fee-for-Service	1033103676	1033103676	1	5	PACIFIC REDWOOD MEDICAL GROU	11/22/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	P, INC.	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
174628	Fee-for-Service	1790096063	1790096063	1	1	PROBASCO, JEANNE C LCSW	4/17/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
174643	Fee-for-Service	1407293830	1407293830	1	1	PANSMART INC	6/19/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1693 FLANIGAN DR	STE 104	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
174653	Fee-for-Service	1427212034	1427212034	1	1	PETERS, AMY C DO	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13720	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	24411 HEALTH CENTER DR	640	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
174657	Fee-for-Service	1518988443	1518988443	1	1	PICETTI, GEORGE D III MD	3/31/1994	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	58523	20	Orthopedic Surgery	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
174685	Fee-for-Service	1265825541	1265825541	1	1	PINGREE, ALEXANDER T DO	12/1/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
174693	Fee-for-Service	1073661880	1073661880	1	1	PADILLA, BENJAMIN MD	6/30/1993	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	49283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
174700	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
174751	Fee-for-Service	1366536963	1366536963	1	1	PROVIDENCE HEALTH & SERVICES	7/1/2016	207L00000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	10150 SE 32ND AVE	None	MILWAUKIE	OR	97222	6516	00	None	45.44944836	-122.6297748	Clackamas County
174757	Fee-for-Service	1477209740	1477209740	1	1	PWN LABORATORY LLC	5/30/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2401 HASSELL RD	1510	HOFFMAN ESTATES	IL	60169	2096	00	None	42.06149977	-88.1396688	Cook County
174765	Fee-for-Service	1093126088	1093126088	1	1	PAPAZIAN, VARTAN D DO	1/7/2019	207R00000X	NA	Other	026	PHYSICIANS	15454	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
174821	Fee-for-Service	1952488819	1952488819	1	1	PONEDELNIKOV, MICHAEL	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67428	41	Internal Medicine	0	In state provider	None	900 KUEKY BLVD	None	SANTA CLARA	CA	95051	0000	43	06085	0	0	None
174831	Fee-for-Service	1972027852	1972027852	1	1	PRIME, DOMINIC R PSYD	4/13/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
174864	Fee-for-Service	1265708424	1265708424	1	1	PALACIOS, ALISON M MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11631	02	General Surgery	0	In state provider	None	HWY 96	None	WILLOW CREEK	CA	95573	1045	12	06023	40.99466457	-123.6316897	Humboldt County
174870	Fee-for-Service	1912187477	1912187477	1	1	POUR, AMIR A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101425	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
174872	Fee-for-Service	1578896429	1578896429	1	1	PHAN, NHUNG T	8/24/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
174875	Fee-for-Service	1740410182	1740410182	1	7	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	9041 MAGNOLIA AVE	STE 206	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
174880	Fee-for-Service	1881012201	1881012201	1	1	PROHEALTH PARTNERS A MEDICAL	4/13/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	2865 ATLANTIC AVENUE	SUITE 221	LONG BEACH	CA	90806	7430	19	06037	33.809418	-118.185058	Los Angeles County
174881	Fee-for-Service	1790782241	1790782241	1	1	PIONEER HOME HEALTH CARE	2/9/2015	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	162 E LINE ST	None	BISHOP	CA	93514	3557	14	06027	37.36148654	-118.3937085	Inyo County
174885	Fee-for-Service	1033103676	1033103676	1	5	PACIFIC REDWOOD MEDICAL GROU	11/22/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	P, INC.	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
174889	Fee-for-Service	1881858728	1881858728	1	1	PACK, RACHEL T DO	10/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11686	25	Physical Medicine and Rehabilitation	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
174904	Fee-for-Service	1205984317	1205984317	1	1	PARK, YONG J OD	7/1/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2609 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	3511	19	06037	34.22140105	-118.2353731	Los Angeles County
174907	Fee-for-Service	1053317537	1053317537	1	1	PAI, SHANTHARAM R	5/27/2010	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	44286	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25271 BARTON RD	None	LOMA LINDA	CA	92354	3098	36	06071	34.04804454	-117.253044	San Bernardino County
174924	Fee-for-Service	1861431876	1861431876	1	1	POHL, JOHN M MD	1/27/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174725	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
174926	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	2/8/2020	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
174929	Fee-for-Service	1659031813	1659031813	1	1	PROUD TO SERVE HOME HEALTH	5/23/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	14401 GILMORE ST	SUITE 201A	VAN NUYS	CA	91401	6231	19	06037	34.18766945	-118.446723	Los Angeles County
174932	Fee-for-Service	1104578442	1104578442	1	1	PAIK, HANNA CRNA	3/1/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
174950	Fee-for-Service	1194944934	1194944934	1	1	PHAN, JANE NP	8/7/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
174984	Fee-for-Service	1225019698	1225019698	1	2	PARIKH, AMAN K MD	1/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	85875	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
174989	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	9/16/2019	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
174996	Fee-for-Service	1245347723	1245347723	1	1	PRABHAKAR, SANDHYA A MD	1/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92400	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
175037	Fee-for-Service	1366536963	1366536963	1	1	PROVIDENCE HEALTH & SERVICES	7/1/2016	207L00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	10150 SE 32ND AVE	None	MILWAUKIE	OR	97222	6516	00	None	45.44944836	-122.6297748	Clackamas County
175110	Fee-for-Service	1558578955	1558578955	1	1	PHILLIPS, JULIE C MD	5/7/2008	207P00000X	NA	Other	026	PHYSICIANS	97440	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175166	Fee-for-Service	1881012201	1881012201	1	1	PROHEALTH PARTNERS A MEDICAL	4/13/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	GROUP	2865 ATLANTIC AVENUE	SUITE 221	LONG BEACH	CA	90806	7430	19	06037	33.809418	-118.185058	Los Angeles County
175169	Fee-for-Service	1811045636	1811045636	1	1	PHAM, PHUONG-CHI T MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6788	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
175199	Fee-for-Service	1053317537	1053317537	1	1	PAI, SHANTHARAM R	5/27/2010	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	44286	08	Family Practice	0	In state provider	None	25271 BARTON RD	None	LOMA LINDA	CA	92354	3098	36	06071	34.04804454	-117.253044	San Bernardino County
175214	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	12/4/2020	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
175217	Fee-for-Service	1225490824	1225490824	1	1	PATEL, KISHAN M MD	1/11/2021	207L00000X	NA	Other	026	PHYSICIANS	168453	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
175226	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
175230	Fee-for-Service	1508300765	1508300765	1	1	PHYSICIANS' PLAZA PHARMACY,	12/13/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	5000 PHYSICIANS BLVD	201	BAKERSFIELD	CA	93301	5836	15	06029	35.39715829	-119.0094177	Kern County
175234	Fee-for-Service	1891872883	1891872883	1	1	PACIFICA OF THE VALLEY	1/4/1994	282E00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
175258	Fee-for-Service	1356444855	1356444855	1	1	PENNISI, ALFRED J MD	10/30/1992	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	21570	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
175270	Fee-for-Service	1871607762	1871607762	1	166	PROVIDENCE MEDICAL FOUNDATIO	5/6/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	SUITE 302	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
175272	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	6/21/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
175293	Fee-for-Service	1982750287	1982750287	1	1	PASI, ASHEESH MD	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93810	08	Family Practice	0	In state provider	None	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	36	06071	34.07045653	-117.3982455	San Bernardino County
175302	Fee-for-Service	1730213737	1730213737	1	2	PRESTON, ANDREW LMFT	4/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
175307	Fee-for-Service	1851478820	1851478820	1	1	PUSSER, NANCY L MD	12/1/1994	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	50958	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	# 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
175308	Fee-for-Service	1245542125	1245542125	1	1	PANBEHI, BAHMAN MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111751	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
175358	Fee-for-Service	1760425862	1760425862	1	4	PROVIDENCE MEDICAL INSTITUTE	5/2/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91091877	-118.3527745	Los Angeles County
175362	Fee-for-Service	1992797906	1992797906	1	1	PIEKOS-SOBCZAK, GRAZYNA M MD	3/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
175374	Fee-for-Service	1912083676	1912083676	1	1	PAGALILAUAN, GENEVIEVE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4245 ROOSEVELT WAY NE	None	SEATTLE	WA	98105	6008	00	None	47.65883901	-122.3177928	King County
175382	Fee-for-Service	1619151685	1619151685	1	1	PENNOCK, ANDREW T MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90049	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
175403	Fee-for-Service	1487946364	1487946364	1	1	PATEL, SHIVANI K MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131871	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
175405	Fee-for-Service	1588828941	1588828941	1	1	PATEL, BHAVIK N MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119484	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175410	Fee-for-Service	1841226990	1841226990	1	8	PHYSICIAN FOUNDATION	5/21/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1000 S ELISEO DRIVE	STE 204	GREENBRAE	CA	94904	2133	21	06041	37.94348559	-122.5335273	Marin County
175431	Fee-for-Service	1568495042	1568495042	1	1	PERTSCH, SUZANNE D MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64384	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
175447	Fee-for-Service	1912493750	1912493750	1	1	PRIOR LEVEL HOME CARE	9/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PHYSICAL THERAPY INC	1200 CALIFORNIA ST	SUITE 112	REDLANDS	CA	92374	2946	36	06071	34.068924	-117.2260445	San Bernardino County
175450	Fee-for-Service	1497453856	1497453856	1	1	PANGILINAN, DEBBIE CNP	4/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1601	07	06013	37.77494737	-121.9771019	Contra Costa County
175502	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	10/3/2012	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
175512	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	10/15/2018	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
175522	Fee-for-Service	1942798509	1942798509	1	1	PAIK, KACIE K MD	8/9/2021	390200000X	NA	Other	026	PHYSICIANS	165648	None	None	0	In state provider	None	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
175546	Fee-for-Service	1730446709	1730446709	1	1	PATEL, LINA C MD	9/30/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	136716	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
175558	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	3/9/2020	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
175575	Fee-for-Service	1417351131	1417351131	1	1	PAN, QINSHI MD	6/12/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147721	15	Obstetrics (D.O. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
175608	Fee-for-Service	1932477460	1932477460	1	1	PELLANDINI, DAVID L	11/3/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	103 CYPRESS STREET	None	FORT BRAGG	CA	95437	5401	23	06045	39.43269788	-123.8061328	Mendocino County
175612	Fee-for-Service	1144595232	1144595232	1	1	PANG, CHRISTIE MD	2/23/2021	207ZP0102X	NA	Other	026	PHYSICIANS	120889	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
175643	Fee-for-Service	1952309288	1952309288	1	1	PERSKY, KATHLEEN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56660	02	General Surgery	0	In state provider	None	620 S DORA ST	STE 201	UKIAH	CA	95482	5482	23	06045	39.14510236	-123.2114198	Mendocino County
175654	Fee-for-Service	1992797906	1992797906	1	1	PIEKOS-SOBCZAK, GRAZYNA M MD	3/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
175661	Fee-for-Service	1437680923	1437680923	1	1	PAUERSTEIN, PHILIP MD	4/10/2020	390200000X	NA	Other	026	PHYSICIANS	161141	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
175673	Fee-for-Service	1861784126	1861784126	1	1	PAREDES, KYLE P MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123955	05	Anesthesiology	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
175694	Fee-for-Service	1356766455	1356766455	1	1	PAKRAVAN, MAHSA M DO	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13127	40	Pediatrics	0	In state provider	None	2011 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3505	19	06037	34.05752693	-118.2749902	Los Angeles County
175695	Fee-for-Service	1801186440	1801186440	1	1	PHELPS, SARA N MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114577	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
175699	Fee-for-Service	1841226990	1841226990	1	8	PHYSICIAN FOUNDATION	5/21/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 S ELISEO DRIVE	STE 204	GREENBRAE	CA	94904	2133	21	06041	37.94348559	-122.5335273	Marin County
175700	Fee-for-Service	1609980234	1609980234	1	1	PASTORES, GLEN F LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
175709	Fee-for-Service	1144378167	1144378167	1	1	PENG, HENRY MD	12/17/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	95408	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
175714	Fee-for-Service	1841486636	1841486636	1	1	PEARSON, NATALYE L J PSY	9/20/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
175744	Fee-for-Service	1003320946	1003320946	1	1	PARMINDER S SIDHU MEDICAL CO	5/8/2019	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RPORATION	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
175776	Fee-for-Service	1104914944	1104914944	1	1	PATEL, JIGNESH K MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56000	41	Internal Medicine	0	In state provider	None	100 UCLA MEDICAL PLAZA 1	None	LOS ANGELES	CA	90095	0001	19	06037	34.0651473	-118.4458393	Los Angeles County
175793	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	2/12/2019	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
175795	Fee-for-Service	1528556651	1528556651	1	1	PATH TO GROWTH COUNSELING	4/9/2020	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1015 FREMONT AVE	2ND FLOOR	SOUTH PASADENA	CA	91030	3224	19	06037	34.114176	-118.1531575	Los Angeles County
175802	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
175833	Fee-for-Service	1235247073	1235247073	1	1	PHILIP KEIZER	3/10/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	940 E 5TH ST	None	COQUILLE	OR	97423	1666	00	None	43.17908426	-124.1788744	Coos County
175851	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	10/15/2018	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
175870	Fee-for-Service	1255924429	1255924429	1	1	PERSONALIZED HOME HEALTH	7/26/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	20061 SATICOY ST	SUITE 202	WINNETKA	CA	91306	2694	19	06037	34.20838313	-118.570699	Los Angeles County
175931	Fee-for-Service	1891341509	1891341509	1	1	PAREDEZ, AIMEE E AU	6/21/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
175934	Fee-for-Service	1336177245	1336177245	1	1	PASCAL, STEVEN G MD	6/21/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	62038	18	Ophthalmology	0	In state provider	None	3300 WEBSTER ST	STE 212	OAKLAND	CA	94609	3120	01	06001	37.82132826	-122.2621843	Alameda County
175944	Fee-for-Service	1295353431	1295353431	1	3	PLANNED PARENTHOOD LOS	1/27/2025	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5246 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3903	19	06037	33.91991002	-118.1832215	Los Angeles County
175974	Fee-for-Service	1922055680	1922055680	1	1	PARVEEZ, RABIA MD	2/1/2000	207RH0003X	NA	Oncology	026	PHYSICIANS	70241	68	Hematology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
175982	Fee-for-Service	1063058170	1063058170	1	1	PARAGON DIAGNOSTICS SAN FRAN	3/5/2020	207ZP0102X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	CISCO	900 HYDE ST FL 1	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
175983	Fee-for-Service	1841226990	1841226990	1	8	PHYSICIAN FOUNDATION	5/21/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	1000 S ELISEO DRIVE	STE 204	GREENBRAE	CA	94904	2133	21	06041	37.94348559	-122.5335273	Marin County
175990	Fee-for-Service	1750325676	1750325676	1	1	PARK, MICHELE H MD	10/31/1990	207L00000X	NA	Other	026	PHYSICIANS	49022	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
176033	Fee-for-Service	1770920936	1770920936	1	1	POKRAJAC, NICHOLAS MD	6/23/2017	207P00000X	NA	Other	026	PHYSICIANS	132509	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
176064	Fee-for-Service	1104914944	1104914944	1	1	PATEL, JIGNESH K MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56000	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 UCLA MEDICAL PLAZA 1	None	LOS ANGELES	CA	90095	0001	19	06037	34.0651473	-118.4458393	Los Angeles County
176065	Fee-for-Service	1265792295	1265792295	1	1	PENUMARTHY, NEELA L MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131425	40	Pediatrics	0	In state provider	None	2200 O'FARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
176078	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
176082	Fee-for-Service	1528556651	1528556651	1	1	PATH TO GROWTH COUNSELING	1/14/2019	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1015 FREMONT AVE	2ND FLOOR	SOUTH PASADENA	CA	91030	3224	19	06037	34.114176	-118.1531575	Los Angeles County
176089	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	9/23/2019	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
176091	Fee-for-Service	1508421868	1508421868	1	1	PATEL, DEVANSHI S MD	8/22/2022	207R00000X	NA	Other	026	PHYSICIANS	178035	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
176104	Fee-for-Service	1225305915	1225305915	1	1	PARK, SANDRA S H MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118835	10	Gastroenterology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176110	Fee-for-Service	1467504225	1467504225	1	1	PAK, YUNCHUL J MD INC	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38260	40	Pediatrics	0	In state provider	None	1433 W MERCED AVE	STE 205	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
176140	Fee-for-Service	1336222397	1336222397	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
176196	Fee-for-Service	1841723327	1841723327	1	7	PEACH TREE HEALTHCARE	12/19/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9980 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2334	51	06101	39.2758002	-121.6612272	Sutter County
176225	Fee-for-Service	1538292404	1538292404	1	2	PROHEALTH PARTNERS	10/22/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1220 W HEMLOCK WAY	STE 204	SANTA ANA	CA	92707	3655	30	06059	33.70975375	-117.8842792	Orange County
176235	Fee-for-Service	1073139796	1073139796	1	1	PATEL, PUJA CNP	3/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2510 EL CAMINO REAL	None	CARLSBAD	CA	92008	1273	37	06073	33.17942276	-117.3266425	San Diego County
176248	Fee-for-Service	1144715251	1144715251	1	1	PATRICK, CORY S MD	3/22/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	173706	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
176262	Fee-for-Service	1922055680	1922055680	1	1	PARVEEZ, RABIA MD	2/1/2000	207RH0003X	NA	Oncology	026	PHYSICIANS	70241	78	Neoplastic Diseases/Oncology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
176276	Fee-for-Service	1790128841	1790128841	1	1	PAK, MARIAN DO MD	10/3/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13783	15	Obstetrics (D.O. only)	0	In state provider	None	8215 VAN NUYS BLVD	SUITE 104	PANORAMA CITY	CA	91402	4810	19	06037	34.22026244	-118.4488066	Los Angeles County
176330	Fee-for-Service	1902987464	1902987464	1	1	PERKASH, RAJAN M D	2/28/1995	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	54677	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
176339	Fee-for-Service	1508879073	1508879073	1	1	PONT, ALLAN MD	3/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35603	67	Endocrinology	0	In state provider	None	1375 SUTTER ST	SUITE 208	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
176357	Fee-for-Service	1083253975	1083253975	1	1	PHONXAYLINKHAM, SAENGDAO NP	11/9/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
176371	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
176375	Fee-for-Service	1275095325	1275095325	1	1	PODRAT, JERICA MD	7/22/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
176376	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	2/8/2020	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
176391	Fee-for-Service	1497196794	1497196794	1	1	PHYSIUS PHYSICAL THERAPY	8/21/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	& WELLNESS	716 GARNER AVENUE	SUITE 103	HANFORD	CA	93230	4313	16	06031	36.3255369	-119.656356	Kings County
176393	Fee-for-Service	1700316817	1700316817	1	1	PIRAKITIKULR, NATHAN MD	6/1/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171565	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
176418	Fee-for-Service	1972500320	1972500320	1	1	POOYA, NAGHMEH MD	12/30/2009	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	100780	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVENUE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
176455	Fee-for-Service	1083827471	1083827471	1	1	PATEL, PRIYA B MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93033	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
176462	Fee-for-Service	1437557626	1437557626	1	1	POWELL, SYRRUS N	4/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
176485	Fee-for-Service	1841723327	1841723327	1	7	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9980 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2334	51	06101	39.2758002	-121.6612272	Sutter County
176536	Fee-for-Service	1871911925	1871911925	1	1	PAUL CHISM	2/24/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
176543	Fee-for-Service	1295231637	1295231637	1	1	POSSAGNOLI, ISABELLA MD	5/6/2024	207R00000X	NA	Other	026	PHYSICIANS	175131	41	Internal Medicine	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
176551	Fee-for-Service	1124200076	1124200076	1	1	POUDEL, MAHENDRA MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133789	77	Infectious Disease	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
176648	Fee-for-Service	1114140571	1114140571	1	1	PREVENTIONGENETICS LLC	12/13/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3800 S BUSINESS PARK AVE	None	MARSHFIELD	WI	54449	9030	00	None	44.62994407	-90.17015639	Wood County
176654	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	6/21/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
176665	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	4/24/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
176670	Fee-for-Service	1821435876	1821435876	1	1	PATEL, NISHI H	7/21/2021	207R00000X	NA	Other	026	PHYSICIANS	171383	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
176683	Fee-for-Service	1295969343	1295969343	1	1	PATEL, PAYAL S MD	8/15/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	154402	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
176725	Fee-for-Service	1689942526	1689942526	1	1	PARIKH, NEIL N MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126031	None	None	0	In state provider	None	200 MEDICAL PLAZA	# 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
176728	Fee-for-Service	1396743605	1396743605	1	1	PETRICK, MARIA M MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132754	03	Allergy	0	In state provider	None	2461 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7815	49	06097	38.441448	-122.6620125	Sonoma County
176733	Fee-for-Service	1033993829	1033993829	1	1	PUTMAN, LEANDRA K PT	8/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5350 OLIVE ST	None	MONTCLAIR	CA	91763	1639	36	06071	34.09054746	-117.6886395	San Bernardino County
176774	Fee-for-Service	1841723327	1841723327	1	7	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9980 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2334	51	06101	39.2758002	-121.6612272	Sutter County
176787	Fee-for-Service	1740489764	1740489764	1	1	PATEL, PAROOL B MD	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	106452	36	Psychiatry	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
176845	Fee-for-Service	1053098152	1053098152	1	1	PREP ED PROGRAMS INC	1/14/2024	251V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	5150 CANDLEWOOD ST.	22C	LAKEWOOD	CA	90712	1929	19	06037	33.85362254	-118.1326815	Los Angeles County
176887	Fee-for-Service	1194379297	1194379297	1	1	PEOPLE'S HOSPICE INC	6/10/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14402 HAYNES ST	SUITE 208	VAN NUYS	CA	91401	6245	19	06037	34.18965658	-118.4468125	Los Angeles County
176905	Fee-for-Service	1922093731	1922093731	1	1	PARKS, FRANK B DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
176914	Fee-for-Service	1134536295	1134536295	1	1	PASCUAL, JONATHAN O NP	12/2/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
176928	Fee-for-Service	1740973791	1740973791	1	1	PSYCHOLOGY TASK FORCE CORP	8/23/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3928 COLEMAN AVE	None	SAN DIEGO	CA	92154	2515	37	06073	32.582945	-117.0496652	San Diego County
176935	Fee-for-Service	1215913470	1215913470	1	1	PRESBYTERIAN HEALTHCARE	10/31/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1100 CENTRAL AVE SE	None	ALBUQUERQUE	NM	87106	4930	00	None	35.08239279	-106.6353509	Bernalillo County
176942	Fee-for-Service	1174704126	1174704126	1	1	PATEL, JYOTIN K MD APC	8/12/2009	193200000X	NA	Other	026	PHYSICIANS	43752	40	Pediatrics	0	In state provider	None	30271 GOLDEN LANTERN	STE C	LAGUNA NIGUEL	CA	92677	5983	30	06059	33.52255101	-117.6859055	Orange County
176943	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
176953	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	6/21/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
177006	Fee-for-Service	1396462149	1396462149	1	1	POST, ALEXANDRA CRNA	8/11/2023	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
177039	Fee-for-Service	1134566839	1134566839	1	1	PHAM, THY H V MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132752	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
177062	Fee-for-Service	1841723327	1841723327	1	7	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9980 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2334	51	06101	39.2758002	-121.6612272	Sutter County
177069	Fee-for-Service	1538574462	1538574462	1	1	PAPASPYRIDI, DIMITRA MD	2/13/2023	207R00000X	NA	Other	026	PHYSICIANS	153046	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
177073	Fee-for-Service	1740489764	1740489764	1	1	PATEL, PAROOL B MD	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	106452	26	Psychiatry (child)	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
177097	Fee-for-Service	1003152364	1003152364	1	1	PETERSEN, KAYLEE NP	3/2/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177157	Fee-for-Service	1124431911	1124431911	1	1	PROFESSIONAL FOOT AND ANKLE	11/28/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	CENTER, INC	2601 W ALAMEDA AVE	SUITE 208	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
177160	Fee-for-Service	1194379297	1194379297	1	1	PEOPLE'S HOSPICE INC	6/10/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14402 HAYNES ST	SUITE 208	VAN NUYS	CA	91401	6245	19	06037	34.18965658	-118.4468125	Los Angeles County
177204	Fee-for-Service	1427205194	1427205194	2	1	PARIKH, NISHA I MD	2/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127544	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
177213	Fee-for-Service	1669259255	1669259255	1	1	POLANCO, DIANA	1/17/2024	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	SUITE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
177224	Fee-for-Service	1215913470	1215913470	1	1	PRESBYTERIAN HEALTHCARE	10/31/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1100 CENTRAL AVE SE	None	ALBUQUERQUE	NM	87106	4930	00	None	35.08239279	-106.6353509	Bernalillo County
177230	Fee-for-Service	1174704126	1174704126	1	1	PATEL, JYOTIN K MD APC	8/12/2009	193200000X	NA	Other	026	PHYSICIANS	43752	01	General Practice	0	In state provider	None	30271 GOLDEN LANTERN	STE C	LAGUNA NIGUEL	CA	92677	5983	30	06059	33.52255101	-117.6859055	Orange County
177232	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	10/15/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
177241	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	10/14/2019	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
177255	Fee-for-Service	1932287430	1932287430	1	1	PENG, BIHAI MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88453	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
177284	Fee-for-Service	1194102137	1194102137	1	1	PHUONG, NEWTON S MD	12/2/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	148290	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
177310	Fee-for-Service	1104484492	1104484492	1	1	PARAGON IMAGING AND INTERVEN	8/30/2019	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	TION INC	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
177332	Fee-for-Service	1578521167	1578521167	1	1	PALMER, GREGORY L MD	5/31/1986	207P00000X	NA	Other	026	PHYSICIANS	27726	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 WEST ROUTE 66	None	GLENDORA	CA	91740	6207	19	06037	34.12866152	-117.86535	Los Angeles County
177371	Fee-for-Service	1154929883	1154929883	1	1	POIRIER, CHANTAL N CNP	8/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
177373	Fee-for-Service	1922625011	1922625011	1	1	PURE LOVE HOSPICE INC	12/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 101	CANOGA PARK	CA	91303	3010	19	06037	34.20099048	-118.60776	Los Angeles County
177390	Fee-for-Service	1649610890	1649610890	1	1	PERALTA, BRANNON P MD	12/27/2019	207P00000X	NA	Other	026	PHYSICIANS	151902	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
177410	Fee-for-Service	1871607762	1871607762	1	63	PROVIDENCE MEDICAL FOUNDATIO	11/5/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	525 DOYLE PARK DR	STE 102	SANTA ROSA	CA	95405	4562	49	06097	38.442636	-122.69889	Sonoma County
177416	Fee-for-Service	1972692754	1972692754	1	1	PACIFIC COAST SURGICAL	11/21/1997	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER #7 LLC	1519 GARCES HWY	STE 101	DELANO	CA	93215	3694	15	06029	35.76146003	-119.2367778	Kern County
177418	Fee-for-Service	1477189330	1477189330	1	1	PELLEGRINO, CHRISTOPHER J MD	7/18/2023	208800000X	NA	Other	026	PHYSICIANS	185811	None	None	0	In state provider	None	501 N ORANGE STREET	None	GLENDALE	CA	91203	1970	19	06037	34.15323119	-118.2565389	Los Angeles County
177435	Fee-for-Service	1376801936	1376801936	1	1	PRADO, KRIS B MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129319	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177489	Fee-for-Service	1427205194	1427205194	2	1	PARIKH, NISHA I MD	2/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127544	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
177494	Fee-for-Service	1619068111	1619068111	1	1	PHAM, XUAN H T OD	10/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 LANDESS AVE	SUITE 117	MILPITAS	CA	95035	8208	43	06085	37.41572489	-121.8763929	Santa Clara County
177501	Fee-for-Service	1174785968	1174785968	1	1	PARK, KUN T MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104493	10	Gastroenterology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
177506	Fee-for-Service	1255636825	1255636825	1	1	PAHWA, AVITA K MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115356	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO ST	3RD FL	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
177508	Fee-for-Service	1568533594	1568533594	1	1	PELLIONI, DONALD J MD	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54687	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
177510	Fee-for-Service	1417330622	1417330622	1	1	PADILLA, JENNIFER F LMFT	11/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118545	-	NOT APPLICABLE	0	In state provider	None	470 CHADBOURNE RD	E	FAIRFIELD	CA	94534	9600	48	06095	38.23474317	-122.0838031	Solano County
177517	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	5/2/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
177530	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	12/29/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
177544	Fee-for-Service	1932287430	1932287430	1	1	PENG, BIHAI MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88453	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
177559	Fee-for-Service	1194455188	1194455188	1	1	PETTENKOFER, MORITZ S MD	10/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
177566	Fee-for-Service	1023093085	1023093085	2	1	PSHAENICH, CHARLES H MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
177592	Fee-for-Service	1750469292	1750469292	1	1	PARIKH, BHAVIN K MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82387	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
177609	Fee-for-Service	1750542916	1750542916	1	1	PACIFIC ARRHYTHMIA SERVICES	9/19/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	71799	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	5525 GROSSMONT CTR DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
177630	Fee-for-Service	1528079639	1528079639	1	1	PARK, MOSES I MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96734	41	Internal Medicine	0	In state provider	None	5957 W RAMSEY ST	None	BANNING	CA	92220	3058	33	06065	33.92937645	-116.942463	Riverside County
177635	Fee-for-Service	1871607762	1871607762	1	8	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
177637	Fee-for-Service	1083934400	1083934400	1	1	PACHECO, WENDALEE R MD	2/11/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	110698	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
177660	Fee-for-Service	1922625011	1922625011	1	1	PURE LOVE HOSPICE INC	12/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22048 SHERMAN WAY	SUITE 101	CANOGA PARK	CA	91303	3010	19	06037	34.20099048	-118.60776	Los Angeles County
177685	Fee-for-Service	1184078149	1184078149	1	1	PHAM, PATRICK J MD	6/12/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168613	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
177696	Fee-for-Service	1871607762	1871607762	1	107	PROVIDENCE MEDICAL FOUNDATIO	11/2/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	6580 HEMBREE LANE	SUITE 270	WINDSOR	CA	95492	6885	49	06097	38.52650514	-122.7897518	Sonoma County
177713	Fee-for-Service	1366002859	1366002859	1	1	PLAN B MARRIAGE & FAMILY THE	6/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RAPY PROFESSIONAL CORPOR	255 NORTH D STREET	300	SAN BERNARDINO	CA	92401	1714	36	06071	34.1036709	-117.291874	San Bernardino County
177719	Fee-for-Service	1447283940	1447283940	1	1	PEDRO DE ARMAS	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
177735	Fee-for-Service	1821669698	1821669698	1	2	PALOMAR INTENSIVIST MEDICAL	9/9/2021	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
177742	Fee-for-Service	1689162414	1689162414	1	1	PATEL, PUJA	7/25/2023	207RR0500X	NA	Other	026	PHYSICIANS	21030	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
177776	Fee-for-Service	1346306321	1346306321	1	1	PAK, FIROOZ MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73904	45	Nephrology (Renal-Kidney)	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 1100	LOS ANGELES	CA	90045	3819	19	06037	33.96022076	-118.3961982	Los Angeles County
177787	Fee-for-Service	1285346809	1285346809	1	1	PAJARO VALLEY HEALTH CARE DI	3/4/2024	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	1820 MAIN ST	None	WATSONVILLE	CA	95076	3092	44	06087	36.91804831	-121.7799502	Santa Cruz County
177790	Fee-for-Service	1174785968	1174785968	1	1	PARK, KUN T MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104493	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
177793	Fee-for-Service	1023549243	1023549243	1	1	PAPATHOMAS, DAPHNE C MD	9/1/2021	390200000X	NA	Other	026	PHYSICIANS	172985	None	None	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
177805	Fee-for-Service	1730218678	1730218678	1	1	PHAM, SALLY T DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94511	4201	01	06001	37.706364	-122.165163	Alameda County
177809	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	3/9/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
177816	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	2/24/2019	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
177869	Fee-for-Service	1093748691	1093748691	1	1	PHILLIPS, NABIL A MD INC	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	46495	78	Neoplastic Diseases/Oncology	0	In state provider	None	1970 OLD TUSTIN AVE	SUITE A	SANTA ANA	CA	92705	7865	30	06059	33.7626	-117.835817	Orange County
177873	Fee-for-Service	1811074016	1811074016	1	1	PIEPER, PATRICK G MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76745	84	Surgery-Head and Neck	0	In state provider	None	200 MEDICAL PLAZA	SUITE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
177893	Fee-for-Service	1245648799	1245648799	1	1	PATEL, SRIDHAR K DO	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
177896	Fee-for-Service	1750542916	1750542916	1	1	PACIFIC ARRHYTHMIA SERVICES	9/19/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	71799	41	Internal Medicine	0	In state provider	INC	5525 GROSSMONT CTR DR	STE 609	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
177909	Fee-for-Service	1194735019	1194735019	1	1	PHAM, MICHAEL X MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71816	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177921	Fee-for-Service	1093204422	1093204422	1	1	PATEL, KUNAAL MD	2/23/2022	208M00000X	NA	Other	026	PHYSICIANS	173482	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
177926	Fee-for-Service	1104142025	1104142025	1	1	PACE, LAURA A MD	5/28/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	126140	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177935	Fee-for-Service	1497822019	1497822019	1	1	PHAM, HANNAH N OD	5/26/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12765 LA MIRADA BLVD	STE 301	LA MIRADA	CA	90638	0000	19	06037	33.91551413	-118.012011	Los Angeles County
177960	Fee-for-Service	1699040782	1699040782	1	1	PHILLIP, AMI T MD	4/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128759	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
177986	Fee-for-Service	1871607762	1871607762	1	19	PROVIDENCE MEDICAL FOUNDATIO	8/16/2012	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	106 LYNCH CREEK WY	STE 9B	PETALUMA	CA	94954	2356	49	06097	38.25206172	-122.634113	Sonoma County
177999	Fee-for-Service	1871607762	1871607762	1	7	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
178004	Fee-for-Service	1235528662	1235528662	1	1	PENA, JACQUELINE LCSW	11/18/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 ABBOTT STREET	200	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
178018	Fee-for-Service	1841226990	1841226990	1	7	PHYSICIAN FOUNDATION	3/17/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1335 EVAN STREET	None	SAN FRANCISCO	CA	94124	1705	38	06075	37.7400938	-122.3835563	San Francisco County
178019	Fee-for-Service	1013221621	1013221621	1	1	POLLARD, STEPHANIE K	9/13/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1370 N BREA BLVD	SUITE 105	FULLERTON	CA	92835	4132	30	06059	33.88482917	-117.9236469	Orange County
178029	Fee-for-Service	1841724895	1841724895	1	1	PMDLAB, LLC	4/2/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	THERN CALIFORNIA	4630 NORTHGATE BLVD	150	SACRAMENTO	CA	95834	1141	34	06067	38.652534	-121.476726	Sacramento County
178046	Fee-for-Service	1588730345	1588730345	1	1	PALMER, BONITA A MD	1/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35457	08	Family Practice	0	In state provider	None	3555 CESAR CHAVEZ STREET	None	SAN FRANCISCO	CA	94110	4415	38	06075	37.7479947	-122.4209132	San Francisco County
178055	Fee-for-Service	1245415280	1245415280	1	1	PITINO, LISA MARIE DO	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10571	25	Physical Medicine and Rehabilitation	0	In state provider	None	2501 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
178064	Fee-for-Service	1346306321	1346306321	1	1	PAK, FIROOZ MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73904	41	Internal Medicine	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 1100	LOS ANGELES	CA	90045	3819	19	06037	33.96022076	-118.3961982	Los Angeles County
178081	Fee-for-Service	1295935799	1295935799	1	1	PENINSULA HEALTHCARE	11/13/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CONNECTION INC	33 ENCINA AVE	STE 103	PALO ALTO	CA	94301	2343	43	06085	37.43913037	-122.1608344	Santa Clara County
178094	Fee-for-Service	1669571063	1669571063	1	1	PHAN, TIM T	7/13/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
178097	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
178105	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
178139	Fee-for-Service	1174932735	1174932735	1	1	PROFESSIONAL HOSPICE	4/3/2025	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	6422 BELLINGHAM AVE	SUITE 207	NORTH HOLLYWOOD	CA	91606	1438	19	06037	34.187391	-118.398713	Los Angeles County
178155	Fee-for-Service	1093748691	1093748691	1	1	PHILLIPS, NABIL A MD INC	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	46495	68	Hematology	0	In state provider	None	1970 OLD TUSTIN AVE	SUITE A	SANTA ANA	CA	92705	7865	30	06059	33.7626	-117.835817	Orange County
178157	Fee-for-Service	1538337126	1538337126	1	1	PEAY, JEREMY W MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97935	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178166	Fee-for-Service	1548739683	1548739683	1	1	PATHOS HOME HEALTH CARE	7/25/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15904 STRATHERN ST	STE 7	VAN NUYS	CA	91406	1314	19	06037	34.21565751	-118.479477	Los Angeles County
178169	Fee-for-Service	1063868180	1063868180	1	1	PIAZZA, SCOTT P DO	6/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15943	08	Family Practice	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
178196	Fee-for-Service	1194735019	1194735019	1	1	PHAM, MICHAEL X MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71816	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178214	Fee-for-Service	1104142025	1104142025	1	1	PACE, LAURA A MD	5/28/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	126140	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178225	Fee-for-Service	1215079751	1215079751	1	1	POTKIN, RALPH MD A MED	4/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	CORPORATION	1125 S BEVERLY DR	STE 406	LOS ANGELES	CA	90035	1152	19	06037	34.05696658	-118.3966613	Los Angeles County
178239	Fee-for-Service	1568620821	1568620821	1	1	PHELPS, ANDREW S MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102402	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
178243	Fee-for-Service	1164668786	1164668786	1	2	PREMIER FAMILY MEDICINE	7/27/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1601 N MONTE VISTA AVE	STE 190	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
178257	Fee-for-Service	1871607762	1871607762	1	82	PROVIDENCE MEDICAL FOUNDATIO	9/4/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1010 W LA VETA AVE	STE 710	ORANGE	CA	92868	4306	30	06059	33.78028244	-117.8635552	Orange County
178290	Fee-for-Service	1871607762	1871607762	1	7	PROVIDENCE MEDICAL FOUNDATIO	11/20/1996	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	N	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
178305	Fee-for-Service	1013317932	1013317932	1	1	PINAL, JOSE	6/30/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
178308	Fee-for-Service	1841226990	1841226990	1	7	PHYSICIAN FOUNDATION	3/17/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1335 EVAN STREET	None	SAN FRANCISCO	CA	94124	1705	38	06075	37.7400938	-122.3835563	San Francisco County
178309	Fee-for-Service	1841226990	1841226990	1	1	PHYSICIAN FOUNDATION	9/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL ASSOCIATES, INC	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
178317	Fee-for-Service	1376970707	1376970707	1	1	PHYSICIANS PREFERRED HOSPICE	9/12/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6047 TAMPA AVE	SUITE 301	TARZANA	CA	91356	1158	19	06037	34.180812	-118.553488	Los Angeles County
178328	Fee-for-Service	1811429624	1811429624	1	1	PARIKH, PRIYA R MD	10/17/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	160744	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
178334	Fee-for-Service	1588730345	1588730345	1	1	PALMER, BONITA A MD	1/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35457	36	Psychiatry	0	In state provider	None	3555 CESAR CHAVEZ STREET	None	SAN FRANCISCO	CA	94110	4415	38	06075	37.7479947	-122.4209132	San Francisco County
178353	Fee-for-Service	1346306321	1346306321	1	1	PAK, FIROOZ MD INC	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73904	01	General Practice	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 1100	LOS ANGELES	CA	90045	3819	19	06037	33.96022076	-118.3961982	Los Angeles County
178367	Fee-for-Service	1295935799	1295935799	1	1	PENINSULA HEALTHCARE	11/13/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CONNECTION INC	33 ENCINA AVE	STE 103	PALO ALTO	CA	94301	2343	43	06085	37.43913037	-122.1608344	Santa Clara County
178376	Fee-for-Service	1770839664	1770839664	1	1	PENNINGTON, OBBIE G OD	12/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2109 FOREST AVENUE	SUITE 50	CHICO	CA	95928	7708	04	06007	39.721518	-121.8015025	Butte County
178381	Fee-for-Service	1871031518	1871031518	1	1	PARK, SE J NP	12/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23961 CALLE DE LA MAGDAL	500	LAGUNA HILLS	CA	92653	7622	30	06059	33.60999658	-117.7126577	Orange County
178383	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	9/16/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
178395	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	9/16/2019	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
178416	Fee-for-Service	1174722078	1174722078	1	1	PANGAN, ERIKA A B	12/27/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
178428	Fee-for-Service	1174932735	1174932735	1	1	PROFESSIONAL HOSPICE	4/3/2025	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	6422 BELLINGHAM AVE	SUITE 207	NORTH HOLLYWOOD	CA	91606	1438	19	06037	34.187391	-118.398713	Los Angeles County
178433	Fee-for-Service	1851311104	1851311104	1	1	PETERSON, RALPH L MD	8/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49099	10	Gastroenterology (M.D. only)	0	In state provider	None	10520 MACARTHUR BLVD	None	OAKLAND	CA	94605	5248	01	06001	37.74310419	-122.152591	Alameda County
178465	Fee-for-Service	1174518765	1174518765	1	1	PETER NAKAJI MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
178469	Fee-for-Service	1164483111	1164483111	1	1	PARVEN, STEPHEN G MD	11/5/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165449	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
178485	Fee-for-Service	1427290766	1427290766	1	1	PANSCIK, MAGDALENA C	3/5/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 W YOSEMITE AVE	STE 1	MANTECA	CA	95337	5191	39	06077	37.79729949	-121.243887	San Joaquin County
178486	Fee-for-Service	1740491422	1740491422	1	1	PV PENINSULA PLASTIC SURGERY	12/8/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	3400 LOMITA BLVD	# 306	TORRANCE	CA	90505	4926	19	06037	33.81309744	-118.3448635	Los Angeles County
178511	Fee-for-Service	1215079751	1215079751	1	1	POTKIN, RALPH MD A MED	4/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORPORATION	1125 S BEVERLY DR	STE 406	LOS ANGELES	CA	90035	1152	19	06037	34.05696658	-118.3966613	Los Angeles County
178520	Fee-for-Service	1871859488	1871859488	1	1	PADILLA-JONES, BRANDY MD	2/18/2021	2086S0127X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	3196 S MARYLAND PKWAY	STE 101A	LAS VEGAS	NV	89109	2317	00	None	36.13194	-115.136873	Clark County
178547	Fee-for-Service	1316975410	1316975410	1	1	PILON, VALERIE N OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 N TUSTIN AVE	STE 130	SANTA ANA	CA	92705	3501	30	06059	33.75564579	-117.8342574	Orange County
178550	Fee-for-Service	1578905741	1578905741	1	1	PAUL, SHERRIE ANN	8/10/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2652 10TH AVENUE	None	MERCED	CA	95340	3106	24	06047	37.30528708	-120.4624477	Merced County
178558	Fee-for-Service	1629051677	1629051677	1	1	PETTEY, ADAM A MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100224	84	Surgery-Head and Neck	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
178566	Fee-for-Service	1518090018	1518090018	1	1	PALACIOS, MARIO F LMFT	12/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
178577	Fee-for-Service	1871607762	1871607762	1	7	PROVIDENCE MEDICAL FOUNDATIO	4/22/2022	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
178578	Fee-for-Service	1386651297	1386651297	1	1	PORTERCARE ADVENTIST HEALTH	1/12/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	9395 CROWN CREST BLVD	None	PARKER	CO	80138	8573	00	None	39.5497445	-104.7700003	Douglas County
178594	Fee-for-Service	1841226990	1841226990	1	1	PHYSICIAN FOUNDATION	9/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	MEDICAL ASSOCIATES, INC	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
178605	Fee-for-Service	1376970707	1376970707	1	1	PHYSICIANS PREFERRED HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6047 TAMPA AVE	SUITE 301	TARZANA	CA	91356	1158	19	06037	34.180812	-118.553488	Los Angeles County
178609	Fee-for-Service	1215015888	1215015888	1	1	PATEL, ANUP J MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95015	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
178634	Fee-for-Service	1467666289	1467666289	1	1	PAPPAS, STEPHANIE D MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116245	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
178645	Fee-for-Service	1700454014	1700454014	1	1	PYTEL, DEVON	9/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
178646	Fee-for-Service	1073550224	1073550224	1	1	PILLSBURY, HELEN M MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73432	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
178671	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	10/14/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
178681	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	2/12/2019	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
178720	Fee-for-Service	1851311104	1851311104	1	1	PETERSON, RALPH L MD	8/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49099	41	Internal Medicine	0	In state provider	None	10520 MACARTHUR BLVD	None	OAKLAND	CA	94605	5248	01	06001	37.74310419	-122.152591	Alameda County
178725	Fee-for-Service	1871286427	1871286427	1	3	PIEDMONT ADVANCED CARE INC	2/28/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AL CORPORATION	1805 WEST ST	None	HAYWARD	CA	94545	1932	01	06001	37.64491782	-122.1159527	Alameda County
178742	Fee-for-Service	1457913808	1457913808	1	1	PROVERI RX LLC	8/21/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5713 N PERSHING AVE	#A3	STOCKTON	CA	95207	4942	39	06077	38.00011235	-121.3261426	San Joaquin County
178807	Fee-for-Service	1932181567	1932181567	1	1	PAN, RICHARD J MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84883	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
178812	Fee-for-Service	1699834507	1699834507	1	1	PEDERSEN, ERIK PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
178818	Fee-for-Service	1740314376	1740314376	1	1	PEARSON, MICHAEL LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
178823	Fee-for-Service	1659584563	1659584563	1	1	PATRICK J SOUSA	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
178830	Fee-for-Service	1659671600	1659671600	1	2	PLANNED PARENTHOOD SHASTA	3/1/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DABLO INC	242-A HOSPITAL DRIVE	None	UKIAH	CA	95482	4556	23	06045	39.15258291	-123.2037212	Mendocino County
178833	Fee-for-Service	1942479951	1942479951	1	1	PERLMAN, MONA M LCSW	1/22/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
178837	Fee-for-Service	1578905741	1578905741	1	1	PAUL, SHERRIE ANN	8/10/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2652 10TH AVENUE	None	MERCED	CA	95340	3106	24	06047	37.30528708	-120.4624477	Merced County
178840	Fee-for-Service	1992846927	1992846927	1	1	PRAMOD S KULKARNI MD INC	8/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	11632 BUTTERFIELD ST	None	LOMA LINDA	CA	92354	3956	36	06071	34.04245392	-117.2371028	San Bernardino County
178864	Fee-for-Service	1093905051	1093905051	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC CRITICAL CARE	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
178867	Fee-for-Service	1386651297	1386651297	1	1	PORTERCARE ADVENTIST HEALTH	1/12/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	9395 CROWN CREST BLVD	None	PARKER	CO	80138	8573	00	None	39.5497445	-104.7700003	Douglas County
178904	Fee-for-Service	1760897557	1760897557	1	1	PARK, MATT Y CRNA	10/20/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
178911	Fee-for-Service	1962683268	1962683268	1	1	PORTER RANCH PSYCHIATRIC	3/2/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	32250	36	Psychiatry	0	In state provider	MEDICAL CORPORATION	18250 ROSCOE BLVD	STE 245	NORTHRIDGE	CA	91325	4248	19	06037	34.22076142	-118.5313223	Los Angeles County
178920	Fee-for-Service	1710946199	1710946199	1	1	POCOCK, EUGENE R MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22881	22	Pathology (M.D. only)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
178959	Fee-for-Service	1336222397	1336222397	1	14	PERMANENTE MEDICAL GROUP INC	2/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
178970	Fee-for-Service	1477744571	1477744571	1	1	PINK LOTUS MEDICAL, INC	11/24/2010	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	120 S SPALDING DR	SUITE 205	BEVERLY HILLS	CA	90212	1840	19	06037	34.06625419	-118.4088854	Los Angeles County
178971	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
178981	Fee-for-Service	1841515509	1841515509	1	1	PAN, CHRIS W MD	10/12/2017	390200000X	NA	Other	026	PHYSICIANS	120568	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
179012	Fee-for-Service	1871607762	1871607762	1	127	PROVIDENCE MEDICAL FOUNDATIO	4/18/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1100 TRANCAS STREET	SUITE 252	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
179060	Fee-for-Service	1114450426	1114450426	1	1	POULDAR, DAVID MD	2/18/2022	207P00000X	NA	Other	026	PHYSICIANS	159194	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
179061	Fee-for-Service	1467926220	1467926220	1	1	PHAM, XUAN HA T CRNA	3/18/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
179070	Fee-for-Service	1205938362	1205938362	1	1	PIMSTONE, KEVIN R MD	7/1/2000	207R00000X	NA	Other	026	PHYSICIANS	62816	41	Internal Medicine	0	In state provider	None	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
179080	Fee-for-Service	1821558123	1821558123	1	1	PASCUA, BENITO MD	6/27/2023	207P00000X	NA	Other	026	PHYSICIANS	180393	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179121	Fee-for-Service	1396721635	1396721635	1	1	PESAVENTO, RICHARD D	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44858	None	None	0	In state provider	None	11340 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3858	36	06071	34.04699925	-117.2436953	San Bernardino County
179122	Fee-for-Service	1629564067	1629564067	1	1	POLKINHORN, CECILIA LMFT	12/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7855 RIVERTON AVE	None	SUN VALLEY	CA	91352	4519	19	06037	34.213716	-118.365988	Los Angeles County
179125	Fee-for-Service	1972690923	1972690923	1	1	PRITHAM,RAJ Y MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OHSU	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	3098	00	None	45.49936609	-122.6856232	Multnomah County
179144	Fee-for-Service	1750750576	1750750576	1	1	PROMINENT HOME HEALTH CARE	11/5/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	6742 VAN NUYS BLVD	SUITE 104	VAN NUYS	CA	91405	4641	19	06037	34.19343344	-118.4487213	Los Angeles County
179146	Fee-for-Service	1457597411	1457597411	1	1	PHAM, T K LOAN MD INC	6/30/2009	207R00000X	NA	Other	026	PHYSICIANS	60749	41	Internal Medicine	0	In state provider	None	79-440 CORPORATE CTR DR	SUITE 117	LA QUINTA	CA	92253	7244	33	06065	33.71039647	-116.2841051	Riverside County
179152	Fee-for-Service	1093905051	1093905051	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PEDIATRIC CRITICAL CARE	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
179185	Fee-for-Service	1295344588	1295344588	1	1	PERMANENT HOSPICE INC	12/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3715 MARKET ST	STE 116	GLENDALE	CA	91208	3469	19	06037	34.20492064	-118.2267985	Los Angeles County
179193	Fee-for-Service	1467981100	1467981100	1	1	PRIMEMED PHARMACY INC	8/10/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	839 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2133	19	06037	34.16087972	-118.274471	Los Angeles County
179202	Fee-for-Service	1841723327	1841723327	1	3	PEACH TREE HEALTHCARE	6/9/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1275 THARP RD	None	YUBA CITY	CA	95993	2640	51	06101	39.14572609	-121.6484225	Sutter County
179210	Fee-for-Service	1467727727	1467727727	1	1	PACIFIC MEDICAL, INC.	4/20/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	123 DI SALVO AVE	STE 60	SAN JOSE	CA	95128	1717	43	06085	37.32628785	-121.9371289	Santa Clara County
179212	Fee-for-Service	1730731639	1730731639	1	1	PATEL, SARVANAND MD	1/3/2023	208M00000X	NA	Other	026	PHYSICIANS	177970	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
179256	Fee-for-Service	1336222397	1336222397	1	7	PERMANENTE MEDICAL GROUP INC	12/4/2020	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
179285	Fee-for-Service	1497790539	1497790539	1	1	PACIFIC EMERGENCY	1/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
179294	Fee-for-Service	1558915256	1558915256	1	1	POWERS PARK HEALTHCARE INC	5/29/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3880 VIA LUCERO	None	SANTA BARBARA	CA	93110	1605	42	06083	34.44207617	-119.7500272	Santa Barbara County
179298	Fee-for-Service	1043348543	1043348543	1	1	PLUMAS HOSPITAL DISTRICT	5/19/1992	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
179299	Fee-for-Service	1871607762	1871607762	1	110	PROVIDENCE MEDICAL FOUNDATIO	2/14/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	57 PRISM	None	IRVINE	CA	92618	3148	30	06059	33.65370507	-117.7508083	Orange County
179327	Fee-for-Service	1063411460	1063411460	1	2	PALM IMAGING INSTITUTE A	11/22/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1850 N RIVERSIDE AVE	STE 160	RIALTO	CA	92376	8056	36	06071	34.132905	-117.3704675	San Bernardino County
179352	Fee-for-Service	1760913594	1760913594	1	1	PITHIA, NEEMA MD	6/12/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	158429	40	Pediatrics	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
179376	Fee-for-Service	1952965394	1952965394	1	1	PEPPER, JOSHUA R MD	11/8/2022	208M00000X	NA	Other	026	PHYSICIANS	181802	None	None	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
179386	Fee-for-Service	1558517748	1558517748	1	1	PALAV, SWAPNA MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102970	08	Family Practice	0	In state provider	None	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1657	15	06029	35.392059	-119.010556	Kern County
179395	Fee-for-Service	1952543514	1952543514	1	1	PATEL, BHAVESH	4/25/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	117569	None	None	0	In state provider	None	9481 PITTSBURGH AVE	200	RANCHO CUCAMONGA	CA	91730	9021	36	06071	34.08094188	-117.5559944	San Bernardino County
179398	Fee-for-Service	1336589787	1336589787	1	1	PHANGUREH, MAYLENE H DO	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14271	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
179405	Fee-for-Service	1699095141	1699095141	1	1	PACK, JESSE C MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124442	40	Pediatrics	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93942	5902	27	06053	36.5785911	-121.9150013	Monterey County
179418	Fee-for-Service	1871607762	1871607762	1	29	PROVIDENCE MEDICAL FOUNDATIO	1/4/2013	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3304 RENNER DR	None	FORTUNA	CA	95540	7102	12	06023	40.58239308	-124.1360417	Humboldt County
179423	Fee-for-Service	1235207234	1235207234	1	1	PRABHLEEN, SINGH MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93789	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DRIVE - 8201	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179450	Fee-for-Service	1033388269	1033388269	1	1	PECK, MELICENT C MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105023	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
179474	Fee-for-Service	1295344588	1295344588	1	1	PERMANENT HOSPICE INC	12/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3715 MARKET ST	STE 116	GLENDALE	CA	91208	3469	19	06037	34.20492064	-118.2267985	Los Angeles County
179477	Fee-for-Service	1720272313	1720272313	1	1	POURTAHERI, NEEMA MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145410	20	Orthopedic Surgery	0	In state provider	None	1405 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4557	49	06097	38.44377	-122.699016	Sonoma County
179489	Fee-for-Service	1841723327	1841723327	1	3	PEACH TREE HEALTHCARE	7/8/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1275 THARP RD	None	YUBA CITY	CA	95993	2640	51	06101	39.14572609	-121.6484225	Sutter County
179526	Fee-for-Service	1790755460	1790755460	1	1	PALOS, MIGUEL M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	53259	None	None	0	In state provider	None	315 N TERRACE VIEW DR	None	MONROVIA	CA	91016	1571	19	06037	34.15599	-118.0212185	Los Angeles County
179533	Fee-for-Service	1982900890	1982900890	1	1	PATEL, JAY J MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101467	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN ST	STE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
179542	Fee-for-Service	1215918784	1215918784	1	1	PERALTA, ELIZABETH A MD	5/31/1995	2086X0206X	NA	General Surgery	026	PHYSICIANS	83732	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
179547	Fee-for-Service	1164586301	1164586301	1	1	PALERMO, JANNETTE L	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
179551	Fee-for-Service	1871607762	1871607762	1	41	PROVIDENCE MEDICAL FOUNDATIO	8/16/2013	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19341 BEAR VALLEY RD	STE 105	APPLE VALLEY	CA	92308	5152	36	06071	34.47101125	-117.2412548	San Bernardino County
179564	Fee-for-Service	1952687790	1952687790	1	1	PADRON, CLAUDIA P MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116556	01	General Practice	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
179585	Fee-for-Service	1043348543	1043348543	1	1	PLUMAS HOSPITAL DISTRICT	5/19/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
179636	Fee-for-Service	1881011633	1881011633	1	1	PJ DRUGSTORE INC	7/22/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2301 CAMINO RAMON	STE 190	SAN RAMON	CA	94583	2060	07	06013	37.77574883	-121.9663326	Contra Costa County
179645	Fee-for-Service	1871607762	1871607762	1	178	PROVIDENCE MEDICAL FOUNDATIO	1/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	955 IMPERIAL HWY	SUITE 200	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
179664	Fee-for-Service	1407069743	1407069743	1	1	PATHWAYS HOME HEALTH AND	7/1/1993	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	585 N. MARY AVE	None	SUNNYVALE	CA	94085	2905	43	06085	37.39246753	-122.0374438	Santa Clara County
179678	Fee-for-Service	1467404525	1467404525	1	1	PRAW, STEPHANIE S	4/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90748	None	None	0	In state provider	None	200 MED PLAZA	#365, 420, 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
179695	Fee-for-Service	1700248762	1700248762	1	1	PHAM, PATRICK T DO	8/23/2020	390200000X	NA	Other	026	PHYSICIANS	16189	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
179703	Fee-for-Service	1386049898	1386049898	1	1	PARKVIEW OPERATING COMPANY	1/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LP	27350 TAMPA AVE	None	HAYWARD	CA	94544	4429	01	06001	37.63470338	-122.0767172	Alameda County
179720	Fee-for-Service	1871607762	1871607762	1	50	PROVIDENCE MEDICAL FOUNDATIO	5/2/2014	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	27871 MEDICAL CENTER RD	STE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
179734	Fee-for-Service	1265791818	1265791818	1	1	PETTIGREW, GAETAN L MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143683	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
179778	Fee-for-Service	1841723327	1841723327	1	3	PEACH TREE HEALTHCARE	7/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1275 THARP RD	None	YUBA CITY	CA	95993	2640	51	06101	39.14572609	-121.6484225	Sutter County
179825	Fee-for-Service	1932782240	1932782240	1	1	PENCE, MARCUS I CRNA	8/2/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
179830	Fee-for-Service	1992231682	1992231682	1	1	PHUNG, LAM	5/31/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171632	None	None	0	In state provider	None	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
179837	Fee-for-Service	1871607762	1871607762	1	3	PROVIDENCE MEDICAL FOUNDATIO	1/10/2022	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
179838	Fee-for-Service	1932457454	1932457454	1	1	POLIDORO, NICOLE R CCC-SLP	6/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
179839	Fee-for-Service	1760844047	1760844047	1	1	PHAM, TRACY D MD	6/19/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156867	40	Pediatrics	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
179862	Fee-for-Service	1265627707	1265627707	1	1	PATHAN, KHALIDA A	10/15/2012	207R00000X	NA	Other	026	PHYSICIANS	97589	41	Internal Medicine	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
179873	Fee-for-Service	1043348543	1043348543	1	1	PLUMAS HOSPITAL DISTRICT	4/19/1999	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
179910	Fee-for-Service	1407069743	1407069743	1	2	PATHWAYS HOME HEALTH AND	8/28/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	395 OYSTER POINT BLVD	SUITE 128	S SAN FRANCISCO	CA	94080	1929	41	06081	37.66641946	-122.3833795	San Mateo County
179930	Fee-for-Service	1871286427	1871286427	1	1	PIEDMONT ADVANCED CARE INC	2/28/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AL CORPORATION	309 MACARTHUR BLVD	None	OAKLAND	CA	94610	3233	01	06001	37.81428418	-122.2515188	Alameda County
179932	Fee-for-Service	1871607762	1871607762	1	178	PROVIDENCE MEDICAL FOUNDATIO	1/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	955 IMPERIAL HWY	SUITE 200	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
179947	Fee-for-Service	1871607762	1871607762	1	6	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
179951	Fee-for-Service	1598836413	1598836413	1	1	PROVONSHA, STEPHEN G MD	5/31/1993	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	51217	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
179962	Fee-for-Service	1184967028	1184967028	1	2	PERRIN, HANNAH MD	8/30/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	134559	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
179998	Fee-for-Service	1780972927	1780972927	1	1	PHAM, JULIE T DO	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11632	08	Family Practice	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
180002	Fee-for-Service	1871607762	1871607762	1	123	PROVIDENCE MEDICAL FOUNDATIO	4/10/2018	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3434 VILLA LANE	STE 260	NAPA	CA	94558	6415	28	06055	38.32515937	-122.2938358	Napa County
180023	Fee-for-Service	1013938711	1013938711	1	1	PARKES, KEVIN JAMES MD	2/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70865	None	None	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9999	36	06071	34.26577765	-117.1695461	San Bernardino County
180044	Fee-for-Service	1932558491	1932558491	1	1	POMARES, CARMEN M	2/14/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6040 COMMERCE BLVD	STE 105	ROHNERT PARK	CA	94928	2181	49	06097	38.35191405	-122.7101718	Sonoma County
180053	Fee-for-Service	1689802027	1689802027	1	1	PHADNIS, KALPANA A MD	11/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120572	08	Family Practice	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
180066	Fee-for-Service	1841723327	1841723327	1	3	PEACH TREE HEALTHCARE	7/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1275 THARP RD	None	YUBA CITY	CA	95993	2640	51	06101	39.14572609	-121.6484225	Sutter County
180077	Fee-for-Service	1871607762	1871607762	1	176	PROVIDENCE MEDICAL FOUNDATIO	1/19/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	32341 GOLDEN LANTERN	STE D	LAGUNA NIGUEL	CA	92677	5343	30	06059	33.49304078	-117.6961838	Orange County
180079	Fee-for-Service	1184776122	1184776122	1	1	PETERSEN, CARLA A LCSW	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23866	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
180086	Fee-for-Service	1942407283	1942407283	1	1	PARK AVENUE WALK IN CLINIC	5/19/2016	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63401	01	General Practice	0	In state provider	None	1280 MONUMENT BLVD	STE 1	CONCORD	CA	94520	4406	07	06013	37.94999213	-122.0480366	Contra Costa County
180126	Fee-for-Service	1871607762	1871607762	1	3	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1514 VALLEY VISTA DR	None	DIAMOND BAR	CA	91765	3929	19	06037	33.99491668	-117.8399137	Los Angeles County
180142	Fee-for-Service	1760003594	1760003594	1	1	PHI HEALTH, LLC	1/11/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	558 WEST RAMP ROAD	2	JACKSON	MS	39209	3429	00	None	32.3385075	-90.22857269	Hinds County
180144	Fee-for-Service	1821145517	1821145517	1	1	PALERMO UNION SCHOOL	4/26/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	7390 BULLDOG WAY	None	PALERMO	CA	95968	9700	04	06007	39.435831	-121.546116	Butte County
180161	Fee-for-Service	1043348543	1043348543	1	1	PLUMAS HOSPITAL DISTRICT	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
180174	Fee-for-Service	1902197437	1902197437	1	1	PANAMA, GABRIEL M PT	8/31/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
180187	Fee-for-Service	1871599357	1871599357	1	1	PROPST, DAVID A DO	8/31/1996	204C00000X	NA	Other	026	PHYSICIANS	6635	20	Orthopedic Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
180208	Fee-for-Service	1538566039	1538566039	1	1	PAI AND CHAN PHARMACY CORP	2/19/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	II	1047 N STATE STREET	None	LOS ANGELES	CA	90033	1332	19	06037	34.05726434	-118.2105838	Los Angeles County
180220	Fee-for-Service	1871607762	1871607762	1	38	PROVIDENCE MEDICAL FOUNDATIO	5/14/2013	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
180262	Fee-for-Service	1861041147	1861041147	1	1	PIATT, NICHOLE A LCSW	11/15/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
180269	Fee-for-Service	1235602871	1235602871	1	1	PAREDES, LUIKA PT	11/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
180310	Fee-for-Service	1417485624	1417485624	1	1	PHAM, VY P T OD	2/6/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	STE P25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
180318	Fee-for-Service	1114180999	1114180999	1	1	PHUNG, JENNIFER T MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107567	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1617 N CALIFORNIA ST	STE 2A	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
180319	Fee-for-Service	1417016007	1417016007	1	1	PARK, JULIE H MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68127	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
180352	Fee-for-Service	1821669698	1821669698	1	1	PALOMAR INTENSIVIST MEDICAL	8/1/2021	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
180363	Fee-for-Service	1104817147	1104817147	1	1	PATEL, RENUKA MD DO	10/24/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	181973	-	NOT APPLICABLE	0	In state provider	None	5849 CROCKER STREET	UNIT L	LOS ANGELES	CA	90003	1311	19	06037	33.988626	-118.268568	Los Angeles County
180449	Fee-for-Service	1255872602	1255872602	1	1	PATEL, RONAK MD	8/10/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	157379	None	None	0	In state provider	None	400 TAYLOR	202	PLEASANT HILL	CA	94523	2147	07	06013	37.96132631	-122.0740275	Contra Costa County
180459	Fee-for-Service	1316796071	1316796071	1	1	PIRAN, MISAGH MD	8/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
180461	Fee-for-Service	1699822940	1699822940	1	1	PELAYO, RAFAEL MD	9/30/1992	2080S0012X	NA	Other	026	PHYSICIANS	76339	13	Neurology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
180474	Fee-for-Service	1750773727	1750773727	1	1	PABLO BASSUK MD INC	7/3/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99057	01	General Practice	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
180481	Fee-for-Service	1457330888	1457330888	1	1	PEREZ & PEREZ MED CORP	11/23/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	630 N 13TH AVE	STE A	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
180502	Fee-for-Service	1427017649	1427017649	1	1	PLESCIA, MARTHA G PT	12/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1021 S WOLFE RD	STE. 125	SUNNYVALE	CA	94086	8874	43	06085	37.355274	-122.0141665	Santa Clara County
180509	Fee-for-Service	1871607762	1871607762	1	178	PROVIDENCE MEDICAL FOUNDATIO	1/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	955 IMPERIAL HWY	SUITE 200	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
180557	Fee-for-Service	1740641620	1740641620	1	1	PHAM, AMANDA DO	12/2/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17059	None	None	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
180571	Fee-for-Service	1053903989	1053903989	1	1	PURE HEART HOME HEALTH	9/14/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	4119 W BURBANK BLVD	STE 130	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
180594	Fee-for-Service	1477520096	1477520096	1	1	POTTORFF, GREGG MD	3/25/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	61064	20	Orthopedic Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
180626	Fee-for-Service	1386945947	1386945947	1	2	PHYSICIANS HOSPITAL OF	9/7/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RADIATION ONCOLOGY SRVS	28078 BAXTER RD	SUITE 130	MURRIETA	CA	92563	1403	33	06065	33.615	-117.1670265	Riverside County
180661	Fee-for-Service	1801392204	1801392204	1	1	PACHON, ANDREW MD	7/6/2021	207P00000X	NA	Other	026	PHYSICIANS	163420	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
180698	Fee-for-Service	1407353121	1407353121	1	1	PHILLIPS, VANTEL J MD	9/21/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165014	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
180699	Fee-for-Service	1598702573	1598702573	1	1	PROFES MEDICAL CARE, INC	4/1/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALL HOME MEDICAL SUPPLY	4774 MURIETTA ST	STE 14	CHINO	CA	91710	5155	36	06071	34.0067869	-117.7005154	San Bernardino County
180737	Fee-for-Service	1275852857	1275852857	1	1	PERRILL, ALISSA L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
180753	Fee-for-Service	1518307511	1518307511	1	1	PARAB, MRUNAD G MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137491	26	Psychiatry (child)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
180814	Fee-for-Service	1174186514	1174186514	1	1	PILLAI, PRIYANKA MD	4/28/2023	207R00000X	NA	Other	026	PHYSICIANS	181745	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
180847	Fee-for-Service	1639435100	1639435100	1	1	PERINO, ALEXANDER C MD	7/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126531	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180877	Fee-for-Service	1871607762	1871607762	1	181	PROVIDENCE MEDICAL FOUNDATIO	8/12/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	26800 CROWN VALLEY PKWY	SUITE 215	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
180916	Fee-for-Service	1083185342	1083185342	1	3	PALM PATHOLOGY MEDICAL GROUP	12/21/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, A PROFESSIONAL CORPORA	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
180934	Fee-for-Service	1568273928	1568273928	1	1	POLANIS, ALEXIS V NP	3/12/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
180935	Fee-for-Service	1407120777	1407120777	1	1	POLLARD, ANTHONY M PSYD	10/14/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
180950	Fee-for-Service	1326274176	1326274176	1	1	POUPORE-KING, HEATHER R PHD	10/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180951	Fee-for-Service	1881067890	1881067890	1	1	POWNER, AMBER M	5/30/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
180986	Fee-for-Service	1871607762	1871607762	1	169	PROVIDENCE MEDICAL FOUNDATIO	7/15/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	947 S ANAHEIM BLVD	STE 125	ANAHEIM	CA	92805	5584	30	06059	33.82164135	-117.909385	Orange County
181022	Fee-for-Service	1679770549	1679770549	1	1	PLATINUM NINE HOLDINGS LLC	8/19/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	326 S STILLAGUAMISH AVE	None	ARLINGTON	WA	98223	1652	00	None	48.1897751	-122.117642	Snohomish County
181023	Fee-for-Service	1538351077	1538351077	1	1	PLANNED PARENTHOOD	1/10/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MAR MONTE LAB	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	43	06085	37.3373761	-121.9192532	Santa Clara County
181043	Fee-for-Service	1518307511	1518307511	1	1	PARAB, MRUNAD G MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137491	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
181047	Fee-for-Service	1386718377	1386718377	1	1	PARK, HANS S	4/28/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	92398	01	General Practice	0	In state provider	None	5320 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
181049	Fee-for-Service	1467900332	1467900332	1	1	PEREZ ALVAREZ, CRYSTAL N LMF	5/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
181111	Fee-for-Service	1174545370	1174545370	1	1	PADILLA, JOAHNNA MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96436	15	Obstetrics (D.O. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
181123	Fee-for-Service	1871607762	1871607762	1	144	PROVIDENCE MEDICAL FOUNDATIO	3/2/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	N	1000 TRANCAS ST	SUITE 1	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
181167	Fee-for-Service	1871607762	1871607762	1	181	PROVIDENCE MEDICAL FOUNDATIO	8/12/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	N	26800 CROWN VALLEY PKWY	SUITE 215	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
181178	Fee-for-Service	1336251586	1336251586	1	1	POOLE, VERNON N OD	12/31/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MURRIETA OPTOMETRIC	39872 LOS ALAMOS RD	STE A11	MURRIETA	CA	92562	5745	33	06065	33.5712411	-117.1838408	Riverside County
181209	Fee-for-Service	1992966725	1992966725	1	1	PREM, VLADIMIR MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114888	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
181225	Fee-for-Service	1770635138	1770635138	1	1	PATEL, HETAL SURESH MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74756	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
181233	Fee-for-Service	1972945434	1972945434	1	1	POONATI, HIMABINDU MD	3/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133592	05	Anesthesiology	0	In state provider	None	5974 PENTZ RD	None	FEATHER RIVER	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
181239	Fee-for-Service	1871607762	1871607762	1	128	PROVIDENCE MEDICAL FOUNDATIO	10/11/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	88 MADRONE ST	None	WILLITS	CA	95490	4249	23	06045	39.40096191	-123.3522096	Mendocino County
181261	Fee-for-Service	1891881447	1891881447	1	1	PETRUS, JAIME L MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115136	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
181272	Fee-for-Service	1336549203	1336549203	1	1	PURE HEART CONGREGATE LIVING	1/27/2016	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15918 NAPA ST	None	NORTH HILLS	CA	91343	5838	19	06037	34.22652039	-118.4793414	Los Angeles County
181277	Fee-for-Service	1871607762	1871607762	1	169	PROVIDENCE MEDICAL FOUNDATIO	7/15/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	N	947 S ANAHEIM BLVD	STE 125	ANAHEIM	CA	92805	5584	30	06059	33.82164135	-117.909385	Orange County
181331	Fee-for-Service	1255421335	1255421335	1	1	PHAM, DIEM Q DO	1/21/2009	207NS0135X	NA	Dermatology	026	PHYSICIANS	7309	07	Dermatology	0	In state provider	None	2025 E ROUTE 66	None	GLENDORA	CA	91740	4670	19	06037	34.12802719	-117.8255325	Los Angeles County
181375	Fee-for-Service	1497738082	1497738082	1	1	PASQUALI, LARRY A MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	26153	20	Orthopedic Surgery	0	In state provider	None	3801 KATELLA AVE	STE 414	LOS ALAMITOS	CA	90720	3386	30	06059	33.80318951	-118.066068	Orange County
181411	Fee-for-Service	1871607762	1871607762	1	32	PROVIDENCE MEDICAL FOUNDATIO	5/3/2013	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1100 TRANCAS ST	STE 212A	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
181412	Fee-for-Service	1881928034	1881928034	1	1	PHINNEY, SHEA M LMFT	10/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6518 LONETREE BLVD.	190	ROCKLIN	CA	95765	5874	31	06061	38.8041476	-121.2936557	Placer County
181445	Fee-for-Service	1710099049	1710099049	1	1	PULMONARY ASSOC MEDICAL	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	5565 GROSSMONT CENTER DR	STE 360	LA MESA	CA	91942	3087	37	06073	32.77978322	-117.0094766	San Diego County
181458	Fee-for-Service	1427735612	1427735612	1	1	PACIFIC INTERVENTIONAL NEURO	2/10/2024	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	SCIENCES	2420 SONOMA ST	SUITE B	REDDING	CA	96001	3033	45	06089	40.57316457	-122.4023033	Shasta County
181462	Fee-for-Service	1437225976	1437225976	1	1	PABARI, MEENAL D MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68756	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
181467	Fee-for-Service	1871607762	1871607762	1	139	PROVIDENCE MEDICAL FOUNDATIO	5/9/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1701 4TH ST	STE 200	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
181468	Fee-for-Service	1457345068	1457345068	1	1	PADILLA, ADRIANA R MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69696	08	Family Practice	0	In state provider	None	1401 ROSE AVE	None	SELMA	CA	93662	3231	10	06019	36.56878207	-119.6041038	Fresno County
181478	Fee-for-Service	1700037801	1700037801	1	1	PROVIDENCE HEALTH & SERVICES	5/14/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	1321 COLBY AVE	None	EVERTT	WA	98201	1665	00	None	47.99969831	-122.207987	Snohomish County
181481	Fee-for-Service	1295353431	1295353431	1	1	PLANNED PARENTHOOD LOS	2/5/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	4402 E COMPTON BLVD	EAST RANCHO	DOMINGUEZ	CA	90221	3667	19	06037	33.8960937	-118.1944727	Los Angeles County
181514	Fee-for-Service	1770635138	1770635138	1	1	PATEL, HETAL SURESH MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74756	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
181518	Fee-for-Service	1306248240	1306248240	1	2	PACIFIC HOSPITALIST ASSOCIAT	9/9/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	1555 SUPERIOR AVE	None	NEWPORT BEACH	CA	92663	3628	30	06059	33.6307388	-117.9290205	Orange County
181529	Fee-for-Service	1871607762	1871607762	1	168	PROVIDENCE MEDICAL FOUNDATIO	4/6/2022	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	17059 MAIN ST	None	HESPERIA	CA	92345	6067	36	06071	34.4199033	-117.2908045	San Bernardino County
181553	Fee-for-Service	1336240837	1336240837	1	1	PENA-PRIDMORE, MARY R MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51623	08	Family Practice	0	In state provider	None	151 E WEBSTER STREET	None	COLUSA	CA	95932	2949	06	06011	39.20745427	-122.0008341	Colusa County
181565	Fee-for-Service	1427408616	1427408616	1	1	PATEL, KIRTAN MD	12/30/2019	207R00000X	NA	Other	026	PHYSICIANS	158411	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
181578	Fee-for-Service	1528292646	1528292646	1	1	PARADEE, KAREN U NP	5/18/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2510 EL CAMINO REAL	None	CARLSBAD	CA	92008	1273	37	06073	33.17942276	-117.3266425	San Diego County
181607	Fee-for-Service	1245507904	1245507904	1	1	PALACIOS, DIANA N LCSW	5/13/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
181617	Fee-for-Service	1194109298	1194109298	1	1	PIROZZI, ASHLEY MD	4/24/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147668	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
181639	Fee-for-Service	1578837894	1578837894	1	1	PHILLIPS, MICHAEL J LMFT	3/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13620 LINCOLN WAY	380	AUBURN	CA	95603	3261	31	06061	38.93032866	-121.0549381	Placer County
181658	Fee-for-Service	1588939789	1588939789	1	1	PEREZ, DANIELLE G LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
181661	Fee-for-Service	1497738082	1497738082	1	1	PASQUALI, LARRY A MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	26153	18	Ophthalmology	0	In state provider	None	3801 KATELLA AVE	STE 414	LOS ALAMITOS	CA	90720	3386	30	06059	33.80318951	-118.066068	Orange County
181665	Fee-for-Service	1518904366	1518904366	1	1	PARKISON, LOIS M MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76382	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
181680	Fee-for-Service	1487933719	1487933719	1	1	PECKLER, ZACHARY J MD	12/2/2019	208600000X	NA	General Surgery	026	PHYSICIANS	164058	02	General Surgery	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
181699	Fee-for-Service	1871607762	1871607762	1	40	PROVIDENCE MEDICAL FOUNDATIO	8/5/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	52 MISSION CIR	STE 121	SANTA ROSA	CA	95409	5370	49	06097	38.457882	-122.674104	Sonoma County
181716	Fee-for-Service	1013069236	1013069236	1	1	PAREKH, PRITI MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94926	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
181735	Fee-for-Service	1710099049	1710099049	1	1	PULMONARY ASSOC MEDICAL	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	GROUP INC	5565 GROSSMONT CENTER DR	STE 360	LA MESA	CA	91942	3087	37	06073	32.77978322	-117.0094766	San Diego County
181749	Fee-for-Service	1427735612	1427735612	1	1	PACIFIC INTERVENTIONAL NEURO	2/10/2024	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	SCIENCES	2420 SONOMA ST	SUITE B	REDDING	CA	96001	3033	45	06089	40.57316457	-122.4023033	Shasta County
181765	Fee-for-Service	1700037801	1700037801	1	1	PROVIDENCE HEALTH & SERVICES	5/14/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	1321 COLBY AVE	None	EVERTT	WA	98201	1665	00	None	47.99969831	-122.207987	Snohomish County
181777	Fee-for-Service	1073517801	1073517801	1	1	PARK, MARK J OD	10/17/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PARK FAMILY OPTOMETRY	919 13TH AVE	None	DELANO	CA	93215	2202	15	06029	35.77314701	-119.2458365	Kern County
181786	Fee-for-Service	1669140166	1669140166	1	1	PHANG, ANALEE M LMFT	4/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
181798	Fee-for-Service	1902945702	1902945702	1	1	POLITES, NANCY LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	425 30TH ST	STE 16	NEWPORT BEACH	CA	92663	3730	30	06059	33.61467542	-117.9289357	Orange County
181817	Fee-for-Service	1871607762	1871607762	1	168	PROVIDENCE MEDICAL FOUNDATIO	4/6/2022	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	17059 MAIN ST	None	HESPERIA	CA	92345	6067	36	06071	34.4199033	-117.2908045	San Bernardino County
181824	Fee-for-Service	1467643106	1467643106	1	1	PANTCHEVA, MINA B MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	18	Ophthalmology	2	Out of state provider	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
181896	Fee-for-Service	1487991261	1487991261	1	1	POULSEN, TIFFANI PSYD	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22864	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
181907	Fee-for-Service	1316993199	1316993199	1	1	PERLSTEIN, JON MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61414	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
181924	Fee-for-Service	1295799104	1295799104	1	1	PATEL, DIPA H MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51518	30	Radiology	0	In state provider	None	1001 POTRERO AVE	# 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
181941	Fee-for-Service	1881012334	1881012334	1	1	PERLEGOS, JOHN C MD	4/22/2020	207R00000X	NA	Other	026	PHYSICIANS	146060	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
181981	Fee-for-Service	1215009048	1215009048	1	1	PENN, ESTHER A MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82492	18	Ophthalmology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
182008	Fee-for-Service	1023071362	1023071362	1	1	PEARSON, THOMAS R OD	9/1/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
182036	Fee-for-Service	1427735612	1427735612	1	1	PACIFIC INTERVENTIONAL NEURO	2/10/2024	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SCIENCES	2420 SONOMA ST	SUITE B	REDDING	CA	96001	3033	45	06089	40.57316457	-122.4023033	Shasta County
182055	Fee-for-Service	1992235600	1992235600	1	1	PFEIFFER, KRISTINA V MD	10/1/2021	207P00000X	NA	Other	026	PHYSICIANS	172404	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
182072	Fee-for-Service	1750486239	1750486239	1	1	PAN, CHERYL MD	12/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70582	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
182105	Fee-for-Service	1578576450	1578576450	1	1	PONCE, RICHARD MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	70883	01	General Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
182106	Fee-for-Service	1801039094	1801039094	1	1	PALITZ, JEFF MFT INC	2/12/2018	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2400 FENTON ST	STE 205	CHULA VISTA	CA	91914	3596	37	06073	32.65249316	-116.9608407	San Diego County
182128	Fee-for-Service	1740867175	1740867175	1	1	PONNA, VIMALA DO	2/19/2024	207R00000X	NA	Other	026	PHYSICIANS	20922	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
182134	Fee-for-Service	1164901302	1164901302	1	1	PINNACLE SURGICAL ASSOCIATES	3/18/2019	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1080 DELBON AVE	None	TURLOCK	CA	95382	2014	50	06099	37.51060458	-120.836153	Stanislaus County
182180	Fee-for-Service	1851592745	1851592745	1	2	PAZ, ZOILA A CNM	6/1/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
182197	Fee-for-Service	1316993199	1316993199	1	1	PERLSTEIN, JON MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61414	02	General Surgery	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
182198	Fee-for-Service	1417619818	1417619818	1	1	PABAND, MASSOODA NP	5/20/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7850 VISTA HILL AVE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
182201	Fee-for-Service	1336160860	1336160860	1	1	PETROSSIAN, EDWIN MD	8/2/1995	208G00000X	NA	General Surgery	026	PHYSICIANS	81847	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
182259	Fee-for-Service	1871607762	1871607762	1	157	PROVIDENCE MEDICAL FOUNDATIO	3/1/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
182282	Fee-for-Service	1023075678	1023075678	1	1	PACIFIC BRAIN & SPINE	11/5/2012	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	MEDICAL GROUP INC APC	20055 LAKE CHABOT RD	STE 110	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
182289	Fee-for-Service	1841226990	1841226990	1	10	PHYSICIAN FOUNDATION	11/13/2008	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL ASSOCIATES, INC	750 LAS GALLINAS AVE	SUITE 210	SAN RAFAEL	CA	94903	3438	21	06041	38.00688138	-122.5463961	Marin County
182308	Fee-for-Service	1871607762	1871607762	1	91	PROVIDENCE MEDICAL FOUNDATIO	2/25/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19582 BEACH BLVD	SUITE 360	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
182312	Fee-for-Service	1578823605	1578823605	1	1	PATEL, ERICA DO	12/4/2019	207LP2900X	NA	Other	026	PHYSICIANS	16630	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
182313	Fee-for-Service	1548234453	1548234453	1	1	PRENTISS, GALE T MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79631	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
182339	Fee-for-Service	1629056254	1629056254	1	1	POON, SING WING MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54567	24	Plastic Surgery	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
182383	Fee-for-Service	1841723327	1841723327	1	11	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE DENTAL VAN	5730 PACKARD AVENUE	None	MARYSVILLE	CA	95901	7118	58	06115	39.12014523	-121.5659991	Yuba County
182396	Fee-for-Service	1316025463	1316025463	1	1	PATEL, SANDEEP B DPM	6/23/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
182414	Fee-for-Service	1033218532	1033218532	1	1	PORTILLO, GENGHIS N MD	10/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
182424	Fee-for-Service	1386233161	1386233161	1	1	PEREZ, RYAN A NP	9/20/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	555 E HARDY ST	IRA KAUFMAN PAVILION	INGLEWOOD	CA	90301	4106	19	06037	33.94909549	-118.3481595	Los Angeles County
182436	Fee-for-Service	1871055277	1871055277	1	1	PHILLIPS, STEPHEN MD	10/6/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187902	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
182441	Fee-for-Service	1275282857	1275282857	1	1	PREFERRED IMAGING CENTER INC	9/1/2022	2085R0202X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	.	535 N BRAND BLVD STE 235	None	GLENDALE	CA	91203	3311	19	06037	34.154298	-118.2551395	Los Angeles County
182443	Fee-for-Service	1457108730	1457108730	1	1	PURELY BRIGHT THERAPY SERVIC	6/3/2024	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ES, INC	1710 PLUM LN	SUITE C	REDLANDS	CA	92374	0100	36	06071	34.06896096	-117.2134285	San Bernardino County
182452	Fee-for-Service	1992716484	1992716484	3	1	P&A RX INC	2/21/2025	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2727 W OLYMPIC BLVD	STE 103	LOS ANGELES	CA	90006	2641	19	06037	34.0527015	-118.2931155	Los Angeles County
182463	Fee-for-Service	1053443473	1053443473	2	2	PORT CITY OPERATING COMPANY,	12/15/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TH CENTER	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
182502	Fee-for-Service	1548655921	1548655921	1	1	PETERSEN, TRUDI J NP	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	432166	-	NOT APPLICABLE	0	In state provider	None	1313 CUTTING BLVD	None	RICHMOND	CA	94804	2554	07	06013	37.92523852	-122.3565435	Contra Costa County
182505	Fee-for-Service	1174926448	1174926448	1	1	PARKWAY OPERATIONS LLC	2/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7760 PARKWAY DRIVE	None	LA MESA	CA	91942	2028	37	06073	32.77419289	-117.0296665	San Diego County
182509	Fee-for-Service	1568844843	1568844843	1	1	PERISHO, RYAN LMFT	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1510 FASHION ISLAND BLVD	STE 110	SAN MATEO	CA	94404	5043	41	06081	37.5583415	-122.2861555	San Mateo County
182516	Fee-for-Service	1932225323	1932225323	1	1	PEHLE, DEREK E PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1320 STANDIFORD AVE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
182525	Fee-for-Service	1023063179	1023063179	1	1	PATEL, SHALIN H MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77972	66	Emergency Medicine (Urgent Care)	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
182529	Fee-for-Service	1205227089	1205227089	1	1	PEREZ, KATERINA CNP	9/2/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11525 BROOKSHIRE AVENUE	300	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
182537	Fee-for-Service	1881848273	1881848273	1	1	POPE, JAMES T LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	534 B ST	None	SANTA ROSA	CA	95401	5211	49	06097	38.44296	-122.7177585	Sonoma County
182546	Fee-for-Service	1871607762	1871607762	1	157	PROVIDENCE MEDICAL FOUNDATIO	9/17/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
182549	Fee-for-Service	1437616133	1437616133	1	1	PANVALKAR, MANISHA A PT	6/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
182570	Fee-for-Service	1699416511	1699416511	1	1	PENTEK, BLANKA OT	10/28/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
182588	Fee-for-Service	1104873215	1104873215	1	1	PINZON, FIDEL F MD	12/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	25429	08	Family Practice	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
182593	Fee-for-Service	1609321728	1609321728	1	1	PRODIGY HEALTHCARE INC	8/29/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2311 SIERRA STREET	None	KINGSBURG	CA	93631	1457	10	06019	36.51790845	-119.5458075	Fresno County
182617	Fee-for-Service	1699126961	1699126961	1	1	PATEL, HIMANI DPM	10/3/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
182629	Fee-for-Service	1871607762	1871607762	1	106	PROVIDENCE MEDICAL FOUNDATIO	11/2/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	925 CORPORATE CENTER	SUITE A	SANTA ROSA	CA	95407	5453	49	06097	38.425383	-122.7536235	Sonoma County
182636	Fee-for-Service	1710097886	1710097886	2	1	PRT RX, INC.	1/17/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8700 W PICO BLVD	None	LOS ANGELES	CA	90035	2206	19	06037	34.05436309	-118.3817094	Los Angeles County
182663	Fee-for-Service	1821005877	1821005877	1	1	PASION-GONZALES, LORI	4/15/2024	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4723 W CHERRY CT	None	VISALIA	CA	93277	5793	54	06107	36.30735	-119.3433525	Tulare County
182672	Fee-for-Service	1841723327	1841723327	1	11	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE DENTAL VAN	5730 PACKARD AVENUE	None	MARYSVILLE	CA	95901	7118	58	06115	39.12014523	-121.5659991	Yuba County
182694	Fee-for-Service	1699922369	1699922369	1	1	PRASUN, PANKAJ MD	9/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153575	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
182732	Fee-for-Service	1457108730	1457108730	1	1	PURELY BRIGHT THERAPY SERVIC	6/3/2024	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ES, INC	1710 PLUM LN	SUITE C	REDLANDS	CA	92374	0100	36	06071	34.06896096	-117.2134285	San Bernardino County
182773	Fee-for-Service	1043226665	1043226665	1	1	PHYSICIANS CHOICE PHYSICAL T	6/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HERAPY	12217 SANTA MONICA BLVD	209	LOS ANGELES	CA	90025	2589	19	06037	34.03988283	-118.4648672	Los Angeles County
182785	Fee-for-Service	1720169352	1720169352	1	1	PAGE, JAMES S MD	1/1/1982	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	37699	20	Orthopedic Surgery	0	In state provider	None	KIELY BLVD	None	SANTA CLARA	CA	95051	0000	43	06085	37.33753554	-121.9762223	Santa Clara County
182803	Fee-for-Service	1659875797	1659875797	1	1	PANDYA, DEVAN S MD	9/10/2020	207P00000X	NA	Other	026	PHYSICIANS	163879	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
182811	Fee-for-Service	1952420689	1952420689	1	2	PRESTIGE HOME HEALTH CARE	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	916 W BURBANK BLD	SUITE L	BURBANK	CA	91506	1448	19	06037	34.18397121	-118.3225966	Los Angeles County
182819	Fee-for-Service	1306988423	1306988423	1	1	PEREZ, GRETA MD	5/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55601	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
182823	Fee-for-Service	1326144486	1326144486	1	1	PFAFF,JOHN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	COOK CHILDRENS PHYS	801 SEVENTH AVE	None	FORT WORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
182834	Fee-for-Service	1518038439	1518038439	1	1	PETRILLA, JEFFREY C MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73241	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
182836	Fee-for-Service	1871607762	1871607762	1	157	PROVIDENCE MEDICAL FOUNDATIO	12/26/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
182861	Fee-for-Service	1548291446	1548291446	1	1	PICKART, MICHAEL C MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82357	84	Surgery-Head and Neck	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
182868	Fee-for-Service	1982862322	1982862322	1	1	PANG, JOHN H MD	4/22/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110748	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
182901	Fee-for-Service	1043335227	1043335227	1	1	PENINSULA NEUROLOGICAL	1/1/1984	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	ASSOCIATES	1800 SULLIVAN AVE	RM 602	DALY CITY	CA	94015	2226	41	06081	37.68077723	-122.4728941	San Mateo County
182919	Fee-for-Service	1649611781	1649611781	1	1	PERRY, BARBARA	1/15/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2524 ALAMEDA ST	None	VALLEJO	CA	94590	2404	48	06095	38.12357869	-122.2486918	Solano County
182931	Fee-for-Service	1366519258	1366519258	1	1	PEARLMAN, PAULA J MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48501	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
182935	Fee-for-Service	1255962338	1255962338	1	1	PANTALEON, PHOEBE IRABAGON	11/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
182939	Fee-for-Service	1225344278	1225344278	1	1	PINEDA, JUAN C CRNA	9/28/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
182955	Fee-for-Service	1134109390	1134109390	1	1	PAZIRANDEH, MAHMOOD MD	12/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52328	83	Rheumatology	0	In state provider	None	3633 CAMINO DEL RIO SO	STE 300	SAN DIEGO	CA	92108	4011	37	06073	32.77801447	-117.1163618	San Diego County
182956	Fee-for-Service	1154610319	1154610319	1	1	PATHAK, BHAVANA MD	10/3/2019	207R00000X	NA	Other	026	PHYSICIANS	135301	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
182962	Fee-for-Service	1174716641	1174716641	1	1	PAN, YU PHD	10/4/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
182964	Fee-for-Service	1023194271	1023194271	2	1	PROVIDENCE HEALTH & SERVICES	4/27/2023	273R00000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
182967	Fee-for-Service	1154712669	1154712669	1	1	PELONIA, ALEXANDRA PSYD	10/13/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
182989	Fee-for-Service	1437730454	1437730454	1	1	PARIKH, AMISH DO	1/1/2025	390200000X	NA	Other	026	PHYSICIANS	22207	41	Internal Medicine	0	In state provider	None	100 W. CALIFORNIA BLVD.	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
183009	Fee-for-Service	1194906792	1194906792	1	1	PAVLATOS, NICOLE S MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1567	00	None	39.52483792	-119.7968314	Washoe County
183015	Fee-for-Service	1801236401	1801236401	1	1	PLUYM, ILINA D MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147986	None	None	0	In state provider	None	200 MED PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
183019	Fee-for-Service	1457108730	1457108730	1	1	PURELY BRIGHT THERAPY SERVIC	6/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ES, INC	1710 PLUM LN	SUITE C	REDLANDS	CA	92374	0100	36	06071	34.06896096	-117.2134285	San Bernardino County
183028	Fee-for-Service	1871607762	1871607762	1	142	PROVIDENCE MEDICAL FOUNDATIO	12/18/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
183112	Fee-for-Service	1316474968	1316474968	1	1	PEREZ, MICHAEL A MD	6/17/2021	390200000X	NA	Other	026	PHYSICIANS	172600	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
183125	Fee-for-Service	1871607762	1871607762	1	140	PROVIDENCE MEDICAL FOUNDATIO	7/9/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	N	2460 BUHNE ST	None	EUREKA	CA	95501	3207	12	06023	40.78588193	-124.1402099	Humboldt County
183160	Fee-for-Service	1982862322	1982862322	1	1	PANG, JOHN H MD	4/22/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110748	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
183187	Fee-for-Service	1114968245	1114968245	1	1	PENG, BONNIE C OD	12/17/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14124 FOOTHILL BLVD	STE 101	SYLMAR	CA	91342	8049	19	06037	34.31598785	-118.4413895	Los Angeles County
183219	Fee-for-Service	1952469686	1952469686	1	1	PETTYJOHN, PAUL L	3/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
183252	Fee-for-Service	1023194271	1023194271	2	1	PROVIDENCE HEALTH & SERVICES	4/27/2023	273R00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
183261	Fee-for-Service	1104890151	1104890151	1	1	PALENCIA, ARTURO E MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79244	05	Anesthesiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
183270	Fee-for-Service	1346471927	1346471927	1	1	PATHAK, ASHUTOSH MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114109	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
183276	Fee-for-Service	1174260772	1174260772	1	1	PAINTER, SHAELYN R	9/21/2022	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
183279	Fee-for-Service	1396745501	1396745501	1	1	PHILLIPS, GEOFFREY B MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81671	36	Psychiatry	0	In state provider	None	1430 E CHAPMAN AVE	None	ORANGE	CA	92866	2229	30	06059	33.7877945	-117.83817	Orange County
183283	Fee-for-Service	1720387186	1720387186	1	1	PERETZ, ADDIE M MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121979	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
183316	Fee-for-Service	1518917897	1518917897	1	1	POGGEMEYER, HANS P MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65367	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
183337	Fee-for-Service	1932330883	1932330883	1	1	PAUDEL, SAYUJ	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	162667	41	Internal Medicine	0	In state provider	None	75 NEILSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
183357	Fee-for-Service	1396927729	1396927729	1	1	PANG, NOELENE K MD	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100437	18	Ophthalmology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
183370	Fee-for-Service	1679770903	1679770903	1	1	PAULANTONIO, KRISTINA A MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129898	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
183393	Fee-for-Service	1861437030	1861437030	1	1	PADLIPSKY, PATRICIA S MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65123	40	Pediatrics	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
183413	Fee-for-Service	1871607762	1871607762	1	157	PROVIDENCE MEDICAL FOUNDATIO	11/11/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
183445	Fee-for-Service	1821013897	1821013897	1	1	PRESTON-SMITH, MICHELLE PT	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
183459	Fee-for-Service	1124240239	1124240239	1	1	PATRIQUIN, EDWARD C MD	10/14/2008	390200000X	NA	Other	026	PHYSICIANS	103901	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
183487	Fee-for-Service	1598083909	1598083909	1	1	PHILLIPS, AUTUMN R PHD	10/28/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5333 MISSION CENTER RD	SUITE 100	SAN DIEGO	CA	92108	1347	37	06073	32.77178608	-117.1547851	San Diego County
183501	Fee-for-Service	1891182044	1891182044	1	1	PRESTIGE BARIATRIC AND	6/9/2015	193400000X	NA	Other	026	PHYSICIANS	106886	01	General Practice	0	In state provider	SURGICAL SPECIALISTS INC	8715 CENTER PARKWAY	SUITE A	SACRAMENTO	CA	95823	7921	34	06067	38.439225	-121.4228745	Sacramento County
183505	Fee-for-Service	1285235713	1285235713	1	1	PATACA, KELLY NP	10/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7050 N RECREATION AVE	STE 101	FRESNO	CA	93720	8001	10	06019	36.83835219	-119.7404373	Fresno County
183510	Fee-for-Service	1215178736	1215178736	1	1	PHAM, TUAN A MD INC	5/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	62514	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1148 SAN BERNARDINO ROAD	STE A203	UPLAND	CA	91786	4961	36	06071	34.10140903	-117.6359301	San Bernardino County
183530	Fee-for-Service	1356508402	1356508402	1	1	PENFIELD, JOSHUA D MD	4/26/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	170560	None	None	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
183600	Fee-for-Service	1518917897	1518917897	1	1	POGGEMEYER, HANS P MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65367	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
183614	Fee-for-Service	1598423519	1598423519	1	1	PEPPLER, STEPHANIE NP	11/9/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
183700	Fee-for-Service	1871607762	1871607762	1	140	PROVIDENCE MEDICAL FOUNDATIO	7/9/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	N	2460 BUHNE ST	None	EUREKA	CA	95501	3207	12	06023	40.78588193	-124.1402099	Humboldt County
183721	Fee-for-Service	1962965525	1962965525	1	1	PIROTTE, BENJAMIN D MD	6/29/2022	390200000X	NA	Other	026	PHYSICIANS	177974	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
183744	Fee-for-Service	1679680458	1679680458	1	1	PORTNOW, JANA L MD	8/16/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80221	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
183791	Fee-for-Service	1891182044	1891182044	1	1	PRESTIGE BARIATRIC AND	6/9/2015	193400000X	NA	Other	026	PHYSICIANS	106886	02	General Surgery	0	In state provider	SURGICAL SPECIALISTS INC	8715 CENTER PARKWAY	SUITE A	SACRAMENTO	CA	95823	7921	34	06067	38.439225	-121.4228745	Sacramento County
183797	Fee-for-Service	1801830575	1801830575	1	1	POWELL, ELIZABETH S MD	2/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	48667	01	General Practice	0	In state provider	None	3000 COLBY ST	STE 304	BERKELEY	CA	94705	2058	01	06001	37.85473248	-122.2575793	Alameda County
183800	Fee-for-Service	1952578254	1952578254	1	1	PADIA, SIDDHARTH A MD	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144506	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
183807	Fee-for-Service	1982830840	1982830840	1	1	PATEL, MINESH R DO	10/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14107	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
183808	Fee-for-Service	1508834862	1508834862	1	1	PAMELA DAVIS	1/9/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	119 W IRON AVE	FL 5	SALINA	KS	67401	2600	00	None	38.84052466	-97.61007206	Saline County
183814	Fee-for-Service	1437400165	1437400165	1	1	PREMIER HEALTHCARE SERVICES	6/11/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	6133 BRISTOL PKWY	SUITE 140	CULVER CITY	CA	90230	6657	19	06037	33.98472747	-118.3891179	Los Angeles County
183854	Fee-for-Service	1871969097	1871969097	1	1	PHAM, ALINA OD	11/30/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
183861	Fee-for-Service	1871286427	1871286427	1	2	PIEDMONT ADVANCED CARE INC	2/28/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AL CORPORATION	25919 GADING RD	None	HAYWARD	CA	94544	2725	01	06001	37.64778968	-122.0814136	Alameda County
183863	Fee-for-Service	1609296151	1609296151	1	1	POWELL, SCOTT W MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146046	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
183902	Fee-for-Service	1871607762	1871607762	1	149	PROVIDENCE MEDICAL FOUNDATIO	8/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	5630 SANTA ANA CANYON	None	ANAHEIM	CA	92807	3122	30	06059	33.85124385	-117.7915652	Orange County
183977	Fee-for-Service	1609482454	1609482454	1	1	PETE DME, LLC	12/16/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6080 CENTER DR.	6TH FLOOR SUITE # 639	LOS ANGELES	CA	90045	9205	19	06037	33.97675505	-118.391083	Los Angeles County
183979	Fee-for-Service	1619232956	1619232956	1	1	PENINSULA HOSPITALIST	10/1/2012	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
183990	Fee-for-Service	1871607762	1871607762	1	150	PROVIDENCE MEDICAL FOUNDATIO	11/6/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	N	1837 SUNNY CREST	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
184002	Fee-for-Service	1508459496	1508459496	1	1	PASTERNAK, ANNA R NP	11/29/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
184031	Fee-for-Service	1679680458	1679680458	1	1	PORTNOW, JANA L MD	8/16/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80221	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
184033	Fee-for-Service	1124361951	1124361951	1	1	PRICE, GREGORY DO	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
184034	Fee-for-Service	1700977477	1700977477	1	1	PATEL, NEHAL M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67686	78	Neoplastic Diseases/Oncology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
184063	Fee-for-Service	1770826406	1770826406	1	1	PARK, DEREK MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132155	02	General Surgery	0	In state provider	None	513 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0476	38	06075	37.76344756	-122.4581992	San Francisco County
184067	Fee-for-Service	1437237286	1437237286	1	1	PATEL, SNEHA A MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86207	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
184074	Fee-for-Service	1447983150	1447983150	1	1	POHLHAMMER, ELISE Y OT	1/2/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
184077	Fee-for-Service	1891182044	1891182044	1	1	PRESTIGE BARIATRIC AND	6/9/2015	193400000X	NA	Other	026	PHYSICIANS	106886	67	Endocrinology	0	In state provider	SURGICAL SPECIALISTS INC	8715 CENTER PARKWAY	SUITE A	SACRAMENTO	CA	95823	7921	34	06067	38.439225	-121.4228745	Sacramento County
184091	Fee-for-Service	1851467617	1851467617	1	1	POWELL, PATRICIA M LCSW	1/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9089 BASELINE RD	200	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
184093	Fee-for-Service	1982830840	1982830840	1	1	PATEL, MINESH R DO	10/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14107	10	Gastroenterology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
184097	Fee-for-Service	1295370351	1295370351	1	1	PRESTIGE PULMONARY CONSULTAN	6/22/2020	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	TS INC	500 N GARFIELD AVE	STE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
184180	Fee-for-Service	1275982852	1275982852	1	1	PHAM, MELISSA MD	10/11/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
184191	Fee-for-Service	1871607762	1871607762	1	149	PROVIDENCE MEDICAL FOUNDATIO	8/13/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	5630 SANTA ANA CANYON	None	ANAHEIM	CA	92807	3122	30	06059	33.85124385	-117.7915652	Orange County
184240	Fee-for-Service	1871607762	1871607762	1	129	PROVIDENCE MEDICAL FOUNDATIO	10/18/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3200 WALFORD AVE	None	EUREKA	CA	95503	4828	12	06023	40.77887445	-124.1378239	Humboldt County
184242	Fee-for-Service	1760425862	1760425862	1	3	PROVIDENCE MEDICAL INSTITUTE	6/15/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
184277	Fee-for-Service	1487725388	1487725388	1	1	PAGEL, KIRK D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44554	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
184305	Fee-for-Service	1962446039	1962446039	2	1	PARK, LOUIS S	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79245	41	Internal Medicine	0	In state provider	None	201 S ALVARADO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
184323	Fee-for-Service	1700977477	1700977477	1	1	PATEL, NEHAL M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67686	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
184327	Fee-for-Service	1730289463	1730289463	1	1	POLISKY, MICHAEL A MD	12/20/2022	207R00000X	NA	Other	026	PHYSICIANS	76529	None	None	0	In state provider	None	2625 W ALAMEDA AVE	404, 518	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
184365	Fee-for-Service	1922363183	1922363183	1	1	PARK, SAMUEL MD	6/19/2020	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	127125	39	Preventive (M.D. only)	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
184398	Fee-for-Service	1396824090	1396824090	1	1	PARK, JAMES M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79414	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
184432	Fee-for-Service	1174755789	1174755789	1	1	POWERS, THOMAS W MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116516	20	Orthopedic Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
184454	Fee-for-Service	1477596872	1477596872	1	1	PILLOW, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
184458	Fee-for-Service	1134756729	1134756729	1	1	PETERSON, EMILY A MD	9/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183133	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
184484	Fee-for-Service	1982829792	1982829792	1	1	PINERS NAPA AMB SVC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1820 PUEBLO AVE	None	NAPA	CA	94558	4751	28	06055	38.3142611	-122.3056178	Napa County
184522	Fee-for-Service	1174682124	1174682124	1	1	PRINCE, KELLEY A MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103486	08	Family Practice	0	In state provider	None	250 E YALE LOOP	STE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
184530	Fee-for-Service	1760425862	1760425862	1	3	PROVIDENCE MEDICAL INSTITUTE	6/15/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
184553	Fee-for-Service	1386663227	1386663227	1	1	PANTUCK, ALLAN J MD	5/1/1999	208800000X	NA	Other	026	PHYSICIANS	85029	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
184565	Fee-for-Service	1487725388	1487725388	1	1	PAGEL, KIRK D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44554	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
184574	Fee-for-Service	1821176504	1821176504	1	1	PHAM, JUNE L MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87436	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
184581	Fee-for-Service	1417900531	1417900531	1	1	PLANNED PARENTHOOD	5/1/1975	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	225 SAN ANTONIO RD	None	MOUNTAIN VIEW	CA	94040	1209	43	06085	37.40620433	-122.110589	Santa Clara County
184599	Fee-for-Service	1962446039	1962446039	2	1	PARK, LOUIS S	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79245	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	201 S ALVARADO ST	STE 505	LOS ANGELES	CA	90057	2385	19	06037	34.06417777	-118.2719543	Los Angeles County
184604	Fee-for-Service	1417375395	1417375395	1	1	PINON-GUTIERREZ, ROGELIO MD	6/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140028	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95820	1536	34	06067	38.555181	-121.4566785	Sacramento County
184607	Fee-for-Service	1285135749	1285135749	1	1	PFAFFMANN, BLAISE S AU	1/9/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
184615	Fee-for-Service	1285346809	1285346809	1	2	PAJARO VALLEY HEALTH CARE DI	3/4/2024	207R00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	65 NIELSON ST	STE 102	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
184627	Fee-for-Service	1619138872	1619138872	1	1	PANDYA, KRUTI A MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127650	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
184650	Fee-for-Service	1083928501	1083928501	1	1	PALM SPRINGS ANESTHESIA	8/29/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERVICES PC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
184653	Fee-for-Service	1851412696	1851412696	1	1	PAKALA, SHILPA R MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88007	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
184669	Fee-for-Service	1336373414	1336373414	1	1	PELED, ANNE G MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107480	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
184694	Fee-for-Service	1194709444	1194709444	1	1	PALMIERI, TINA L MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85254	None	None	0	In state provider	None	4301 X ST	None	SACRAMENTO	CA	95817	2214	34	06067	38.5536003	-121.455135	Sacramento County
184703	Fee-for-Service	1538107057	1538107057	1	1	PETROSOVA, NATALIA MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79899	05	Anesthesiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
184704	Fee-for-Service	1265989255	1265989255	1	1	PENA, ELMMA J PT	9/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	291 EAST MAIN ST.	D, E	LOS GATOS	CA	95030	6137	43	06085	37.22109751	-121.9747502	Santa Clara County
184709	Fee-for-Service	1215918883	1215918883	1	1	PEARE, GREGORY D. MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	2281 W 24TH ST	STE 2	YUMA	AZ	85364	6197	00	None	32.68368	-114.64776	Yuma County
184720	Fee-for-Service	1851854806	1851854806	1	1	PALUY, MICHAEL MD	8/10/2024	207L00000X	NA	Other	026	PHYSICIANS	178932	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
184750	Fee-for-Service	1285056994	1285056994	1	1	PINE MOUNTAIN NURSING HEALTH	4/25/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	16233 ASKIN DRIVE	STE A	FRAZIER PARK	CA	93222	5536	15	06029	34.85010626	-119.1648907	Kern County
184753	Fee-for-Service	1861064792	1861064792	1	1	PREFERRED THERAPY SERVICES I	1/11/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC	6962 BOULDER AVE	None	HIGHLAND	CA	92346	3328	36	06071	34.12738951	-117.1956728	San Bernardino County
184784	Fee-for-Service	1447011655	1447011655	1	1	PRUITT, JAYA	2/29/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
184823	Fee-for-Service	1760425862	1760425862	1	3	PROVIDENCE MEDICAL INSTITUTE	6/15/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
184834	Fee-for-Service	1811050156	1811050156	1	1	PHYSICAL THERAPY-SPORTS INST	12/20/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ITUTE, INC.	1515 W FLORIDA AVE	SUITE E	HEMET	CA	92543	3817	33	06065	33.74738653	-116.9879535	Riverside County
184854	Fee-for-Service	1740285907	1740285907	1	1	PARK, SAMUEL M MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87601	25	Physical Medicine and Rehabilitation	0	In state provider	None	340 W EAST AVE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
184856	Fee-for-Service	1790312619	1790312619	1	1	PHAM, BINH MD	1/22/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
184866	Fee-for-Service	1437173051	1437173051	1	1	PITERS, KENNETH M MD	2/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	29348	05	Anesthesiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
184870	Fee-for-Service	1760896104	1760896104	1	1	PACIFIC CENTRAL COAST HEALTH	8/17/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1941 JOHNSON AVE	SUITE 301	SAN LUIS OBISPO	CA	93401	4175	40	06079	35.27804785	-120.649711	San Luis Obispo County
184879	Fee-for-Service	1174579957	1174579957	1	1	PLANNED PARENTHOOD MAR MONTE	1/31/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	678 N WILSON WAY	STE G	STOCKTON	CA	95205	4272	39	06077	37.962954	-121.2735326	San Joaquin County
184892	Fee-for-Service	1275516544	1275516544	1	1	PADBURY, JAMES F MD	1/24/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	27131	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
184894	Fee-for-Service	1841288842	1841288842	1	1	PHAN, GIA-HUNG L DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1654 BURDETTE AVE	STE 185	SAN JOSE	CA	95121	1630	43	06085	37.31999311	-121.825499	Santa Clara County
184907	Fee-for-Service	1265528111	1265528111	1	1	PATHAK, RAJIV J MD	2/26/2025	207R00000X	NA	Other	026	PHYSICIANS	143677	41	Internal Medicine	0	In state provider	None	31001 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	8703	30	06059	33.50974262	-117.6596065	Orange County
184913	Fee-for-Service	1619138872	1619138872	1	1	PANDYA, KRUTI A MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127650	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
184935	Fee-for-Service	1083928501	1083928501	1	1	PALM SPRINGS ANESTHESIA	2/28/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	SERVICES PC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
184939	Fee-for-Service	1679319792	1679319792	1	1	PAGANO, KATELYN OT	1/1/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	733 CEDAR STREET	None	GARBERVILLE	CA	95542	3201	12	06023	40.10148699	-123.7927018	Humboldt County
184942	Fee-for-Service	1992870042	1992870042	1	1	PHYSICIAN FOUNDATION AT CPMC	1/16/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3801 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
184947	Fee-for-Service	1417451170	1417451170	1	1	PARK, BRIAN H MD	8/15/2022	207L00000X	NA	Other	026	PHYSICIANS	180014	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
184953	Fee-for-Service	1447419833	1447419833	1	1	PATEL, YOGESH V MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97026	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
184971	Fee-for-Service	1629385836	1629385836	1	1	PRETORIUS, GERT D V MD	12/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113774	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
185037	Fee-for-Service	1487607792	1487607792	1	1	PINEY WOODS HEALTHCARE SYSTE	7/31/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	505 S JOHN REDDITT DR	None	LUFKIN	TX	75904	3120	00	None	31.32808527	-94.75619799	Angelina County
185040	Fee-for-Service	1285056994	1285056994	1	1	PINE MOUNTAIN NURSING HEALTH	10/13/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	16233 ASKIN DRIVE	STE A	FRAZIER PARK	CA	93222	5536	15	06029	34.85010626	-119.1648907	Kern County
185055	Fee-for-Service	1871607762	1871607762	1	35	PROVIDENCE MEDICAL FOUNDATIO	5/3/2013	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	N	1100 TRANCAS ST	STE 210	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
185070	Fee-for-Service	1598077364	1598077364	1	1	PREMIER HEALTHCARE SERVICES	4/20/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	338 VIA VERA CRUZ	STE 210	SAN MARCOS	CA	92078	2647	37	06073	33.13698917	-117.1888061	San Diego County
185119	Fee-for-Service	1104191592	1104191592	2	1	PGBB LLC	12/7/2015	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 E. KATELLA AVE	SUITE A	ORANGE	CA	92867	0000	30	06059	33.80906952	-117.851751	Orange County
185137	Fee-for-Service	1912950130	1912950130	1	1	PATSY A UKEN	11/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1210 W 18TH ST	STE LL03	SIOUX FALLS	SD	57104	4654	00	None	43.537329	-96.743223	Minnehaha County
185164	Fee-for-Service	1336502814	1336502814	1	1	PETERSON, ALEXANDER B MD	9/2/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	154775	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
185167	Fee-for-Service	1982704516	1982704516	1	1	PALMER, JONATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	7102	00	None	34.744437	-92.3813595	Pulaski County
185191	Fee-for-Service	1528200425	1528200425	1	2	PATRIOT HOME HEALTH CARE INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	440 W COLORADO ST	SUITE 215	GLENDALE	CA	91204	3065	19	06037	34.14249549	-118.2628035	Los Angeles County
185275	Fee-for-Service	1811450968	1811450968	1	1	PATEL, NIMESH A DO	6/18/2023	207L00000X	NA	Other	026	PHYSICIANS	21216	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
185277	Fee-for-Service	1669674644	1669674644	1	1	PRIVETT, DARRIN D MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100314	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
185280	Fee-for-Service	1255302089	1255302089	1	1	PILPOUL, ANAT MD	8/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89102	40	Pediatrics	0	In state provider	None	751 S BASCON AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
185281	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	11/20/2023	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
185286	Fee-for-Service	1073661914	1073661914	1	1	PIANIM, NANA A MD	5/31/1990	208C00000X	NA	General Surgery	026	PHYSICIANS	69574	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
185317	Fee-for-Service	1851584486	1851584486	1	1	PACIFIC CARDIOVASCULAR	4/6/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	AND THORACIC	11190 WARNER AVE	STE 303	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
185326	Fee-for-Service	1285056994	1285056994	1	1	PINE MOUNTAIN NURSING HEALTH	3/21/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	16233 ASKIN DRIVE	STE A	FRAZIER PARK	CA	93222	5536	15	06029	34.85010626	-119.1648907	Kern County
185327	Fee-for-Service	1487607792	1487607792	1	1	PINEY WOODS HEALTHCARE SYSTE	7/31/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	505 S JOHN REDDITT DR	None	LUFKIN	TX	75904	3120	00	None	31.32808527	-94.75619799	Angelina County
185376	Fee-for-Service	1669767943	1669767943	1	1	PALMERO, GOLDA O MD	6/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	127078	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
185402	Fee-for-Service	1710306048	1710306048	1	1	PRASHANT, GIYARPURAM N MD	10/7/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	142094	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
185413	Fee-for-Service	1558998500	1558998500	1	1	PATEL, ARISHNA C MD	7/12/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187207	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
185472	Fee-for-Service	1780362814	1780362814	1	1	PETERSEN, KATE E PSYD	3/13/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
185494	Fee-for-Service	1821356742	1821356742	1	1	PREMIER SURGICAL ASSOC	3/25/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	PALM SPRINGS INC	1180 N INDIAN CANYON DR	STE E421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
185506	Fee-for-Service	1023351806	1023351806	1	1	PHAM, KIMBERLY Q OD	5/11/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
185556	Fee-for-Service	1487617791	1487617791	1	1	PHILLIO BUFFORD	2/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
185560	Fee-for-Service	1407245665	1407245665	1	1	PHELPS, DENNIS B MD INC	3/11/2015	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	35221	20	Orthopedic Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 208	SANTA BARBARA	CA	93105	3877	42	06083	34.43202913	-119.7212339	Santa Barbara County
185571	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	1/22/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
185606	Fee-for-Service	1407189657	1407189657	1	1	PAGTAMA, JUDY Y NP	7/21/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185615	Fee-for-Service	1285056994	1285056994	1	1	PINE MOUNTAIN NURSING HEALTH	10/13/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	16233 ASKIN DRIVE	STE A	FRAZIER PARK	CA	93222	5536	15	06029	34.85010626	-119.1648907	Kern County
185643	Fee-for-Service	1104901131	1104901131	2	2	PETRA PHARMACY CORP	6/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1477 SOUTH SAN JACINTO A	None	SAN JACINTO	CA	92583	5105	33	06065	33.77331006	-116.9587885	Riverside County
185659	Fee-for-Service	1043465388	1043465388	1	1	PARTOVI, SHAY MD	12/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106967	08	Family Practice	0	In state provider	None	9375 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
185674	Fee-for-Service	1699979153	1699979153	1	1	PALMDALE SCHOOL DIST	11/16/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	39139 10TH ST E	None	PALMDALE	CA	93550	3419	19	06037	34.592544	-118.1120755	Los Angeles County
185698	Fee-for-Service	1760415178	1760415178	1	1	PARHIZKAR, NOOSHIN MD	2/11/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	109103	04	Otology, Laryngology, Rhinology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185713	Fee-for-Service	1346378114	1346378114	1	1	PHAM-DIAZ, THAO T OD	5/7/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5261 ARLINGTON AVE	None	RIVERSIDE	CA	92504	2604	33	06065	33.94609195	-117.4170522	Riverside County
185717	Fee-for-Service	1568534683	1568534683	1	1	POWERS, SCOTT N PT	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
185782	Fee-for-Service	1821356742	1821356742	1	1	PREMIER SURGICAL ASSOC	3/25/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	PALM SPRINGS INC	1180 N INDIAN CANYON DR	STE E421	PALM SPRINGS	CA	92262	4882	33	06065	33.839505	-116.5455735	Riverside County
185831	Fee-for-Service	1245388065	1245388065	1	1	PARDO, VICTORIA R MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69261	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
185846	Fee-for-Service	1407245665	1407245665	1	1	PHELPS, DENNIS B MD INC	3/11/2015	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	35221	46	Hand Surgery	0	In state provider	None	2323 DE LA VINA ST	STE 208	SANTA BARBARA	CA	93105	3877	42	06083	34.43202913	-119.7212339	Santa Barbara County
185859	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	1/22/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
185866	Fee-for-Service	1871607762	1871607762	1	171	PROVIDENCE MEDICAL FOUNDATIO	11/22/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	SUITE 103	SANTA ROSA	CA	95405	4558	49	06097	38.44332	-122.6985255	Sonoma County
185869	Fee-for-Service	1114439684	1114439684	1	1	PHUONG, CHRISTINA MD	7/12/2024	2085R0001X	NA	Other	026	PHYSICIANS	182450	32	Radiation Therapy (D.O. only)	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
185875	Fee-for-Service	1912060732	1912060732	1	1	PLUMMER, HOLLY A LMFT	2/23/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30011 IVY GLENN DR.	SUITE 206	LAGUNA NIGUEL	CA	92677	5017	30	06059	33.52732273	-117.715146	Orange County
185906	Fee-for-Service	1902278187	1902278187	1	1	PHILLIPS, DANNY N LCSW	10/3/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 E TAHQUITZ CANYON W	3	PALM SPRINGS	CA	92262	7045	33	06065	33.82322949	-116.5230675	Riverside County
185908	Fee-for-Service	1093085102	1093085102	1	1	PLACID PATH HOSPICE LLC	8/7/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	150 4TH AVENUE NORTH	SUITE 2300	NASHVILLE	TN	37219	2466	19	06037	36.16270091	-86.77830671	Davidson County
185920	Fee-for-Service	1518979418	1518979418	1	1	PISTEL, WILLIAM L DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7594	20	Orthopedic Surgery	0	In state provider	STANISLAUS ORTHOP SPORTS	609 E ORANGEBURG AVE	STE 201	MODESTO	CA	95350	5580	50	06099	37.66364947	-120.9857985	Stanislaus County
185927	Fee-for-Service	1073908885	1073908885	1	1	PATEL, VIKRAM R MD	8/9/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	178681	None	None	0	In state provider	None	1083 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65821658	-121.6450795	Monterey County
185956	Fee-for-Service	1275038861	1275038861	1	1	PIMENTEL, MATTHEW A MD	10/14/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	181247	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
185961	Fee-for-Service	1336226331	1336226331	1	1	PRICE, ELIZABETH A MD	12/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82817	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185963	Fee-for-Service	1104956291	1104956291	1	1	PEREZ, LATICHA R LMFT	10/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	STE 6	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
185983	Fee-for-Service	1316110455	1316110455	1	1	PAYDAR, KIARASH MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119688	05	Anesthesiology	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
185997	Fee-for-Service	1912019563	1912019563	1	1	PAIK-TESCH, JOHN B MD	9/30/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75912	08	Family Practice	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
186004	Fee-for-Service	1235178385	1235178385	1	1	PHILIP F BRONOWITZ, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9901 ROYAL LN	STE 106	DALLAS	TX	75231	1830	00	None	32.89460545	-96.723045	Dallas County
186007	Fee-for-Service	1871607762	1871607762	1	159	PROVIDENCE MEDICAL FOUNDATIO	3/1/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
186008	Fee-for-Service	1861648669	1861648669	1	1	PERLSTEIN, RACHEL L LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
186019	Fee-for-Service	1194722801	1194722801	1	1	PACIFIC ORTHOPAEDIC	10/12/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	MEDICAL GROUP, INC	707 S GARFIELD AVE	None	ALHAMBRA	CA	91801	5859	19	06037	34.088688	-118.123106	Los Angeles County
186021	Fee-for-Service	1043268840	1043268840	1	2	PREMIERE SURGERY CENTER, INC	8/5/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	.	700 W. EL NORTE	None	ESCONDIDO	CA	92026	3923	37	06073	33.14611822	-117.1023285	San Diego County
186033	Fee-for-Service	1790762573	1790762573	1	1	POURKARAM, NANCY T DPM	6/1/2003	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CHAPMAN FOOT & ANKLE CLI	1966 E CHAPMAN AVE	STE C	FULLERTON	CA	92831	4142	30	06059	33.87415051	-117.896427	Orange County
186059	Fee-for-Service	1740268077	1740268077	1	1	PODBERESKY, DANIEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
186069	Fee-for-Service	1578627022	1578627022	1	1	PAIN CARE PROVIDERS A	1/27/2012	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	PROFESSIONAL MEDICAL COR	113 WATERWORKS WY	STE 345	IRVINE	CA	92618	2126	30	06059	33.66497942	-117.7635578	Orange County
186075	Fee-for-Service	1215600945	1215600945	1	1	PACIFIC COAST CRITICAL CARE	10/1/2021	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
186080	Fee-for-Service	1760425862	1760425862	1	10	PROVIDENCE MEDICAL INSTITUTE	2/24/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	201 S. BUENA VISTA ST.	SUITE 100	BURBANK	CA	91505	4570	19	06037	34.15978726	-118.3289164	Los Angeles County
186083	Fee-for-Service	1477176204	1477176204	1	1	PRISTINE HOSPICE INC	1/3/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	400 N MOUNTAIN AVE	STE 123B	UPLAND	CA	91786	5176	36	06071	34.098489	-117.670074	San Bernardino County
186094	Fee-for-Service	1316968555	1316968555	1	1	PRASAD, ARTI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNMH	2211 LOMAS NE	None	ALBUQUERQUE	NM	87131	0000	00	None	35.08771808	-106.6192188	Bernalillo County
186097	Fee-for-Service	1437906500	1437906500	1	1	PIORKOWSKI, KAYLA CCC-SLP	10/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	667 LIGHTHOUSE AVE	201	PACIFIC GROVE	CA	93950	2644	27	06053	36.62205802	-121.9200608	Monterey County
186098	Fee-for-Service	1841619038	1841619038	1	1	PEARSON, BRANDON M MD	7/25/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
186104	Fee-for-Service	1972789642	1972789642	2	1	PHARMACY4HUMANITY	6/17/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8212 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90046	5913	19	06037	34.0907007	-118.3675202	Los Angeles County
186112	Fee-for-Service	1649667288	1649667288	1	1	PUGA, SUSANNA LMFT	10/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	224 W GRAHAM AVE	None	LAKE ELSINORE	CA	92530	3740	33	06065	33.66853666	-117.3296688	Riverside County
186132	Fee-for-Service	1023189099	1023189099	1	1	POTREBIC, SONJA B MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55962	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	STE A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186146	Fee-for-Service	1871607762	1871607762	1	109	PROVIDENCE MEDICAL FOUNDATIO	9/22/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
186152	Fee-for-Service	1326057373	1326057373	1	1	PHOENIX MEDICAL DEVICES, LLC	10/15/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PAIN RELIEF TECHNOLOGIES	2458 ALTON PARKWAY	None	IRVINE	CA	92606	5037	30	06059	33.69144961	-117.8363741	Orange County
186155	Fee-for-Service	1750471199	1750471199	1	1	PADILLA, BRIAN T	8/2/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	5673	57	06113	38.55491538	-121.7876886	Yolo County
186193	Fee-for-Service	1093085102	1093085102	1	1	PLACID PATH HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	150 4TH AVENUE NORTH	SUITE 2300	NASHVILLE	TN	37219	2466	19	06037	36.16270091	-86.77830671	Davidson County
186204	Fee-for-Service	1568814846	1568814846	1	1	PARK, DANIEL H MD	6/4/2020	390200000X	NA	Other	026	PHYSICIANS	153817	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
186213	Fee-for-Service	1548216765	1548216765	1	1	PETERSON,RODNEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	0000	00	None	40.248072	-111.6673905	Utah County
186257	Fee-for-Service	1255697686	1255697686	1	1	PATEL, ANKUR D MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130850	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
186274	Fee-for-Service	1679807010	1679807010	1	1	PHAM, DENISE N U LCSW	3/6/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	STE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
186286	Fee-for-Service	1942301445	1942301445	1	1	PFIEFLE, HARVEY D MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	34821	08	Family Practice	0	In state provider	None	3975 JACKSON ST	STE 101	RIVERSIDE	CA	92503	3938	33	06065	33.92729721	-117.4413503	Riverside County
186296	Fee-for-Service	1871607762	1871607762	1	159	PROVIDENCE MEDICAL FOUNDATIO	11/27/2024	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
186306	Fee-for-Service	1598930059	1598930059	1	1	PARROTT, MEDIE NP	8/1/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15259	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
186316	Fee-for-Service	1770937815	1770937815	1	1	PEARLMAN SHAPIRO, MARIT MD	12/5/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181783	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
186340	Fee-for-Service	1871607762	1871607762	1	94	PROVIDENCE MEDICAL FOUNDATIO	5/9/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
186345	Fee-for-Service	1609308733	1609308733	1	1	PHAN, HUY A MD	8/4/2020	207P00000X	NA	Other	026	PHYSICIANS	169286	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
186371	Fee-for-Service	1477176204	1477176204	1	1	PRISTINE HOSPICE INC	1/3/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	400 N MOUNTAIN AVE	STE 123B	UPLAND	CA	91786	5176	36	06071	34.098489	-117.670074	San Bernardino County
186377	Fee-for-Service	1275636201	1275636201	1	2	PASCUAL, FILOMENA S MD	1/25/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	42652	40	Pediatrics	0	In state provider	None	8710 MONROE CT	STE 200	RANCHO CUCAMONGA	CA	91730	4884	36	06071	34.09544496	-117.5747968	San Bernardino County
186378	Fee-for-Service	1043416787	1043416787	1	1	PADILLA, MICHAEL A MD	3/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116644	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186392	Fee-for-Service	1265004634	1265004634	1	1	PEOPLES CHOICE HOME HEALTH	8/30/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	5301 LAUREL CANYON BLVD	SUITE 124	VALLEY VILLAGE	CA	91607	2769	19	06037	34.166907	-118.396546	Los Angeles County
186396	Fee-for-Service	1922502335	1922502335	1	1	PATEL, PRATIK D DO	4/11/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19093	None	None	0	In state provider	None	350 30TH ST	100	OAKLAND	CA	94609	3422	01	06001	37.81892183	-122.2640154	Alameda County
186420	Fee-for-Service	1548908163	1548908163	1	1	PLATINUM DIAGNOSTICS LLC	6/21/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3 CORNWALL DR	SUITE 100	EAST BRUNSWICK	NJ	08816	3311	00	None	40.41078548	-74.42103613	Middlesex County
186425	Fee-for-Service	1134133358	1134133358	1	1	PATEL, RAVI R MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95922	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
186434	Fee-for-Service	1871607762	1871607762	1	109	PROVIDENCE MEDICAL FOUNDATIO	12/7/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
186448	Fee-for-Service	1760406615	1760406615	1	1	PADILLA, GUADALUPE MD	10/31/1987	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	40747	40	Pediatrics	0	In state provider	None	1040 ELM AVE	STE 301	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
186454	Fee-for-Service	1417391301	1417391301	1	1	PRYOR, LINDSEY L MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143457	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
186462	Fee-for-Service	1841226990	1841226990	1	12	PHYSICIAN FOUNDATION	12/12/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL ASSOCIATES, INC	1625 VAN NESS	None	SAN FRANCISCO	CA	94109	4586	38	06075	37.79086154	-122.4225663	San Francisco County
186526	Fee-for-Service	1821002288	1821002288	1	1	PARK,WILLIAM BYUNG HO M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52866	None	None	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
186583	Fee-for-Service	1871607762	1871607762	1	159	PROVIDENCE MEDICAL FOUNDATIO	7/17/2019	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
186589	Fee-for-Service	1457569303	1457569303	1	1	PATEL, MALHAR P MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81226	41	Internal Medicine	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
186593	Fee-for-Service	1093956849	1093956849	1	1	PATIENT CARE MEDICAL CNETER	9/1/2009	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	INC	330 S GARFIELD AVE	STE 248	ALHAMBRA	CA	91801	3896	19	06037	34.09137167	-118.1241735	Los Angeles County
186599	Fee-for-Service	1548236243	1548236243	1	1	PATEL, SHARAD S MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25839	41	Internal Medicine	0	In state provider	None	501 SOUTH BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
186624	Fee-for-Service	1942200100	1942200100	1	1	POSNER, DAVID M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	38375	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
186632	Fee-for-Service	1518461888	1518461888	1	1	POSTLETHWAIT, RACHAEL A MD	10/18/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	177548	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
186642	Fee-for-Service	1568424422	1568424422	1	1	PALAFOX, BRIAN A MD	7/19/1999	174400000X	NA	Other	026	PHYSICIANS	33498	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
186648	Fee-for-Service	1063523595	1063523595	1	1	PASKIN, JARED A MD	3/11/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45379	08	Family Practice	0	In state provider	None	535 W 25TH ST	None	MERCED	CA	95340	2801	24	06047	37.30968971	-120.4794777	Merced County
186650	Fee-for-Service	1801962592	1801962592	2	1	PARK, SUNGHO DO	2/14/2022	207L00000X	NA	Other	026	PHYSICIANS	7204	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
186679	Fee-for-Service	1821416025	1821416025	1	1	PARK, JOYCE H MD	6/17/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	156381	07	Dermatology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
186680	Fee-for-Service	1366644676	1366644676	1	1	PUJAZON, MELISSA A MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104965	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
186684	Fee-for-Service	1609419670	1609419670	1	1	PARRISH, WENDELL R CRNA	6/6/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5176 HILL RD E.	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
186703	Fee-for-Service	1932337748	1932337748	1	1	PERKEL, MARC PSYD	9/12/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
186715	Fee-for-Service	1740410182	1740410182	1	9	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	1666 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5113	36	06071	34.129395	-117.2788075	San Bernardino County
186720	Fee-for-Service	1710039607	1710039607	1	1	PLEET, HELAINE B MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37228	40	Pediatrics	0	In state provider	None	1063 SAN PABLO AVE	STE B	PINOLE	CA	94564	2473	07	06013	38.00437479	-122.3038873	Contra Costa County
186724	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	1/22/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
186754	Fee-for-Service	1841226990	1841226990	1	12	PHYSICIAN FOUNDATION	12/12/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MEDICAL ASSOCIATES, INC	1625 VAN NESS	None	SAN FRANCISCO	CA	94109	4586	38	06075	37.79086154	-122.4225663	San Francisco County
186755	Fee-for-Service	1881666774	1881666774	1	1	PURNELL, MIKI T MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80786	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186770	Fee-for-Service	1871607762	1871607762	1	163	PROVIDENCE MEDICAL FOUNDATIO	1/22/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	1140 W LA VETA AVE	STE 770	ORANGE	CA	98268	4225	30	06059	33.7802984	-117.8651669	Orange County
186790	Fee-for-Service	1871607762	1871607762	1	175	PROVIDENCE MEDICAL FOUNDATIO	12/11/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	13400 JAMBOREE RD	None	IRVINE	CA	92602	2308	30	06059	33.724863	-117.788022	Orange County
186795	Fee-for-Service	1508285735	1508285735	1	1	PEREZ, FELIPE D MD	8/9/2019	207L00000X	NA	Other	026	PHYSICIANS	140584	05	Anesthesiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
186827	Fee-for-Service	1053489872	1053489872	1	1	PLANNED PARENTHOOD	4/29/1996	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	GOLDEN GATE	1866 B ST	None	HAYWARD	CA	94541	3139	01	06001	37.68271803	-122.0657206	Alameda County
186853	Fee-for-Service	1871607762	1871607762	1	138	PROVIDENCE MEDICAL FOUNDATIO	6/14/2021	207Q00000X	NA	Adult Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	N	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
186865	Fee-for-Service	1871607762	1871607762	1	125	PROVIDENCE MEDICAL FOUNDATIO	4/30/2021	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	2280 HARRISON AVE	STE K	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
186871	Fee-for-Service	1871607762	1871607762	1	159	PROVIDENCE MEDICAL FOUNDATIO	3/16/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
186872	Fee-for-Service	1508288291	1508288291	1	1	PULMONARY & CRITICAL CARE	3/24/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	GROUP OF ORANGE COUNTY	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
186877	Fee-for-Service	1457569303	1457569303	1	1	PATEL, MALHAR P MD	9/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81226	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
186912	Fee-for-Service	1447279799	1447279799	1	1	PRESSMAN, LEAH J PHD	10/22/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
186920	Fee-for-Service	1699265629	1699265629	1	1	PHAETON, BELLINY M MD	10/17/2022	207R00000X	NA	Other	026	PHYSICIANS	180520	None	None	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
186927	Fee-for-Service	1568424422	1568424422	1	1	PALAFOX, BRIAN A MD	7/19/1999	174400000X	NA	Other	026	PHYSICIANS	33498	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
186972	Fee-for-Service	1902839418	1902839418	1	1	PRETORIUS, DOLORES H MD	7/1/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	39102	30	Radiology	0	In state provider	UCSD DEPT OF RADIOLOGY	225 DICKINSON ST	# H756	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
186977	Fee-for-Service	1538292404	1538292404	1	1	PROHEALTH PARTNERS	5/10/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	1045 ATLANTIC AVE	STE 708	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
186990	Fee-for-Service	1801252226	1801252226	1	1	PURDUE, CRYSTAL LCSW	12/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
187001	Fee-for-Service	1467590158	1467590158	1	1	PROVENCIO, AUGUSTINE Q	9/28/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48099	None	None	0	In state provider	MD	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
187003	Fee-for-Service	1740410182	1740410182	1	9	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	1666 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5113	36	06071	34.129395	-117.2788075	San Bernardino County
187009	Fee-for-Service	1265651756	1265651756	1	1	POTTS, KYLE B MD INC	11/30/2007	261QA1903X	NA	Other	026	PHYSICIANS	64819	02	General Surgery	0	In state provider	None	805 W ACEQUIA AVE	STE 2A	VISALIA	CA	93891	6164	54	06107	36.32895	-119.30031	Tulare County
187010	Fee-for-Service	1871607762	1871607762	1	109	PROVIDENCE MEDICAL FOUNDATIO	6/17/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
187033	Fee-for-Service	1427811389	1427811389	1	1	PHOENIX HOUSE ORANGE COUNTY,	11/26/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	13333 PALMDALE ROAD	None	VICTORVILLE	CA	92392	9364	36	06071	34.503642	-117.3710025	San Bernardino County
187043	Fee-for-Service	1841226990	1841226990	1	5	PHYSICIAN FOUNDATION	2/20/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MEDICAL ASSOCIATES INC	2324 SACRAMENTO ST	None	SAN FRANCISCO	CA	94115	2383	38	06075	37.79020149	-122.4313011	San Francisco County
187050	Fee-for-Service	1285979187	1285979187	1	1	PHAM, JULIE CRNA	8/23/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
187060	Fee-for-Service	1740410182	1740410182	1	6	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	2140 GRAND AVE	STE 260	CHINO HILLS	CA	91709	6806	36	06071	33.99623518	-117.7579477	San Bernardino County
187061	Fee-for-Service	1245403500	1245403500	1	1	PATEL, SUNIT R MD	2/10/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A PROFESSIONAL CORP	3389 G ST	STE B	MERCED	CA	95340	0964	24	06047	37.32623805	-120.4692747	Merced County
187068	Fee-for-Service	1841348810	1841348810	1	1	PANTAROTTO, RICHARD E MD	10/29/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70177	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
187079	Fee-for-Service	1871607762	1871607762	1	100	PROVIDENCE MEDICAL FOUNDATIO	9/19/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 SUPERIOR AVE	SUITE 160	NEWPORT BEACH	CA	92663	3677	30	06059	33.63017269	-117.929499	Orange County
187089	Fee-for-Service	1588818421	1588818421	1	1	PURI, CHARU MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102545	41	Internal Medicine	0	In state provider	None	350 30TH STREET	STE 411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
187100	Fee-for-Service	1942347257	1942347257	1	1	POLO, MICHAEL I MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107883	36	Psychiatry	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
187115	Fee-for-Service	1033103676	1033103676	1	1	PACIFIC REDWOOD MEDICAL GROU	1/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP, INC	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
187117	Fee-for-Service	1871607762	1871607762	1	98	PROVIDENCE MEDICAL FOUNDATIO	9/2/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	4870 BARRANCA PKWY	STE 300	IRVINE	CA	92604	4737	30	06059	33.67639712	-117.7961326	Orange County
187121	Fee-for-Service	1891182044	1891182044	1	2	PRESTIGE BARIATRIC AND	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106886	02	General Surgery	0	In state provider	SURGICAL SPECIALISTS INC	1746 WEST KETTLEMAN	SUITE D	LODI	CA	95242	9287	39	06077	38.1153297	-121.2939369	San Joaquin County
187126	Fee-for-Service	1073673810	1073673810	1	1	PATEL, SUJATA P MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75806	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
187127	Fee-for-Service	1871607762	1871607762	1	74	PROVIDENCE MEDICAL FOUNDATIO	7/28/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	831 VIA SUERTE	STE 102	SAN CLEMENTE	CA	92673	6531	30	06059	33.4630839	-117.5988297	Orange County
187132	Fee-for-Service	1912036401	1912036401	1	1	PEARSON, STEVEN W MD INC	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	59445	20	Orthopedic Surgery	0	In state provider	None	5333 HOLLISTER AVE	STE 120	SANTA BARBARA	CA	93111	3314	42	06083	34.43491982	-119.8105484	Santa Barbara County
187134	Fee-for-Service	1235750498	1235750498	1	1	PHAN, THU M LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
187144	Fee-for-Service	1871607762	1871607762	1	138	PROVIDENCE MEDICAL FOUNDATIO	1/3/2020	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
187150	Fee-for-Service	1710002282	1710002282	1	1	PILLOFF, SHAUNA L LCSW	1/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5500 E ATHERTON ST	STE 227B	LONG BEACH	CA	90815	4018	19	06037	33.7885453	-118.1236854	Los Angeles County
187153	Fee-for-Service	1871607762	1871607762	1	125	PROVIDENCE MEDICAL FOUNDATIO	3/30/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	2280 HARRISON AVE	STE K	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
187158	Fee-for-Service	1871607762	1871607762	1	159	PROVIDENCE MEDICAL FOUNDATIO	2/16/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
187159	Fee-for-Service	1508288291	1508288291	1	1	PULMONARY & CRITICAL CARE	3/24/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP OF ORANGE COUNTY	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
187180	Fee-for-Service	1174978654	1174978654	1	1	POLANSKY, ANGELA Y MD	9/27/2020	207P00000X	NA	Other	026	PHYSICIANS	162376	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
187189	Fee-for-Service	1023103660	1023103660	1	1	PREPAS, STEPHEN B MD	3/9/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32851	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
187198	Fee-for-Service	1538176474	1538176474	1	1	PAYLESS DRUG STORE 6080	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1314 FULTON AVE	None	SACRAMENTO	CA	95825	3604	34	06067	38.589381	-121.400037	Sacramento County
187199	Fee-for-Service	1780950428	1780950428	1	1	PATEL, ANUJ R MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13982	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
187202	Fee-for-Service	1043398191	1043398191	1	1	PARIKH, RAHUL K MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75421	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
187227	Fee-for-Service	1871607762	1871607762	1	44	PROVIDENCE MEDICAL FOUNDATIO	9/16/2013	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	N	108 LYNCH CREEK WAY	STE 3	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
187230	Fee-for-Service	1801007679	1801007679	1	1	PHAN, QUANG Q MD FACP INC	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44365	10	Gastroenterology (M.D. only)	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 304	GARDEN GROVE	CA	92843	1917	30	06059	33.77450141	-117.9123364	Orange County
187264	Fee-for-Service	1538292404	1538292404	1	1	PROHEALTH PARTNERS	5/10/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	A MEDICAL GROUP INC	1045 ATLANTIC AVE	STE 708	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
187284	Fee-for-Service	1528466448	1528466448	1	1	PYLES, DAVID A PHD	5/23/2018	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1555 N VERDUGO RD	STE 201	GLENDALE	CA	91208	3207	19	06037	34.16965778	-118.2276168	Los Angeles County
187300	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	10/29/2021	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
187302	Fee-for-Service	1942527544	1942527544	1	1	PHAM, ANN P MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119485	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
187305	Fee-for-Service	1801023742	1801023742	1	1	PEDERSEN, NIGEL P MD	9/15/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	181410	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
187307	Fee-for-Service	1891489282	1891489282	1	1	PANNELL, BREANNA M	6/14/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
187347	Fee-for-Service	1356997290	1356997290	1	1	PHAM, LAURENA LMFT	5/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
187348	Fee-for-Service	1740410182	1740410182	1	6	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	2140 GRAND AVE	STE 260	CHINO HILLS	CA	91709	6806	36	06071	33.99623518	-117.7579477	San Bernardino County
187350	Fee-for-Service	1386102184	1386102184	1	1	PLACE, ARIEL R LPCC	7/29/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1130 CONROY LN	SUITE 150	ROSEVILLE	CA	95661	4154	31	06061	38.73792807	-121.2748427	Placer County
187370	Fee-for-Service	1871607762	1871607762	1	175	PROVIDENCE MEDICAL FOUNDATIO	12/11/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	13400 JAMBOREE RD	None	IRVINE	CA	92602	2308	30	06059	33.724863	-117.788022	Orange County
187378	Fee-for-Service	1619656154	1619656154	1	1	PIPER, KENT B NP	9/19/2024	390200000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
187403	Fee-for-Service	1033103676	1033103676	1	1	PACIFIC REDWOOD MEDICAL GROU	1/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GROUP, INC	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
187414	Fee-for-Service	1073673810	1073673810	1	1	PATEL, SUJATA P MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75806	26	Psychiatry (child)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
187420	Fee-for-Service	1912036401	1912036401	1	1	PEARSON, STEVEN W MD INC	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	5333 HOLLISTER AVE	STE 120	SANTA BARBARA	CA	93111	3314	42	06083	34.43491982	-119.8105484	Santa Barbara County
187427	Fee-for-Service	1871607762	1871607762	1	172	PROVIDENCE MEDICAL FOUNDATIO	1/9/2024	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
187431	Fee-for-Service	1871607762	1871607762	1	138	PROVIDENCE MEDICAL FOUNDATIO	5/16/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
187436	Fee-for-Service	1245356484	1245356484	1	1	PURDY, JEFFREY M OD	1/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
187443	Fee-for-Service	1871607762	1871607762	1	125	PROVIDENCE MEDICAL FOUNDATIO	11/13/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	2280 HARRISON AVE	STE K	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
187465	Fee-for-Service	1972608008	1972608008	1	1	PHAM, XUAN T OD	3/25/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19501 STEVENS CREEK BLVD	103	CUPERTINO	CA	95014	2468	43	06085	37.32307147	-122.0119695	Santa Clara County
187486	Fee-for-Service	1639708670	1639708670	1	1	POKHRIYAL, MEGHA DO	1/27/2025	207R00000X	NA	Other	026	PHYSICIANS	23674	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
187501	Fee-for-Service	1619947090	1619947090	1	1	PALOMAR POMERADO HEALTH	5/5/1988	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	VILLA POMERADO	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
187513	Fee-for-Service	1871607762	1871607762	1	44	PROVIDENCE MEDICAL FOUNDATIO	12/3/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	108 LYNCH CREEK WAY	STE 3	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
187519	Fee-for-Service	1801007679	1801007679	1	1	PHAN, QUANG Q MD FACP INC	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44365	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 304	GARDEN GROVE	CA	92843	1917	30	06059	33.77450141	-117.9123364	Orange County
187571	Fee-for-Service	1619952405	1619952405	1	1	PANGULURI, RANGARAO MD	4/13/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52987	01	General Practice	0	In state provider	None	13909 AMAR RD	STE B	LA PUENTE	CA	91746	1600	19	06037	34.05338302	-117.9741244	Los Angeles County
187587	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	2/20/2020	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
187598	Fee-for-Service	1245288547	1245288547	1	1	PENROSE, PHILIP J MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	78833	18	Ophthalmology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
187642	Fee-for-Service	1871607762	1871607762	1	179	PROVIDENCE MEDICAL FOUNDATIO	2/13/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	1201 WHITTIER BLVD	None	LA HABRA	CA	90631	3610	30	06059	33.9391647	-117.9595151	Orange County
187646	Fee-for-Service	1760697015	1760697015	1	1	PAUL, KARISSA L OD	8/20/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
187651	Fee-for-Service	1912931098	1912931098	1	2	PETERS, ALAN MD	10/13/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	45138	-	NOT APPLICABLE	0	In state provider	None	105 HOSPITAL ROAD	None	SONORA	CA	95370	5227	55	06109	37.9746569	-120.3783281	Tuolumne County
187657	Fee-for-Service	1871607762	1871607762	1	175	PROVIDENCE MEDICAL FOUNDATIO	12/11/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	13400 JAMBOREE RD	None	IRVINE	CA	92602	2308	30	06059	33.724863	-117.788022	Orange County
187659	Fee-for-Service	1356689871	1356689871	1	1	PEDERSEN, ANDREA E CNP	5/17/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187677	Fee-for-Service	1144611591	1144611591	1	1	PECK, EDWIN C MD	5/21/2020	390200000X	NA	Other	026	PHYSICIANS	140979	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
187706	Fee-for-Service	1871607762	1871607762	1	172	PROVIDENCE MEDICAL FOUNDATIO	12/29/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
187711	Fee-for-Service	1194972562	1194972562	1	1	PEREZ, PEREZ M LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84627	-	NOT APPLICABLE	0	In state provider	None	2344 OLD SONOMA ROAD	BLDGS A, B, C, F, J	NAPA	CA	94559	1344	28	06055	38.2878005	-122.298057	Napa County
187720	Fee-for-Service	1871607762	1871607762	1	9	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1501 N PLACENTIA AVE	None	PLACENTIA	CA	92870	2332	30	06059	33.89044889	-117.8741363	Orange County
187731	Fee-for-Service	1396969572	1396969572	1	1	PHAN, EMILY MD	8/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98740	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
187739	Fee-for-Service	1871607762	1871607762	1	21	PROVIDENCE MEDICAL FOUNDATIO	6/15/2012	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	N	2752 HARRISON AVE	STE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
187741	Fee-for-Service	1467536441	1467536441	1	1	POCEKAY, DENNIS E MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35682	01	General Practice	0	In state provider	None	95 MONTGOMERY DR	None	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
187751	Fee-for-Service	1346733367	1346733367	1	1	PHILIP K. FRYKMAN, M.D., INC	9/21/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	None	85	Surgery-Pediatric	0	In state provider	ERY, A PROFESSIONAL CORP	2190 LYNN ROAD	SUITE 200	THOUSAND OAKS	CA	91360	8020	56	06111	34.20728091	-118.8855456	Ventura County
187760	Fee-for-Service	1386789428	1386789428	1	1	PERKINS, GREGORY M MD	7/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98883	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
187780	Fee-for-Service	1457482432	1457482432	1	1	PARK, JOSEPH H MD	6/30/1991	207R00000X	NA	Other	026	PHYSICIANS	47815	01	General Practice	0	In state provider	None	2727 W OLYMPIC BLVD	SUITE 113	LOS ANGELES	CA	90006	2641	19	06037	34.0527015	-118.2931155	Los Angeles County
187782	Fee-for-Service	1619462918	1619462918	1	1	PACE-SOLER, ELODIE DO	1/21/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21231	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
187819	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	11/6/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
187860	Fee-for-Service	1619952405	1619952405	1	1	PANGULURI, RANGARAO MD	4/13/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52987	41	Internal Medicine	0	In state provider	None	13909 AMAR RD	STE B	LA PUENTE	CA	91746	1600	19	06037	34.05338302	-117.9741244	Los Angeles County
187869	Fee-for-Service	1871607762	1871607762	1	59	PROVIDENCE MEDICAL FOUNDATIO	10/6/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3200 WALFORD AVE	STE A	EUREKA	CA	95503	4828	12	06023	40.77887445	-124.1378239	Humboldt County
187873	Fee-for-Service	1053392613	1053392613	1	1	POPE,RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 MEDICAL DR	None	BOUNTIFUL	UT	84010	0000	00	None	40.88671331	-111.8683023	Davis County
187875	Fee-for-Service	1871607762	1871607762	1	87	PROVIDENCE MEDICAL FOUNDATIO	9/2/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
187891	Fee-for-Service	1871607762	1871607762	1	10	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1041 E YORBA LINDA BLVD	STE 5	PLACENTIA	CA	92870	3736	30	06059	33.88848865	-117.8451029	Orange County
187915	Fee-for-Service	1689602500	1689602500	1	1	PENNER, MARK S MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8037	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
187930	Fee-for-Service	1871607762	1871607762	1	179	PROVIDENCE MEDICAL FOUNDATIO	7/25/2024	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1201 WHITTIER BLVD	None	LA HABRA	CA	90631	3610	30	06059	33.9391647	-117.9595151	Orange County
187949	Fee-for-Service	1770214801	1770214801	1	1	PRIYANKA JAIN MD INC	9/1/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	1100 OLIVEWOOD DR	None	MERCED	CA	95348	1210	24	06047	37.31799103	-120.4869437	Merced County
187975	Fee-for-Service	1063712214	1063712214	1	1	PREMIUM HOSPICE INC	6/29/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12241 FIRESTONE BLVD	SUITE A & B	NORWALK	CA	90650	9342	19	06037	33.90728643	-118.0715753	Los Angeles County
187980	Fee-for-Service	1467675017	1467675017	1	1	POSITIVE DIRECTIONS INC	7/1/2005	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1755 MAIN ST	None	DELANO	CA	93215	1448	15	06029	35.779419	-119.246906	Kern County
187992	Fee-for-Service	1871607762	1871607762	1	172	PROVIDENCE MEDICAL FOUNDATIO	12/29/2022	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
187993	Fee-for-Service	1790106862	1790106862	1	1	PARISH ANESTHESIA OF	12/14/2015	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CALIFORNIA APMC	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
188055	Fee-for-Service	1861542672	1861542672	1	1	PINGILI, GEETHA MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88798	41	Internal Medicine	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
188083	Fee-for-Service	1366618019	1366618019	1	1	PROCARE MEDICAL CENTER LLC	1/25/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6870 S RAINBOW BLVD	STE 106-107	LAS VEGAS	NV	89118	2107	00	None	36.064125	-115.2423745	Clark County
188089	Fee-for-Service	1417021163	1417021163	1	1	PEDERSEN, MAREN	3/31/1986	207R00000X	NA	Other	026	PHYSICIANS	43586	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
188110	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	5/14/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
188152	Fee-for-Service	1841723327	1841723327	1	6	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	114 MISSION RANCH BLVD	STE 50	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
188186	Fee-for-Service	1952846727	1952846727	1	1	POPAL, FARYAL	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
188195	Fee-for-Service	1659897650	1659897650	1	1	PUJO, NATALIE G PSYD	8/28/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
188218	Fee-for-Service	1871607762	1871607762	1	179	PROVIDENCE MEDICAL FOUNDATIO	2/13/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	1201 WHITTIER BLVD	None	LA HABRA	CA	90631	3610	30	06059	33.9391647	-117.9595151	Orange County
188223	Fee-for-Service	1255869566	1255869566	1	1	PHAN, HOA T MD	9/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180758	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
188235	Fee-for-Service	1497402408	1497402408	1	1	PALMS RETIREMENT CENTER INC	3/30/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	312 N ROOSEVELT AVE	None	FULLERTON	CA	92832	1610	30	06059	33.87309167	-117.9407794	Orange County
188263	Fee-for-Service	1063712214	1063712214	1	1	PREMIUM HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12241 FIRESTONE BLVD	SUITE A & B	NORWALK	CA	90650	9342	19	06037	33.90728643	-118.0715753	Los Angeles County
188274	Fee-for-Service	1316032907	1316032907	1	1	PANDURANGI, SETURAM MD	1/1/1979	207KA0200X	NA	Other	026	PHYSICIANS	31312	40	Pediatrics	0	In state provider	None	2601 NUT TREE RD	STE B	VACAVILLE	CA	95687	6918	48	06095	38.33422507	-121.9531913	Solano County
188287	Fee-for-Service	1871607762	1871607762	1	172	PROVIDENCE MEDICAL FOUNDATIO	12/29/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
188295	Fee-for-Service	1770622763	1770622763	1	1	PAULRAJ, NIRUPA MD	1/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
188297	Fee-for-Service	1942543319	1942543319	1	1	POURHASSAN, HODA Z MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140737	41	Internal Medicine	0	In state provider	None	555 TACHEVAH DR	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
188315	Fee-for-Service	1073802443	1073802443	1	1	PATEL, AMAR A MD	3/29/2021	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	167298	None	None	0	In state provider	None	22 ODYSSEY	SUITE 205	IRVINE	CA	92618	3197	30	06059	33.66719598	-117.7642461	Orange County
188333	Fee-for-Service	1841226990	1841226990	1	4	PHYSICIAN FOUNDATION	7/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	MEDICAL ASSOCIATES INC	2100 WEBSTER ST	STE 511&521	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
188377	Fee-for-Service	1316930373	1316930373	1	2	PAUL, DRAKE A MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74098	40	Pediatrics	0	In state provider	None	1010 MURRAY ST	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.29101669	-120.6663647	San Luis Obispo County
188396	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	11/6/2017	193200000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
188425	Fee-for-Service	1952438814	1952438814	1	1	PERTI, TARA R MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137158	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
188434	Fee-for-Service	1861830234	1861830234	1	1	PATEL, SAGAR A MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155063	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
188437	Fee-for-Service	1841723327	1841723327	1	6	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	114 MISSION RANCH BLVD	STE 50	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
188458	Fee-for-Service	1235210428	1235210428	1	1	PICKERING, ANDREW LMFT	7/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2423 CAMINO DEL RIO S	STE 101	SAN DIEGO	CA	92108	3734	37	06073	32.76759179	-117.1387533	San Diego County
188463	Fee-for-Service	1184953127	1184953127	1	1	PEREZ, RUTH NP	7/14/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
188486	Fee-for-Service	1023235025	1023235025	1	1	PAPPAS, JAMES MD	7/31/1988	207ZP0105X	NA	Other	026	PHYSICIANS	59351	01	General Practice	0	In state provider	None	4080 TYLER ST	STE A	RIVERSIDE	CA	92503	3432	33	06065	33.91721134	-117.4657583	Riverside County
188489	Fee-for-Service	1497822258	1497822258	1	1	PEREIRA, STEVEN CRNA	5/3/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
188492	Fee-for-Service	1184045510	1184045510	1	1	PARKER, NATALIE NICOLE	1/26/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1825 EL PASO AVE	None	CLOVIS	CA	93611	6658	10	06019	36.84882949	-119.6835335	Fresno County
188522	Fee-for-Service	1558321901	1558321901	2	1	PROFESSIONAL HEALTHCARE	5/1/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AT HOME, LLC	395 TAYLOR BLVD	SUITE 118	PLEASANT HILL	CA	94523	2276	07	06013	37.96119614	-122.070409	Contra Costa County
188541	Fee-for-Service	1154143485	1154143485	1	1	PHARMMED EL MONTE INC	12/27/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11436 GARVEY AVE	STE C	EL MONTE	CA	91732	3304	19	06037	34.06282769	-118.0281402	Los Angeles County
188554	Fee-for-Service	1235375155	1235375155	1	1	POLINENI, RAHUL D MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154751	68	Hematology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
188569	Fee-for-Service	1871607762	1871607762	1	172	PROVIDENCE MEDICAL FOUNDATIO	12/29/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	253 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1606	19	06037	34.02108125	-117.8103432	Los Angeles County
188597	Fee-for-Service	1508081530	1508081530	1	1	PATEL, SAMEER A MD	7/22/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	10702	30	Radiology	0	In state provider	None	330 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
188604	Fee-for-Service	1629631130	1629631130	1	1	POMERANTZ, MAXWILL D MD	6/6/2023	207L00000X	NA	Other	026	PHYSICIANS	177081	05	Anesthesiology	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
188671	Fee-for-Service	1659906725	1659906725	1	1	PURI, NISHA MD	7/5/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
188684	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	2/20/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
188710	Fee-for-Service	1861830234	1861830234	1	1	PATEL, SAGAR A MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155063	30	Radiology	0	In state provider	None	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
188730	Fee-for-Service	1952569063	1952569063	1	1	PARTHASARATHY,MURALIKRISHNA	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105423	36	Psychiatry	0	In state provider	MURALIKRISHNAN MD	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
188731	Fee-for-Service	1871010702	1871010702	1	1	PATRICK, SHANNON K CRNA	8/27/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
188735	Fee-for-Service	1407030778	1407030778	1	1	PEDERSEN, KRISTINA M LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1392	43	06085	37.23418124	-121.7818366	Santa Clara County
188749	Fee-for-Service	1871607762	1871607762	1	39	PROVIDENCE MEDICAL FOUNDATIO	6/12/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	1100 TRANCAS ST	STE 350	NAPA	CA	94558	2959	28	06055	38.32316569	-122.2981938	Napa County
188772	Fee-for-Service	1023235025	1023235025	1	1	PAPPAS, JAMES MD	7/31/1988	207ZP0105X	NA	Other	026	PHYSICIANS	59351	41	Internal Medicine	0	In state provider	None	4080 TYLER ST	STE A	RIVERSIDE	CA	92503	3432	33	06065	33.91721134	-117.4657583	Riverside County
188779	Fee-for-Service	1184045510	1184045510	1	1	PARKER, NATALIE NICOLE	1/26/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1825 EL PASO AVE	None	CLOVIS	CA	93611	6658	10	06019	36.84882949	-119.6835335	Fresno County
188807	Fee-for-Service	1952333858	1952333858	1	1	PASTORE, GAETANO N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CENTURIAN DR	STE 200	NEWARK	DE	19713	2150	00	None	39.69604971	-75.65624854	New Castle County
188814	Fee-for-Service	1871607762	1871607762	1	121	PROVIDENCE MEDICAL FOUNDATIO	10/2/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1165 S DORA ST	None	UKIAH	CA	95482	8325	23	06045	39.13602308	-123.2095502	Mendocino County
188846	Fee-for-Service	1083140560	1083140560	1	2	PROFICIO SPEECH THERAPY GROU	6/5/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P, INC.	400 29TH ST	SUITE 317	OAKLAND	CA	94609	3522	01	06001	37.81784861	-122.2652263	Alameda County
188848	Fee-for-Service	1235375155	1235375155	1	1	POLINENI, RAHUL D MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154751	78	Neoplastic Diseases/Oncology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
188872	Fee-for-Service	1114070265	1114070265	1	1	PERRINE, EMILY E PSYD	4/26/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
188881	Fee-for-Service	1962636522	1962636522	1	1	PATEL, AJAY H MD	7/2/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	120793	None	None	0	In state provider	None	10441 LAKEWOOD BLVD.	SUITE E	DOWNEY	CA	90241	2744	19	06037	33.94358034	-118.1193714	Los Angeles County
188884	Fee-for-Service	1134189160	1134189160	1	1	PATRICK WAYNE KELLY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 SOUTH GRANGE AVE	None	SIOUX FALLS	SD	57105	0433	00	None	43.53462	-96.7409415	Minnehaha County
188896	Fee-for-Service	1346328036	1346328036	1	1	PHAM, MARK M MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85352	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
188902	Fee-for-Service	1265871438	1265871438	1	1	PARADIS, MOLLY K OT	10/28/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR	SUITE 340	PALM DESERT	CA	92211	0450	33	06065	33.75833451	-116.3114325	Riverside County
188907	Fee-for-Service	1205499241	1205499241	1	1	PATEL, KARISHMA NP	7/29/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
188910	Fee-for-Service	1538710025	1538710025	1	1	PHARMEDQUEST PHARMACY SERVIC	4/15/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	954 NORTH VERMONT AVE	132	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
188913	Fee-for-Service	1942364377	1942364377	1	1	POL-RODRIGUEZ, MARLYANNE	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96841	07	Dermatology	0	In state provider	M MD	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
188927	Fee-for-Service	1548631419	1548631419	1	1	PERLMAN, SHARON	4/25/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
188937	Fee-for-Service	1104857598	1104857598	1	1	PETERS, WALTER JAMES MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	50476	41	Internal Medicine	0	In state provider	None	3871 PIEDMONT AVE	None	OAKLAND	CA	94611	5378	01	06001	37.82472647	-122.2547297	Alameda County
188941	Fee-for-Service	1578018669	1578018669	1	1	PACIFIC VALLEY HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	813 N LA CADENA DR	None	COLTON	CA	92324	2747	36	06071	34.07372869	-117.3229585	San Bernardino County
188960	Fee-for-Service	1427247931	1427247931	2	1	PATEL, KIRITKUMAR B MD	6/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35277	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE C310	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
188961	Fee-for-Service	1295881860	1295881860	1	1	PACIFIC CARDIOVASCULAR	10/7/1993	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SURGEONS	1500 SOUTHGATE AVE	STE 209	DALY CITY	CA	94015	2231	41	06081	37.67558248	-122.4750825	San Mateo County
188971	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	11/6/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
188983	Fee-for-Service	1225099237	1225099237	1	1	PACIFIC RIM PATHOLOGY	10/1/1997	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
188986	Fee-for-Service	1295755882	1295755882	1	1	PISEGNA, JOSEPH R MD	6/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	72435	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
188988	Fee-for-Service	1871607762	1871607762	1	104	PROVIDENCE MEDICAL FOUNDATIO	10/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	8607 IRVINE CENTER DR	None	IRVINE	CA	92618	4219	30	06059	33.64504816	-117.74363	Orange County
189006	Fee-for-Service	1235170994	1235170994	1	1	POWE, NEIL R MD	3/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88635	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE RM 5H22	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
189007	Fee-for-Service	1336484419	1336484419	1	1	PURPOSE DRIVEN HOME HEALTH	8/15/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	11901 BOLTHOUSE DRIVE	SUITE 100	BAKERSFIELD	CA	93301	8456	15	06029	35.31307854	-119.1350222	Kern County
189009	Fee-for-Service	1386740454	1386740454	1	1	PIERCE, TERRI L	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
189026	Fee-for-Service	1477992311	1477992311	1	1	PEREZ LOPEZ, ARIANNA M MD	1/10/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	182655	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
189036	Fee-for-Service	1639353279	1639353279	1	1	PATHI, SUJATHA MD	10/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	95639	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
189043	Fee-for-Service	1194915157	1194915157	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	PEDTRC GASTROENTEROLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
189064	Fee-for-Service	1881888725	1881888725	1	1	PSYCHOLOGICAL & FAMILY	11/1/2001	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SUPPORT SERVICES INC	5400 CONNECTICUT AVENUE	SUITE E	LA MESA	CA	91942	1213	37	06073	32.77550774	-117.0456926	San Diego County
189067	Fee-for-Service	1871607762	1871607762	1	143	PROVIDENCE MEDICAL FOUNDATIO	1/14/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
189073	Fee-for-Service	1568486090	1568486090	1	1	PICCININI, PHILLIP M MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
189109	Fee-for-Service	1992885131	1992885131	1	1	PAHL, MADELINE MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	40573	45	Nephrology (Renal-Kidney)	0	In state provider	U C I M C	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
189117	Fee-for-Service	1740291400	1740291400	1	1	PORTER HOSPITAL INC	8/1/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	115 PORTER DR	None	MIDDLEBURY	VT	05753	8423	00	None	43.99976318	-73.16779144	Addison County
189118	Fee-for-Service	1841271434	1841271434	1	1	PHAM, TONY D OD INC	11/7/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5931 STANLEY AVE	SUITE 1	CARMICHAEL	CA	95608	3846	34	06067	38.622978	-121.326966	Sacramento County
189181	Fee-for-Service	1871008623	1871008623	1	1	PAREENJA, RITA	5/18/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
189186	Fee-for-Service	1902987613	1902987613	2	1	PATEL, PRAKASH MD	3/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34471	41	Internal Medicine	0	In state provider	None	315 N 3RD AVE	STE 306	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
189223	Fee-for-Service	1083185342	1083185342	1	1	PALM PATHOLOGY MEDICAL GROUP	4/16/2019	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	, A PROFESSIONAL CORPORA	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
189224	Fee-for-Service	1871607762	1871607762	1	66	PROVIDENCE MEDICAL FOUNDATIO	12/19/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	N	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
189229	Fee-for-Service	1578018669	1578018669	1	1	PACIFIC VALLEY HOSPICE CARE	11/30/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	813 N LA CADENA DR	None	COLTON	CA	92324	2747	36	06071	34.07372869	-117.3229585	San Bernardino County
189239	Fee-for-Service	1083111322	1083111322	1	1	PINEDA, ROSE N MD	3/5/2024	390200000X	NA	Other	026	PHYSICIANS	165831	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
189247	Fee-for-Service	1538174990	1538174990	2	1	POINT LOMA REHABILITATION	5/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	3202 DUKE ST	None	SAN DIEGO	CA	92110	5401	37	06073	32.75280396	-117.2187575	San Diego County
189250	Fee-for-Service	1104857598	1104857598	1	1	PETERS, WALTER JAMES MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	50476	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3871 PIEDMONT AVE	None	OAKLAND	CA	94611	5378	01	06001	37.82472647	-122.2547297	Alameda County
189258	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	10/3/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
189267	Fee-for-Service	1295766129	1295766129	1	1	PEREZ, NORMA NP	2/19/2025	2251P0200X	NA	Physical Therapist	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
189290	Fee-for-Service	1326354937	1326354937	1	1	PERALTA-AVILA, ANGEL R MD	2/10/2022	207R00000X	NA	Other	026	PHYSICIANS	175635	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
189333	Fee-for-Service	1194915157	1194915157	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDTRC GASTROENTEROLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
189361	Fee-for-Service	1871607762	1871607762	1	55	PROVIDENCE MEDICAL FOUNDATIO	9/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	N	2332 23RD ST	None	EUREKA	CA	95501	3231	12	06023	40.78684548	-124.1425485	Humboldt County
189386	Fee-for-Service	1073732590	1073732590	1	2	PALMIRA DEVELOPMENT INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14328 VICTORY BLVD	UNIT D & E	VAN NUYS	CA	91401	6566	19	06037	34.1866137	-118.4454117	Los Angeles County
189401	Fee-for-Service	1740291400	1740291400	1	1	PORTER HOSPITAL INC	8/1/2012	193200000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	115 PORTER DR	None	MIDDLEBURY	VT	05753	8423	00	None	43.99976318	-73.16779144	Addison County
189517	Fee-for-Service	1376575449	1376575449	1	1	P&J HOSPITAL, INC	9/1/2005	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4900 FLORENCE AVE	None	BELL	CA	90201	4392	19	06037	33.96944334	-118.1801376	Los Angeles County
189519	Fee-for-Service	1871607762	1871607762	1	73	PROVIDENCE MEDICAL FOUNDATIO	4/7/2015	193200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	N	8078 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1108	30	06059	33.86628	-117.750789	Orange County
189534	Fee-for-Service	1750590030	1750590030	1	1	PATEL, RAKESH B MD	7/22/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	102326	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
189547	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	11/6/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
189575	Fee-for-Service	1871607762	1871607762	1	58	PROVIDENCE MEDICAL FOUNDATIO	9/22/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	999 ADAMS ST	STE 107	ST HELENA	CA	94574	1148	28	06055	38.5071543	-122.4685546	Napa County
189611	Fee-for-Service	1922073170	1922073170	1	1	PAULSEN, THOMAS C MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48105	05	Anesthesiology	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
189629	Fee-for-Service	1851786370	1851786370	1	1	POORSATTAR, SOPHIA MD	3/23/2020	207L00000X	NA	Other	026	PHYSICIANS	146464	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
189633	Fee-for-Service	1700293347	1700293347	1	1	PEDDIREDDY, SHIVAPRIYA MD	9/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149890	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
189635	Fee-for-Service	1073760815	1073760815	1	1	POLVERINI, AMY C MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111253	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
189645	Fee-for-Service	1407068463	1407068463	1	1	PELAYO, JUAN C MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	99088	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189744	Fee-for-Service	1407804750	1407804750	1	1	PASCAL, LEROY B MD	5/24/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76597	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
189746	Fee-for-Service	1588829394	1588829394	1	1	PFEIFFER, CYNTHIA MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116043	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
189752	Fee-for-Service	1780203562	1780203562	1	1	POTKA, GRISELDA	9/3/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	185516	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
189759	Fee-for-Service	1730421983	1730421983	1	1	PARK, STANLEY S MD	10/18/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	169924	18	Ophthalmology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
189760	Fee-for-Service	1588641948	1588641948	1	1	PHAM, KELLY H MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77932	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
189767	Fee-for-Service	1861476079	1861476079	1	1	PIROMGRAIPAKD, MITREE M PT	9/25/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
189800	Fee-for-Service	1871607762	1871607762	1	66	PROVIDENCE MEDICAL FOUNDATIO	12/19/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	N	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
189812	Fee-for-Service	1083716120	1083716120	1	1	PEMBERTON, CHRISTINE A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
189834	Fee-for-Service	1871607762	1871607762	1	120	PROVIDENCE MEDICAL FOUNDATIO	11/6/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	N	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
189850	Fee-for-Service	1497735427	1497735427	1	1	PEREZ, LUIS M OD	11/16/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3350-52 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2206	19	06037	34.02790658	-118.201319	Los Angeles County
189859	Fee-for-Service	1447447248	1447447248	1	10	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	101 MONROE ST	None	PETALUMA	CA	94954	2328	49	06097	38.25630881	-122.62758	Sonoma County
189866	Fee-for-Service	1871607762	1871607762	1	24	PROVIDENCE MEDICAL FOUNDATIO	4/18/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19333 BEAR VALLEY ROAD	SUITE 106	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
189921	Fee-for-Service	1841226990	1841226990	1	2	PHYSICIAN FOUNDATION	7/27/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES INC	CASTRO AND DUBOCE ST LE	STE 160 AND 175	SAN FRANCISCO	CA	94112	0000	38	06075	37.769049	-122.43582	San Francisco County
189922	Fee-for-Service	1073760815	1073760815	1	1	POLVERINI, AMY C MD	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111253	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
189958	Fee-for-Service	1558915694	1558915694	1	1	PERKINS, JOSHUA L MD	9/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177306	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
189969	Fee-for-Service	1497734123	1497734123	1	1	PHELAN, JEFFREY S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
189988	Fee-for-Service	1023493145	1023493145	1	1	PALANA, CESAR MD INC	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137027	41	Internal Medicine	0	In state provider	None	4333 TORRANCE BLVD	2ND FLOOR	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
189997	Fee-for-Service	1508805334	1508805334	1	1	PRICE, RONALD L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3555 S VAL VISTA DR	None	GILBERT	AZ	85297	7323	00	None	33.286572	-111.7527525	Maricopa County
190003	Fee-for-Service	1245400167	1245400167	1	1	PANCHAL, RIPUL R DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9785	14	Neurological Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
190020	Fee-for-Service	1225188105	1225188105	1	1	PAGNINI, PAUL G MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85253	30	Radiology	0	In state provider	None	401 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3803	36	06071	34.1358627	-117.2757778	San Bernardino County
190041	Fee-for-Service	1639257223	1639257223	1	1	POGGI, JACQUELINE M MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79249	01	General Practice	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
190056	Fee-for-Service	1730523952	1730523952	1	1	PIRO, KATHLEEN L MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134106	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
190082	Fee-for-Service	1609972520	1609972520	1	1	PC CARE, LLC	9/29/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1323 17TH ST	None	SANTA MONICA	CA	90404	1901	19	06037	34.02721763	-118.4838152	Los Angeles County
190095	Fee-for-Service	1871607762	1871607762	1	73	PROVIDENCE MEDICAL FOUNDATIO	4/7/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	8078 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1108	30	06059	33.86628	-117.750789	Orange County
190099	Fee-for-Service	1932149382	1932149382	1	1	PENMAN, ROBERT A MD	11/4/1977	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33731	30	Radiology	0	In state provider	None	5301 F ST	STE 100	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
190112	Fee-for-Service	1871607762	1871607762	1	76	PROVIDENCE MEDICAL FOUNDATIO	7/31/2015	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	26800 CROWN VALLEY PKWY	SUITE 103	MISSION VIEJO	CA	92691	6389	30	06059	33.56286021	-117.6673449	Orange County
190130	Fee-for-Service	1053803627	1053803627	1	1	PANG, KATHERINE DO	12/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19149	None	None	0	In state provider	None	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
190133	Fee-for-Service	1962854471	1962854471	1	1	PARKS, KELLY DPM	1/12/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	795 E SECOND ST	SUITE 7	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
190134	Fee-for-Service	1356498935	1356498935	1	1	PARA LATINO MEDICAL CENTER I	6/16/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	15717 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	5113	19	06037	33.890355	-118.160178	Los Angeles County
190137	Fee-for-Service	1801040845	1801040845	1	1	PAXTON, DON A MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101005	05	Anesthesiology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
190148	Fee-for-Service	1447447248	1447447248	1	10	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	101 MONROE ST	None	PETALUMA	CA	94954	2328	49	06097	38.25630881	-122.62758	Sonoma County
190181	Fee-for-Service	1376593657	1376593657	1	1	PATEL, GNYANDEN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61869	41	Internal Medicine	0	In state provider	None	1045 E ANAHEIM ST	None	LONG BEACH	CA	90813	3628	19	06037	33.78263347	-118.1796525	Los Angeles County
190184	Fee-for-Service	1497051627	1497051627	1	1	PRODIGY HEALTHCARE, INC.	7/18/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	311 E MERCED ST	01-7, CO	FOWLER	CA	93625	2316	10	06019	36.63148462	-119.6774341	Fresno County
190198	Fee-for-Service	1871607762	1871607762	1	17	PROVIDENCE MEDICAL FOUNDATIO	8/20/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	108 LYNCH CREEK WAY	STE 2	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
190212	Fee-for-Service	1275572984	1275572984	1	1	PARK, LARRY A MD	3/31/1988	207P00000X	NA	Other	026	PHYSICIANS	30292	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
190239	Fee-for-Service	1518954122	1518954122	1	1	PACIFIC CARE NURSING CTR	11/1/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3355 PACIFIC PL	None	LONG BEACH	CA	90806	1239	19	06037	33.8185462	-118.1957085	Los Angeles County
190254	Fee-for-Service	1780709345	1780709345	1	1	PRATHIPATI, KUMARA S MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40438	41	Internal Medicine	0	In state provider	INC	502 S EUCLID AVE	STE 203	NATIONAL CITY	CA	91950	2988	37	06073	32.68505421	-117.0832793	San Diego County
190257	Fee-for-Service	1760845879	1760845879	1	1	PETERSON, RACHEAL I MD	8/9/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	185676	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
190263	Fee-for-Service	1154464329	1154464329	1	1	PENINSULA ORTHOPEDIC	10/31/1991	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES INC	1850 SULLIVAN AVE	STE 330	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
190275	Fee-for-Service	1053444935	1053444935	1	1	PROHEALTH PARTNERS	3/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL GROUP INC	3650 SOUTH ST	STE 210	LAKEWOOD	CA	90712	1527	19	06037	33.86019847	-118.149255	Los Angeles County
190306	Fee-for-Service	1891777272	1891777272	1	1	PATEL, JAGDISH M MD DBA	8/26/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	32536	30	Radiology	0	In state provider	PACIFIC COAST IMG MD GRP	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
190309	Fee-for-Service	1225188105	1225188105	1	1	PAGNINI, PAUL G MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85253	78	Neoplastic Diseases/Oncology	0	In state provider	None	401 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3803	36	06071	34.1358627	-117.2757778	San Bernardino County
190314	Fee-for-Service	1184809733	1184809733	1	1	PATEL, RITA NP	7/8/2022	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
190318	Fee-for-Service	1932654043	1932654043	1	1	PAHLEVAN CHALESHTARI, TARA	9/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OD	230 MINOR HALL	None	BERKELEY	CA	94720	2020	01	06001	37.87133398	-122.2545466	Alameda County
190355	Fee-for-Service	1033103676	1033103676	1	6	PACIFIC REDWOOD MEDICAL GROU	9/29/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	P, INC.	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
190411	Fee-for-Service	1972014058	1972014058	1	1	POLSKY, MARCY B LMFT	10/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	STE C	WOODLAND HILLS	CA	91364	2676	19	06037	34.17245599	-118.5633517	Los Angeles County
190416	Fee-for-Service	1871607762	1871607762	1	137	PROVIDENCE MEDICAL FOUNDATIO	3/6/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
190422	Fee-for-Service	1356498935	1356498935	1	1	PARA LATINO MEDICAL CENTER I	6/16/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	15717 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	5113	19	06037	33.890355	-118.160178	Los Angeles County
190423	Fee-for-Service	1568042133	1568042133	1	1	PATEL, AVI	10/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
190432	Fee-for-Service	1720274038	1720274038	1	1	PRESANT, ERIN MEAGHAN DO	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12263	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
190447	Fee-for-Service	1235142951	1235142951	1	1	PAPADOPOULOS, ROBERT MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57027	02	General Surgery	0	In state provider	None	612 W DUARTE RD	STE 602	ARCADIA	CA	91007	9241	19	06037	34.12647805	-118.051994	Los Angeles County
190461	Fee-for-Service	1629137062	1629137062	1	1	PETERSEN, KARLA M MD	2/8/2015	2084P0804X	NA	Psychiatry	026	PHYSICIANS	79787	36	Psychiatry	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
190477	Fee-for-Service	1346203973	1346203973	2	1	PATEL, SURENDRA M MD	5/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50956	41	Internal Medicine	0	In state provider	None	5680 N FRESNO STREET	SUITE 101	FRESNO	CA	93710	8331	10	06019	36.820746	-119.7812905	Fresno County
190483	Fee-for-Service	1417992868	1417992868	1	1	PATHOLOGY MEDICAL GROUP	8/21/2003	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	OF ST JOHNS	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2032	19	06037	34.02980528	-118.4786605	Los Angeles County
190491	Fee-for-Service	1467569947	1467569947	1	1	PERRY, ADAM C MD	6/19/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183975	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
190522	Fee-for-Service	1992460794	1992460794	1	1	PROGRESSIVE OB/GYN MEDICAL G	3/19/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ROUP INC	1800 WESTERN AVE	STE 101	SAN BERNARDINO	CA	92411	1352	36	06071	34.1315778	-117.3182453	San Bernardino County
190554	Fee-for-Service	1457428278	1457428278	1	1	PANDIRI, BHANU MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63247	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
190557	Fee-for-Service	1902678246	1902678246	1	1	PERRYMAN, ALEXIS DOULA	5/20/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
190574	Fee-for-Service	1326215096	1326215096	1	1	PURI, RUCHI MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132279	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
190603	Fee-for-Service	1003070640	1003070640	1	1	PARK, SUSAN J MD	9/12/2008	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	98140	08	Family Practice	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
190623	Fee-for-Service	1265980882	1265980882	1	1	PROFFITT, ERIC R PSYD	12/21/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
190626	Fee-for-Service	1033566971	1033566971	1	1	PATEL, DEVAN D MD	10/3/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	175442	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
190643	Fee-for-Service	1598403867	1598403867	1	1	PHAM, NINA OD	12/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	342 F STREET	None	CHULA VISTA	CA	91910	2625	37	06073	32.64073026	-117.0815293	San Diego County
190644	Fee-for-Service	1033103676	1033103676	1	6	PACIFIC REDWOOD MEDICAL GROU	9/29/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	P, INC.	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
190657	Fee-for-Service	1538609987	1538609987	1	1	PREMIERCARE 1 CONGREGATE	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING INC	3141 EUCLID AVE	None	LYNWOOD	CA	90262	4971	19	06037	33.91339473	-118.2154277	Los Angeles County
190688	Fee-for-Service	1063427565	1063427565	2	1	PURANDARE, AMAR Y MD	3/21/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	169351	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
190700	Fee-for-Service	1639737240	1639737240	1	1	PANNU, GURJIT MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	183763	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
190705	Fee-for-Service	1871607762	1871607762	1	137	PROVIDENCE MEDICAL FOUNDATIO	3/6/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
190710	Fee-for-Service	1356498935	1356498935	1	1	PARA LATINO MEDICAL CENTER I	6/16/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	15717 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	5113	19	06037	33.890355	-118.160178	Los Angeles County
190723	Fee-for-Service	1386848216	1386848216	1	1	PENDLETON, ROBERT B MD	8/26/2010	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	PHD INC	3637 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.18108911	-117.3086107	San Diego County
190728	Fee-for-Service	1396820189	1396820189	1	1	PERKINS, CHRISTOPHER MD	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41513	68	Hematology	0	In state provider	None	3636 N 1ST ST	STE 120	FRESNO	CA	93726	6818	10	06019	36.78322578	-119.7724022	Fresno County
190731	Fee-for-Service	1780203943	1780203943	1	2	PILLAY, YEOSHINA MD	10/9/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	188620	-	NOT APPLICABLE	0	In state provider	None	2100 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
190752	Fee-for-Service	1841226990	1841226990	1	11	PHYSICIAN FOUNDATION	12/10/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	MEDICAL ASSOCIATES INC	1375 SUTTER STREET	None	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
190753	Fee-for-Service	1871607762	1871607762	1	2	PROVIDENCE MEDICAL FOUNDATIO	10/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	731 N BEACH BLVD	None	LA HABRA	CA	90631	3657	30	06059	33.93812202	-117.9680337	Orange County
190794	Fee-for-Service	1871607762	1871607762	1	167	PROVIDENCE MEDICAL FOUNDATIO	4/8/2022	207Q00000X	NA	Adult Primary Care	027	PODIATRISTS	-	None	None	0	In state provider	N	106 LYNCH CREEK WAY	SUITE 9A & 9B	PETALUMA	CA	94954	2356	49	06097	38.25206172	-122.634113	Sonoma County
190795	Fee-for-Service	1669814729	1669814729	1	1	PUN, MELISSA S MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132392	25	Physical Medicine and Rehabilitation	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
190796	Fee-for-Service	1295017580	1295017580	1	1	PIRRUCCELLO, KELLY S PSYD	10/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
190842	Fee-for-Service	1700865839	1700865839	1	1	POLICY, JAMES F MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	135 THE UPLANDS	None	BERKELEY	CA	94705	2816	01	06001	37.85324494	-122.2422811	Alameda County
190858	Fee-for-Service	1932285467	1932285467	1	1	PAI, MEENA P MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53810	40	Pediatrics	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
190864	Fee-for-Service	1972719037	1972719037	1	1	PACIFIC PALMS HEALTHCARE	12/1/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1020 TERMINO AVE	None	LONG BEACH	CA	90804	4123	19	06037	33.779385	-118.1458605	Los Angeles County
190910	Fee-for-Service	1538373998	1538373998	1	1	PATIENTS CHOICE LLC	5/8/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	625 WEST UNIVERSITY DR	UNIT A	ARLINGTON HEIGHTS	IL	60004	1826	00	None	42.13268553	-87.990867	Cook County
190912	Fee-for-Service	1356579379	1356579379	1	1	POTI, SHANNON M MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116649	84	Surgery-Head and Neck	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
190932	Fee-for-Service	1033103676	1033103676	1	6	PACIFIC REDWOOD MEDICAL GROU	9/29/2022	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC.	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
190973	Fee-for-Service	1194353193	1194353193	1	1	PHAM, ANDREW MD	7/31/2024	207P00000X	NA	Other	026	PHYSICIANS	181709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
190992	Fee-for-Service	1871607762	1871607762	1	137	PROVIDENCE MEDICAL FOUNDATIO	3/6/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
190999	Fee-for-Service	1013270339	1013270339	1	1	PICO SQUARE PHARMACY RX INC	12/20/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2334 W PICO BLVD	None	LOS ANGELES	CA	90006	4002	19	06037	34.0472755	-118.287666	Los Angeles County
191013	Fee-for-Service	1396820189	1396820189	1	1	PERKINS, CHRISTOPHER MD	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41513	78	Neoplastic Diseases/Oncology	0	In state provider	None	3636 N 1ST ST	STE 120	FRESNO	CA	93726	6818	10	06019	36.78322578	-119.7724022	Fresno County
191040	Fee-for-Service	1841226990	1841226990	1	11	PHYSICIAN FOUNDATION	12/10/2008	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL ASSOCIATES INC	1375 SUTTER STREET	None	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
191047	Fee-for-Service	1073951323	1073951323	1	1	POTOK, OLIVIA MD	7/14/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	141725	07	Dermatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191064	Fee-for-Service	1295792737	1295792737	1	1	PEREZ-STABLE, ELISEO MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	41676	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
191067	Fee-for-Service	1871607762	1871607762	1	70	PROVIDENCE MEDICAL FOUNDATIO	11/22/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	8911 LAKEWOOD DR	SUITE 13	WINDSOR	CA	95492	7857	49	06097	38.55034733	-122.8042316	Sonoma County
191075	Fee-for-Service	1144328378	1144328378	1	1	PEREZ, IRIS A MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53205	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191078	Fee-for-Service	1063498749	1063498749	1	1	PAGSOLINGAN,J RODERICK	6/1/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
191091	Fee-for-Service	1053375444	1053375444	1	1	PARK, JOHN W MD	10/31/1989	207RX0202X	NA	Oncology	026	PHYSICIANS	63196	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
191131	Fee-for-Service	1700865839	1700865839	1	1	POLICY, JAMES F MD	12/1/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	81037	40	Pediatrics	0	In state provider	None	135 THE UPLANDS	None	BERKELEY	CA	94705	2816	01	06001	37.85324494	-122.2422811	Alameda County
191166	Fee-for-Service	1598187924	1598187924	1	1	PHAN, MIMI A OD	1/14/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13161 MINDANAO WAY	SUITE D6A	MARINA DEL REY	CA	90292	6307	19	06037	33.98496412	-118.4375544	Los Angeles County
191178	Fee-for-Service	1104882075	1104882075	1	1	PAUL P HUANG, M.D.	12/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 17TH AVE	STE 680	SEATTLE	WA	98122	5795	00	None	47.60689769	-122.3102467	King County
191180	Fee-for-Service	1871607762	1871607762	1	141	PROVIDENCE MEDICAL FOUNDATIO	12/12/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	30	06059	33.89691672	-117.9291749	Orange County
191191	Fee-for-Service	1356882435	1356882435	1	1	PROHEALTH PARTNERS A	9/19/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	101 E BEVERLY BLVD	STE 207	MONTEBELLO	CA	90640	4315	19	06037	34.01556395	-118.0983878	Los Angeles County
191196	Fee-for-Service	1184200198	1184200198	1	1	PELPOLA, JUDITH MD	2/10/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
191258	Fee-for-Service	1235463944	1235463944	1	1	PALMER, BEN C OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2406	38	06075	37.75670558	-122.4211139	San Francisco County
191269	Fee-for-Service	1366514101	1366514101	1	1	PAULS, LINDA C MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79735	08	Family Practice	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
191271	Fee-for-Service	1578925855	1578925855	1	1	PENGSON, JOSHUA MD	12/5/2020	207R00000X	NA	Other	026	PHYSICIANS	162979	None	None	0	In state provider	None	23180 HEMLOCK AVE	SUITE 201	MORENO VALLEY	CA	92557	8001	33	06065	33.94245952	-117.2585565	Riverside County
191276	Fee-for-Service	1326421827	1326421827	1	1	PHAM, JOHN V MD	1/21/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17004	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
191281	Fee-for-Service	1871607762	1871607762	1	80	PROVIDENCE MEDICAL FOUNDATIO	8/17/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1847 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89240254	-117.9314841	Orange County
191284	Fee-for-Service	1871607762	1871607762	1	101	PROVIDENCE MEDICAL FOUNDATIO	9/22/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	510 SUPERIOR AVE	SUITE 200B	NEWPORT BEACH	CA	92663	3663	30	06059	33.63019271	-117.9294795	Orange County
191290	Fee-for-Service	1447447248	1447447248	1	17	PACIFIC INPATIENT MEDICAL GR	4/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1280 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7313	49	06097	38.445534	-122.6642715	Sonoma County
191297	Fee-for-Service	1588334973	1588334973	1	1	PACE, RACHELLE NP	12/6/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
191329	Fee-for-Service	1679815898	1679815898	1	1	PARK, HANNA MD	9/1/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	133676	33	Thoracic Surgery	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
191336	Fee-for-Service	1306248240	1306248240	1	5	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	24962 CALLE ARAGON	None	LAGUNA HILLS	CA	92637	3883	30	06059	33.59966168	-117.7155087	Orange County
191356	Fee-for-Service	1871607762	1871607762	1	70	PROVIDENCE MEDICAL FOUNDATIO	3/3/2015	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	8911 LAKEWOOD DR	SUITE 13	WINDSOR	CA	95492	7857	49	06097	38.55034733	-122.8042316	Sonoma County
191362	Fee-for-Service	1144328378	1144328378	1	1	PEREZ, IRIS A MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53205	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
191363	Fee-for-Service	1962617522	1962617522	1	1	PRUTASERANEE, PANDA MD	8/23/2010	207R00000X	NA	Other	026	PHYSICIANS	104602	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
191423	Fee-for-Service	1871607762	1871607762	1	33	PROVIDENCE MEDICAL FOUNDATIO	5/16/2013	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2504 HARRISON AVE	STE B & C	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
191450	Fee-for-Service	1013306323	1013306323	1	1	PETERS, STEPHANIE	10/4/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
191469	Fee-for-Service	1871607762	1871607762	1	141	PROVIDENCE MEDICAL FOUNDATIO	12/12/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	30	06059	33.89691672	-117.9291749	Orange County
191472	Fee-for-Service	1679979884	1679979884	1	1	PEYMANI, REZA MD	5/4/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	170597	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
191476	Fee-for-Service	1538459888	1538459888	1	1	PIPER, MERISA L MD	6/4/2019	208200000X	NA	General Surgery	026	PHYSICIANS	123958	24	Plastic Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
191532	Fee-for-Service	1730743964	1730743964	1	1	PRENDERGAST, MICHAEL MD	9/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184595	None	None	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
191534	Fee-for-Service	1053787002	1053787002	1	1	PAPPAS, ALYSON	7/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
191552	Fee-for-Service	1124195011	1124195011	1	1	PARIKH, RESHMA MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71726	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
191557	Fee-for-Service	1548348030	1548348030	1	1	PANJWANI, GULSHAN S MD	6/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93517	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
191561	Fee-for-Service	1295833242	1295833242	1	1	PEREZ, JUAN C PSYD	12/7/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
191578	Fee-for-Service	1811238967	1811238967	1	1	PREMIER HEALTHCARE SERVICES	5/6/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	40015 SIERRA HIGHWAY	SUITE B-180	PALMDALE	CA	93550	2106	19	06037	34.60998199	-118.1226322	Los Angeles County
191580	Fee-for-Service	1447447248	1447447248	1	17	PACIFIC INPATIENT MEDICAL GR	4/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1280 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7313	49	06097	38.445534	-122.6642715	Sonoma County
191612	Fee-for-Service	1871607762	1871607762	1	154	PROVIDENCE MEDICAL FOUNDATIO	8/15/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	478 S ANAHEIM HILLS RD	None	ANAHEIM	CA	92807	4241	30	06059	33.84478184	-117.7771266	Orange County
191624	Fee-for-Service	1245672302	1245672302	1	1	PATEL, SAGAR R MD	5/12/2021	207R00000X	NA	Other	026	PHYSICIANS	154925	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
191640	Fee-for-Service	1871607762	1871607762	1	105	PROVIDENCE MEDICAL FOUNDATIO	11/2/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
191669	Fee-for-Service	1144389230	1144389230	1	4	PERINATAL DIAGNOSTIC CENTER	11/21/2023	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	29 N BRENT ST	None	VENTURA	CA	93003	2807	56	06111	34.27250156	-119.2568624	Ventura County
191689	Fee-for-Service	1902165913	1902165913	1	1	PEARL, JEREMY I MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127548	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
191711	Fee-for-Service	1871607762	1871607762	1	96	PROVIDENCE MEDICAL FOUNDATIO	9/2/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	360 SAN MIGUEL DR	STE 105	NEWPORT BEACH	CA	92660	7815	30	06059	33.61321911	-117.8722084	Orange County
191726	Fee-for-Service	1740212976	1740212976	1	1	PIEROG, JAMES E MD	4/18/1978	207PE0004X	NA	Other	026	PHYSICIANS	24241	01	General Practice	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
191798	Fee-for-Service	1275251563	1275251563	1	1	PRANEET K KALKAT MD	9/14/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	950 S ARROYO PKWY	FL 3	PASADENA	CA	91105	3932	19	06037	34.12942212	-118.1471619	Los Angeles County
191809	Fee-for-Service	1356613087	1356613087	1	1	PENINSULA ANESTHESIA	3/7/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CONSULTANTS INC	1900 SULLIVAN AVENUE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
191816	Fee-for-Service	1417282898	1417282898	1	1	PASION, FRANCES I MD	6/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115867	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
191851	Fee-for-Service	1427044544	1427044544	1	2	PROCARE HM HLTH SVCS INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9683 TIERRA GRANDE ST	SUITE 201	SAN DIEGO	CA	92126	6503	37	06073	32.89502548	-117.1207935	San Diego County
191880	Fee-for-Service	1104443399	1104443399	1	1	PENNINGTON OPTOMETRIC CORPOR	8/15/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2109 FOREST AVE	50	CHICO	CA	95928	7708	04	06007	39.721518	-121.8015025	Butte County
191887	Fee-for-Service	1063935237	1063935237	1	1	POTT, EMILY	7/5/2023	207P00000X	NA	Other	026	PHYSICIANS	178207	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
191889	Fee-for-Service	1235349432	1235349432	1	1	POURDEHNAD, MICHAEL MD	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107796	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191903	Fee-for-Service	1871607762	1871607762	1	154	PROVIDENCE MEDICAL FOUNDATIO	2/16/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	478 S ANAHEIM HILLS RD	None	ANAHEIM	CA	92807	4241	30	06059	33.84478184	-117.7771266	Orange County
191909	Fee-for-Service	1881753515	1881753515	1	1	PRAMONO, MARISA S OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
192002	Fee-for-Service	1275187379	1275187379	1	1	PROMINENT HOSPICE CARE GROUP	5/20/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	4605 LANKERSHIM BLVD	SUITE 311 A	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
192016	Fee-for-Service	1740212976	1740212976	1	1	PIEROG, JAMES E MD	4/18/1978	207PE0004X	NA	Other	026	PHYSICIANS	24241	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
192109	Fee-for-Service	1417262163	1417262163	1	1	PARVINCHIHA, AMIR P MD	12/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113408	41	Internal Medicine	0	In state provider	None	1600 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
192115	Fee-for-Service	1316320864	1316320864	1	1	PATEL, KETAN MD	7/12/2023	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	184155	None	None	0	In state provider	None	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
192116	Fee-for-Service	1871607762	1871607762	1	117	PROVIDENCE MEDICAL FOUNDATIO	5/15/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	4900 BARRANCA PKWY	SUITE 103	IRVINE	CA	92604	8603	30	06059	33.67629075	-117.7956464	Orange County
192173	Fee-for-Service	1639339997	1639339997	1	1	PANHWAR, SABENA MD	5/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116180	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
192182	Fee-for-Service	1871607762	1871607762	1	53	PROVIDENCE MEDICAL FOUNDATIO	8/25/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	110 LYNCH CREEK WAY	STE A	PETALUMA	CA	94954	2337	49	06097	38.25171165	-122.6351052	Sonoma County
192187	Fee-for-Service	1396823522	1396823522	1	1	PREGNANCY HELP CENTER	3/19/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1311 CRENSHAW BLVD	STE A	TORRANCE	CA	90501	2486	19	06037	33.83507493	-118.3286969	Los Angeles County
192202	Fee-for-Service	1760639793	1760639793	1	1	PURAN,ALEXIE	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVENUE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
192248	Fee-for-Service	1306248240	1306248240	1	6	PACIFIC HOSPITALIST ASSOCIAT	9/11/2019	314000000X	NA	Skilled Nursing Facility	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	661 CENTER STREET	None	COSTA MESA	CA	92627	2708	30	06059	33.64155466	-117.9259877	Orange County
192249	Fee-for-Service	1811381429	1811381429	1	1	PESYNA, MEGAN A DO	12/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16354	None	None	0	In state provider	None	131 STONY CIR	1600	SANTA ROSA	CA	95401	9520	49	06097	38.439477	-122.7451095	Sonoma County
192265	Fee-for-Service	1679090591	1679090591	1	1	PHAM, LUYEN DPM INC	8/14/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	81713 US HIGHWAY 111	STE F	INDIO	CA	92201	5496	33	06065	33.71013488	-116.2391755	Riverside County
192277	Fee-for-Service	1871607762	1871607762	1	69	PROVIDENCE MEDICAL FOUNDATIO	11/22/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	652 PETALUMA AVE	SUITE B	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
192288	Fee-for-Service	1275187379	1275187379	1	1	PROMINENT HOSPICE CARE GROUP	5/20/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4605 LANKERSHIM BLVD	SUITE 311 A	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
192304	Fee-for-Service	1265879928	1265879928	1	1	PAI, VIDYA V	6/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140889	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
192322	Fee-for-Service	1790170249	1790170249	1	1	PATEL, PARTH M MD	4/1/2021	208800000X	NA	Other	026	PHYSICIANS	171874	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
192329	Fee-for-Service	1598033920	1598033920	1	1	POLADIAN, JACKLIN M D INC	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110327	41	Internal Medicine	0	In state provider	None	301 S FAIR OAKS AVE	SUITE 403	PASADENA	CA	91105	2562	19	06037	34.140348	-118.1504565	Los Angeles County
192345	Fee-for-Service	1558330498	1558330498	1	1	PANDYA, PULIN K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 W LITTLE YORK RD	STE E	HOUSTON	TX	77091	2496	00	None	29.86973947	-95.408901	Harris County
192352	Fee-for-Service	1871607762	1871607762	1	108	PROVIDENCE MEDICAL FOUNDATIO	2/6/2017	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	400 N MCDOWELL BLVD	None	PETALUMA	CA	95954	2339	49	06097	38.25477	-122.63175	Sonoma County
192390	Fee-for-Service	1942755137	1942755137	1	1	PANDIT, PRITAM K NP	7/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
192393	Fee-for-Service	1114053808	1114053808	1	1	POSTON, KATHLEEN L MD	1/12/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	86599	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
192407	Fee-for-Service	1295924470	1295924470	1	2	PACIFIC REDWOOD MEDICAL SERV	10/31/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERVICES, INC	1 MARCELA DRIVE	None	WILLITS	CA	95490	4225	23	06045	39.3901086	-123.339055	Mendocino County
192412	Fee-for-Service	1699278374	1699278374	1	1	PANDIT, RUNJHUN N LPCC	12/23/2020	101YA0400X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4929 WILSHIRE BLVD	SUITE 245	LOS ANGELES	CA	90010	3859	19	06037	34.0621435	-118.3380975	Los Angeles County
192420	Fee-for-Service	1902208507	1902208507	1	2	PREMIER PHYSICAL THERAPY & A	11/13/2018	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ASSOCIATES INC	6591 COLLINS DR	STE E8	MOORPARK	CA	93021	1492	56	06111	34.2944564	-118.8424453	Ventura County
192427	Fee-for-Service	1609968320	1609968320	1	1	PARNELL, STEPHEN A C MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45223	10	Gastroenterology (M.D. only)	0	In state provider	A MEDICAL CORPORATION	575 E HARDY ST	None	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
192438	Fee-for-Service	1255345112	1255345112	1	1	POONIA, ROOPINDER S MD	11/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96233	41	Internal Medicine	0	In state provider	None	1645 PINE ST	None	REDDING	CA	96001	1018	45	06089	40.58295477	-122.3888377	Shasta County
192439	Fee-for-Service	1033166905	1033166905	1	1	PETER LOSEV	9/5/2001	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALAMEDA ORTHO FOOT CNTR	2322 SANTA CLARA AVE	None	ALAMEDA	CA	94501	4522	01	06001	37.76553065	-122.2423998	Alameda County
192462	Fee-for-Service	1912485749	1912485749	1	1	POE, DAVID RCP	8/22/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
192471	Fee-for-Service	1770618605	1770618605	1	1	PILLINER, JEANETTE N MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72590	40	Pediatrics	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
192472	Fee-for-Service	1871607762	1871607762	1	34	PROVIDENCE MEDICAL FOUNDATIO	5/28/2013	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	85 BROOKWOOD AVE	STE 10	SANTA ROSA	CA	95404	4512	49	06097	38.44242	-122.7068055	Sonoma County
192481	Fee-for-Service	1265811392	1265811392	1	1	PAPA, ALEXANDRA L LMFT	6/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
192516	Fee-for-Service	1063688430	1063688430	1	1	PARRA, PHILLIP LCSW	4/25/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 BEAUMONT AVE	213	BEAUMONT	CA	92223	5900	33	06065	33.93223614	-116.9771302	Riverside County
192550	Fee-for-Service	1174852628	1174852628	1	1	PARKER, DANIEL R PHD	7/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
192564	Fee-for-Service	1871607762	1871607762	1	69	PROVIDENCE MEDICAL FOUNDATIO	3/3/2015	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	652 PETALUMA AVE	SUITE B	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
192635	Fee-for-Service	1871607762	1871607762	1	108	PROVIDENCE MEDICAL FOUNDATIO	10/3/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	400 N MCDOWELL BLVD	None	PETALUMA	CA	95954	2339	49	06097	38.25477	-122.63175	Sonoma County
192715	Fee-for-Service	1609968320	1609968320	1	1	PARNELL, STEPHEN A C MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45223	01	General Practice	0	In state provider	A MEDICAL CORPORATION	575 E HARDY ST	None	INGLEWOOD	CA	90301	4036	19	06037	33.94909392	-118.3477665	Los Angeles County
192719	Fee-for-Service	1689060006	1689060006	1	1	PATHAK, ARADHANA MD	10/8/2024	208M00000X	NA	Other	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	43723 20TH ST WEST	STE 101	LANCASTER	CA	93534	4784	19	06037	34.67746837	-118.1657415	Los Angeles County
192758	Fee-for-Service	1871607762	1871607762	1	102	PROVIDENCE MEDICAL FOUNDATIO	9/21/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	16300 SAND CANYON AVE	SUITE 311	IRVINE	CA	92618	3703	30	06059	33.66115075	-117.7742405	Orange County
192759	Fee-for-Service	1508938317	1508938317	1	1	PETERSON, STEPHANIE M MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91574	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
192772	Fee-for-Service	1871607762	1871607762	1	83	PROVIDENCE MEDICAL FOUNDATIO	11/12/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	1100 TRANCAS ST	SUITE 256	NAPA	CA	94558	2921	28	06055	38.32316569	-122.2981938	Napa County
192802	Fee-for-Service	1811453392	1811453392	1	1	PUROHIT, NARESH MD	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
192812	Fee-for-Service	1588053797	1588053797	1	1	PIZANO-MARTINEZ, LUIS G	12/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
192912	Fee-for-Service	1619706991	1619706991	1	1	PEERY, ASHTIN LMFT	8/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
192921	Fee-for-Service	1902167695	1902167695	1	1	PAEZ, MARCO A MD	5/31/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	154078	10	Gastroenterology (M.D. only)	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
192926	Fee-for-Service	1174923684	1174923684	1	1	PLANNED PARENTHOOD MAR MONTE	12/11/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1032 A STREET	None	HAYWARD	CA	94541	4106	01	06001	37.67439519	-122.0831733	Alameda County
192928	Fee-for-Service	1871607762	1871607762	1	108	PROVIDENCE MEDICAL FOUNDATIO	6/17/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	400 N MCDOWELL BLVD	None	PETALUMA	CA	95954	2339	49	06097	38.25477	-122.63175	Sonoma County
192946	Fee-for-Service	1811778202	1811778202	1	1	PATEL, PURVI OD	12/10/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	661 N EUCLID ST	None	ANAHEIM	CA	92801	4622	30	06059	33.840603	-117.943902	Orange County
192954	Fee-for-Service	1245297084	1245297084	1	1	PRATHIKANTI, SUDHA MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74510	36	Psychiatry	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
193027	Fee-for-Service	1740855055	1740855055	1	1	PAREKH, SAGAR DO	10/3/2024	207R00000X	NA	Other	026	PHYSICIANS	22695	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
193034	Fee-for-Service	1891727947	1891727947	1	1	POST, STEPHEN E MD	11/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	40250	18	Ophthalmology	0	In state provider	None	2149 CENTRAL AVE	None	ALAMEDA	CA	94501	2894	01	06001	37.76643361	-122.2479293	Alameda County
193040	Fee-for-Service	1386458487	1386458487	1	1	PEOPLECONNECT INC	6/5/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1309 E SOMERSET PLACE	None	LONG BEACH	CA	90807	3724	19	06037	33.83191154	-118.1746864	Los Angeles County
193043	Fee-for-Service	1871607762	1871607762	1	88	PROVIDENCE MEDICAL FOUNDATIO	2/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	49	06097	38.24451673	-122.6303052	Sonoma County
193050	Fee-for-Service	1841634565	1841634565	1	1	POH, MEMIE C MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133707	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
193062	Fee-for-Service	1871607762	1871607762	1	83	PROVIDENCE MEDICAL FOUNDATIO	9/8/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	N	1100 TRANCAS ST	SUITE 256	NAPA	CA	94558	2921	28	06055	38.32316569	-122.2981938	Napa County
193070	Fee-for-Service	1528015559	1528015559	1	1	PERRY, RUSSELL M MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42812	30	Radiology	0	In state provider	INC	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
193072	Fee-for-Service	1104974542	1104974542	1	1	PURUGANAN, ISABELITA G	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
193074	Fee-for-Service	1548331804	1548331804	1	1	PULLING, MELISSA E MD	11/25/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77584	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
193075	Fee-for-Service	1447747530	1447747530	1	1	PARSONS, MIGNON H MD	6/10/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163495	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
193125	Fee-for-Service	1245814987	1245814987	1	1	PABLA, MANDEEP DO	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20777	08	Family Practice	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
193166	Fee-for-Service	1902842990	1902842990	1	1	PETRIE, CLARENCE R MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	32946	02	General Surgery	0	In state provider	None	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	30	06059	33.89443025	-117.9288328	Orange County
193199	Fee-for-Service	1295792661	1295792661	1	1	PAUL MELNICK MD	12/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 W HIGH ST	STE 107	ELKTON	MD	21921	5549	00	None	39.60913888	-75.83194859	Cecil County
193205	Fee-for-Service	1851794176	1851794176	1	1	P & I TRANSPORTATION, INC	1/19/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8258 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3301	19	06037	34.22088144	-118.3675155	Los Angeles County
193207	Fee-for-Service	1013049840	1013049840	1	1	PENG, PAUL H OD	3/18/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
193218	Fee-for-Service	1548664089	1548664089	1	1	PAK, SUSANA S CRNA	9/4/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
193225	Fee-for-Service	1588078448	1588078448	1	1	PAULSEN, MARK I MD	7/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138251	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
193287	Fee-for-Service	1871607762	1871607762	1	51	PROVIDENCE MEDICAL FOUNDATIO	8/18/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE G-06	SANTA ROSA	CA	95405	4558	49	06097	38.44332	-122.6985255	Sonoma County
193290	Fee-for-Service	1750309837	1750309837	1	1	PROVIDENCE HOLY CROSS	5/1/1996	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11600A INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.28104231	-118.4588039	Los Angeles County
193293	Fee-for-Service	1437169372	1437169372	1	1	PAK, SU-YONG MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	34079	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
193305	Fee-for-Service	1437170826	1437170826	1	1	PARK, KYEONG H MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55771	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
193328	Fee-for-Service	1255726261	1255726261	1	1	PALLA, MISBAH Y MD	1/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159135	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
193329	Fee-for-Service	1871607762	1871607762	1	88	PROVIDENCE MEDICAL FOUNDATIO	3/12/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	49	06097	38.24451673	-122.6303052	Sonoma County
193334	Fee-for-Service	1023115615	1023115615	1	1	PITAFI, ALI A MD	8/5/2024	207R00000X	NA	Other	026	PHYSICIANS	148057	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
193349	Fee-for-Service	1871607762	1871607762	1	83	PROVIDENCE MEDICAL FOUNDATIO	9/26/2020	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	1100 TRANCAS ST	SUITE 256	NAPA	CA	94558	2921	28	06055	38.32316569	-122.2981938	Napa County
193351	Fee-for-Service	1982846077	1982846077	1	1	PRIDDY, NATHAN MD	5/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164673	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
193383	Fee-for-Service	1619952199	1619952199	1	1	PENMETCHA, VINAY MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51900	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
193389	Fee-for-Service	1962049643	1962049643	1	1	PRIEST, MARK	3/9/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4171 OCEANSIDE BLVD	108	OCEANSIDE	CA	92056	6023	37	06073	33.20689886	-117.2859505	San Diego County
193390	Fee-for-Service	1255771028	1255771028	1	1	POGGESI, ROSA PHD	7/10/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
193403	Fee-for-Service	1831254747	1831254747	1	1	PHARMACORP INC	1/27/1997	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2530-B SAN VICENTE BLVD	None	SANTA MONICA	CA	90402	2021	19	06037	34.0482654	-118.4919588	Los Angeles County
193410	Fee-for-Service	1245487479	1245487479	1	1	PIGAL, ANASTASIYA MD	7/11/2022	207ZP0102X	NA	Other	026	PHYSICIANS	178145	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
193411	Fee-for-Service	1598125247	1598125247	1	1	PILGREEN, VALERIE K LCSW	4/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA COURT	A6-304	PALMDALE	CA	93550	7607	19	06037	34.64013337	-118.1280539	Los Angeles County
193414	Fee-for-Service	1245814987	1245814987	1	1	PABLA, MANDEEP DO	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20777	70	Clinic (mixed specialty)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
193418	Fee-for-Service	1437555984	1437555984	1	1	PREMIER HEALTHCARE SERVICES	2/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	5250 NORTH PALM AVE	STE 227	FRESNO	CA	93704	2228	10	06019	36.8129445	-119.8083179	Fresno County
193424	Fee-for-Service	1942543681	1942543681	1	1	POURTAHERI, NAVID MD	12/28/2021	208200000X	NA	General Surgery	026	PHYSICIANS	167926	None	None	0	In state provider	None	167 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2343	49	06097	38.25155667	-122.6346031	Sonoma County
193438	Fee-for-Service	1104831890	1104831890	1	1	PATEL, JAGRUTI A MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100659	41	Internal Medicine	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
193465	Fee-for-Service	1518064278	1518064278	1	1	PATEL, AMI N MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88993	41	Internal Medicine	0	In state provider	None	1505 WILSON TERRACE	STE 340	GLENDALE	CA	91206	4072	19	06037	34.14960934	-118.2313491	Los Angeles County
193468	Fee-for-Service	1235261553	1235261553	1	1	PREMIER MED SUP SER LLC	10/21/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PREMIER MED SUPPL SERV	2630 W MANCHESTER BLVD	STE C	INGLEWOOD	CA	90305	2434	19	06037	33.9598587	-118.3228097	Los Angeles County
193472	Fee-for-Service	1497719942	1497719942	1	1	PARK, JONG W MD	9/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	44338	01	General Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
193491	Fee-for-Service	1437178985	1437178985	1	1	PETERSON, MICHAEL W MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86406	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
193496	Fee-for-Service	1154377489	1154377489	1	1	PRIMA MEDICAL GROUP INC	11/6/2001	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	4000 CIVIC CENTER DR	#200B	SAN RAFAEL	CA	94903	5232	21	06041	38.0041783	-122.538861	Marin County
193575	Fee-for-Service	1841226990	1841226990	1	9	PHYSICIAN FOUNDATION	3/17/2008	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1315 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5246	34	06067	38.568429	-121.4665605	Sacramento County
193616	Fee-for-Service	1871607762	1871607762	1	112	PROVIDENCE MEDICAL FOUNDATIO	5/22/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1476 PROFESSIONAL DR	SUITE 504	PETALUMA	CA	94954	1500	49	06097	38.25537028	-122.633451	Sonoma County
193647	Fee-for-Service	1437268984	1437268984	1	1	PAYLESS DRUG STORE 5937	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1355 MACARTHUR BLVD	None	SAN LEANDRO	CA	94577	3918	01	06001	37.72917298	-122.1387677	Alameda County
193667	Fee-for-Service	1568806560	1568806560	1	1	PUENTES, JOSEPH C PSYD	10/15/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2455 BENNETT VALLEY RD	B-208	SANTA ROSA	CA	95404	5643	49	06097	38.434284	-122.6918565	Sonoma County
193673	Fee-for-Service	1023384054	1023384054	1	1	PATEL, ALOK S MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155682	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
193683	Fee-for-Service	1548354418	1548354418	1	1	PIEKARSKI, STEPHANIE MSW LC	5/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	514 SOUTH SCHOOL STREET	None	UKIAH	CA	95482	5438	23	06045	39.14665998	-123.2079563	Mendocino County
193699	Fee-for-Service	1871607762	1871607762	1	133	PROVIDENCE MEDICAL FOUNDATIO	11/5/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	17043 MAIN ST	None	HESPERIA	CA	92345	6055	36	06071	34.41993077	-117.2910197	San Bernardino County
193704	Fee-for-Service	1902130305	1902130305	2	1	PATEL, RAJAN H MD	3/26/2024	208M00000X	NA	Other	026	PHYSICIANS	113726	None	None	0	In state provider	None	25775 MCBEAN PKWY	202, 215	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
193726	Fee-for-Service	1104831890	1104831890	1	1	PATEL, JAGRUTI A MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100659	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
193753	Fee-for-Service	1518064278	1518064278	1	1	PATEL, AMI N MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88993	78	Neoplastic Diseases/Oncology	0	In state provider	None	1505 WILSON TERRACE	STE 340	GLENDALE	CA	91206	4072	19	06037	34.14960934	-118.2313491	Los Angeles County
193769	Fee-for-Service	1225609969	1225609969	1	1	PURE HANDS HOME HEALTH, INC	4/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14555 HAMLIN ST	SUITE 1A	VAN NUYS	CA	91411	1612	19	06037	34.18872722	-118.4506359	Los Angeles County
193780	Fee-for-Service	1154377489	1154377489	1	1	PRIMA MEDICAL GROUP INC	11/6/2001	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	4000 CIVIC CENTER DR	#200B	SAN RAFAEL	CA	94903	5232	21	06041	38.0041783	-122.538861	Marin County
193782	Fee-for-Service	1942253273	1942253273	1	1	PEREZ, DARIO MD INC	3/23/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	PEREZ SURGICAL MEDICAL	1510 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2588	19	06037	34.12709764	-118.2577911	Los Angeles County
193786	Fee-for-Service	1215103098	1215103098	1	1	PURI, MEESHA CNP	6/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2630 W EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	1117	43	06085	37.40212151	-122.1149462	Santa Clara County
193804	Fee-for-Service	1083185342	1083185342	1	2	PALM PATHOLOGY MEDICAL GROUP	11/5/2020	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	, A PROFESSIONAL CORPORA	47111 MONROE ST	None	INDIO	CA	91355	6739	33	06065	33.70620698	-116.2339008	Riverside County
193808	Fee-for-Service	1396457248	1396457248	1	1	PHAM, CRYSTAL A CRNA	4/18/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
193813	Fee-for-Service	1790284727	1790284727	1	1	PRATT, KRISTEN C LCSW	8/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
193839	Fee-for-Service	1114452224	1114452224	1	1	PEDIATRICS R US INC	4/12/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	31569 CANYON ESTATES DR	STE 225	LAKE ELSINORE	CA	92532	0470	33	06065	33.6671373	-117.3012532	Riverside County
193863	Fee-for-Service	1841226990	1841226990	1	9	PHYSICIAN FOUNDATION	3/17/2008	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1315 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5246	34	06067	38.568429	-121.4665605	Sacramento County
193867	Fee-for-Service	1871607762	1871607762	1	158	PROVIDENCE MEDICAL FOUNDATIO	2/12/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	N	845 LA VETA	STE 108	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
193901	Fee-for-Service	1649598285	1649598285	1	1	PANDEY, VIKAS MD	9/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	159136	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
193905	Fee-for-Service	1871607762	1871607762	1	77	PROVIDENCE MEDICAL FOUNDATIO	7/31/2015	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	30131 TOWN CENTER DR	SUITE 211	LAGUNA NIGUEL	CA	92677	2088	30	06059	33.52530096	-117.7148334	Orange County
193936	Fee-for-Service	1396776977	1396776977	1	1	PHAM, NHU Q MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79163	41	Internal Medicine	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
193990	Fee-for-Service	1871607762	1871607762	1	65	PROVIDENCE MEDICAL FOUNDATIO	3/17/2021	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	N	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
194004	Fee-for-Service	1932593167	1932593167	1	1	PRABHAKAR, VIJAY K MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144053	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
194028	Fee-for-Service	1215561444	1215561444	1	1	PORTOLA GARDENS LLC	8/20/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	350 UNIVERSITY STREET	None	SAN FRANCISCO	CA	94134	1635	38	06075	37.72565215	-122.4137414	San Francisco County
194041	Fee-for-Service	1518064278	1518064278	1	1	PATEL, AMI N MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88993	68	Hematology	0	In state provider	None	1505 WILSON TERRACE	STE 340	GLENDALE	CA	91206	4072	19	06037	34.14960934	-118.2313491	Los Angeles County
194060	Fee-for-Service	1841297272	1841297272	1	1	PASTO, MATTHEW E MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31256	30	Radiology	0	In state provider	None	2410 SAMARITAN DR	STE 101	SAN JOSE	CA	95124	3909	43	06085	37.25107654	-121.9451342	Santa Clara County
194091	Fee-for-Service	1083185342	1083185342	1	2	PALM PATHOLOGY MEDICAL GROUP	11/5/2020	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	, A PROFESSIONAL CORPORA	47111 MONROE ST	None	INDIO	CA	91355	6739	33	06065	33.70620698	-116.2339008	Riverside County
194092	Fee-for-Service	1396771218	1396771218	1	1	PHAM, THANG MD	3/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	60186	None	None	0	In state provider	None	4902 IRVINE CENTER DR	STE 105	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
194097	Fee-for-Service	1366768541	1366768541	1	1	POON, KENNETH S Y MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139907	78	Neoplastic Diseases/Oncology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
194107	Fee-for-Service	1659722320	1659722320	1	1	PERPETUA, GABRIEL M PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
194128	Fee-for-Service	1962436410	1962436410	1	1	PIRNAZAR, JONATHAN R MD	7/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72632	18	Ophthalmology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
194150	Fee-for-Service	1841226990	1841226990	1	9	PHYSICIAN FOUNDATION	3/17/2008	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	1315 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5246	34	06067	38.568429	-121.4665605	Sacramento County
194153	Fee-for-Service	1871607762	1871607762	1	158	PROVIDENCE MEDICAL FOUNDATIO	2/12/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	845 LA VETA	STE 108	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
194162	Fee-for-Service	1508400987	1508400987	1	1	PORTILLO, DANILA Y NP	1/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
194165	Fee-for-Service	1558362343	1558362343	1	1	PEARSON, JACK A MD	3/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52964	41	Internal Medicine	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
194169	Fee-for-Service	1871607762	1871607762	1	28	PROVIDENCE MEDICAL FOUNDATIO	1/4/2013	207Y00000X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3770 JANES ROAD	None	ARCATA	CA	95521	4744	12	06023	40.89583739	-124.0932916	Humboldt County
194175	Fee-for-Service	1881811354	1881811354	1	1	PATHAK, APURBA S MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82740	34	Urology and Urological Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
194188	Fee-for-Service	1396242574	1396242574	1	1	PARISH, AUSTIN J MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	184421	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
194220	Fee-for-Service	1912122631	1912122631	1	1	POLOSAJIAN, LEO MD APC	6/26/2007	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	81080	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7640 TAMPA AVE	STE 101	RESEDA	CA	91335	1735	19	06037	34.20951144	-118.5534786	Los Angeles County
194249	Fee-for-Service	1861928582	1861928582	1	1	POQUETTE, AMELIA J MD	4/26/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160523	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
194281	Fee-for-Service	1871607762	1871607762	1	89	PROVIDENCE MEDICAL FOUNDATIO	3/21/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	2323 BERTHARDS DRIVE	None	SANTA ROSA	CA	95405	8500	49	06097	38.427075	-122.6666655	Sonoma County
194287	Fee-for-Service	1437110368	1437110368	1	1	PUTNAM,CATHEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PIONEER VALLEY HOSPITAL	3460 S. PIONEER PARKWAY	None	WEST VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
194292	Fee-for-Service	1679585731	1679585731	1	1	PENN, JOSHUA MD	10/31/1992	174400000X	NA	Other	026	PHYSICIANS	76919	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	414 N CAMDEN DR	STE 1100	BEVERLY HILLS	CA	90210	4517	19	06037	34.06880486	-118.4042308	Los Angeles County
194384	Fee-for-Service	1366768541	1366768541	1	1	POON, KENNETH S Y MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139907	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
194423	Fee-for-Service	1467543744	1467543744	1	1	PUROHIT, NIKUNJ J MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52996	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194443	Fee-for-Service	1528385002	1528385002	1	1	PEERENBOOM, SCOTT R DO	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13678	41	Internal Medicine	0	In state provider	None	424 28TH ST	None	OAKLAND	CA	94609	3603	01	06001	37.81660247	-122.2659563	Alameda County
194453	Fee-for-Service	1558362343	1558362343	1	1	PEARSON, JACK A MD	3/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52964	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
194470	Fee-for-Service	1407920978	1407920978	1	1	PETERS, RACHEL K	8/24/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
194481	Fee-for-Service	1558401547	1558401547	1	1	PEREZ-RICHTER, MARIA LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	482 N ROSEMEAD BLVD	SUITE 103	PASADENA	CA	91107	3000	19	06037	34.15457831	-118.078192	Los Angeles County
194508	Fee-for-Service	1053421016	1053421016	1	1	PHELAN, GEOFFREY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36207	01	General Practice	0	In state provider	None	1220 E AVENUE S	STE F	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
194510	Fee-for-Service	1225586951	1225586951	1	1	PROVIDENCE HOSPICE INC	2/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	440 N MOUNTAIN AVENUE	SUITE 201G	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
194534	Fee-for-Service	1770921975	1770921975	1	1	POLLAK, BRANDON A MD	5/13/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
194561	Fee-for-Service	1801015599	1801015599	1	1	POON, PETER MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35568	01	General Practice	0	In state provider	None	9817 ARKANSAS ST	None	BELLFLOWER	CA	90706	5913	19	06037	33.87937427	-118.1245762	Los Angeles County
194568	Fee-for-Service	1891713228	1891713228	2	1	PETRUS, EARL P MD	4/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	19750	36	Psychiatry	0	In state provider	None	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4996	19	06037	34.24271597	-118.5915861	Los Angeles County
194571	Fee-for-Service	1871607762	1871607762	1	89	PROVIDENCE MEDICAL FOUNDATIO	3/14/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2323 BERTHARDS DRIVE	None	SANTA ROSA	CA	95405	8500	49	06097	38.427075	-122.6666655	Sonoma County
194578	Fee-for-Service	1891177440	1891177440	1	1	PALMDALE REGIONAL CONGREGATE	7/7/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	733 CELTIC DR	None	PALMDALE	CA	93551	4596	19	06037	34.5803345	-118.143927	Los Angeles County
194604	Fee-for-Service	1578588489	1578588489	1	2	PACIFIC EYE SPECIALISTS A PR	11/21/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1850 SULLIVAN AVE	STE 540	DALY CITY	CA	94015	2215	41	06081	37.68085904	-122.4728842	San Mateo County
194623	Fee-for-Service	1750539524	1750539524	1	1	PRIETO, MAYRA L LCSW	12/21/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	920 S BROADWAY	STE B	SANTA MARIA	CA	93454	6662	42	06083	34.942311	-120.4359745	Santa Barbara County
194634	Fee-for-Service	1083667323	1083667323	1	1	PLANNED PARENTHOOD	1/1/1995	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	398 S GREEN VALLEY ROAD	None	WATSONVILLE	CA	95076	3099	44	06087	36.93055964	-121.7769628	Santa Cruz County
194643	Fee-for-Service	1871607762	1871607762	1	25	PROVIDENCE MEDICAL FOUNDATIO	4/18/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19333 BEAR VALLEY ROAD	SUITE 104	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
194740	Fee-for-Service	1477855344	1477855344	1	1	PAYAN IZABAL, NIDIA C MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119012	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
194743	Fee-for-Service	1639138399	1639138399	1	1	PATINO, MARIA M MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72514	22	Pathology (M.D. only)	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
194788	Fee-for-Service	1316221617	1316221617	1	1	PLANNED PARENTHOOD MAR MONTE	6/20/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	29 BAYWOOD AVE	None	SAN MATEO	CA	94402	1516	41	06081	37.56478204	-122.3289243	San Mateo County
194792	Fee-for-Service	1457573313	1457573313	1	1	PRIVETTE, ALICIA R MD	5/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115704	02	General Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94410	3518	38	06075	37.75548534	-122.4065362	San Francisco County
194799	Fee-for-Service	1053421016	1053421016	1	1	PHELAN, GEOFFREY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36207	08	Family Practice	0	In state provider	None	1220 E AVENUE S	STE F	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
194806	Fee-for-Service	1225058092	1225058092	1	1	POKRASSA, MITCHELL A DPM	2/8/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	321 N LARCHMONT BLVD	STE 525	LOS ANGELES	CA	90004	6401	19	06037	34.0769016	-118.323663	Los Angeles County
194807	Fee-for-Service	1225586951	1225586951	1	1	PROVIDENCE HOSPICE INC	2/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	440 N MOUNTAIN AVENUE	SUITE 201G	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
194829	Fee-for-Service	1346274909	1346274909	1	1	PARK, SUNG K MD	3/15/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62442	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
194848	Fee-for-Service	1801015599	1801015599	1	1	POON, PETER MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35568	78	Neoplastic Diseases/Oncology	0	In state provider	None	9817 ARKANSAS ST	None	BELLFLOWER	CA	90706	5913	19	06037	33.87937427	-118.1245762	Los Angeles County
194855	Fee-for-Service	1871607762	1871607762	1	65	PROVIDENCE MEDICAL FOUNDATIO	11/20/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
194872	Fee-for-Service	1275573982	1275573982	1	1	POWELL, DOUGLAS L MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	48606	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
194888	Fee-for-Service	1134302664	1134302664	1	1	PREFERRED NON EMERGENCY	4/30/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORT, LLC	15847 ASH ST	None	HESPERIA	CA	92345	4258	36	06071	34.39607452	-117.3171918	San Bernardino County
194961	Fee-for-Service	1043284813	1043284813	1	1	PECCI, CHRISTINE C MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56032	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
194970	Fee-for-Service	1205465994	1205465994	1	1	PARHAMI, TANIA CNP	11/17/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
195016	Fee-for-Service	1639497019	1639497019	1	1	PATEL, DR PRAKASCHANDRA MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34471	41	Internal Medicine	0	In state provider	INC APC	315 N 3RD AVE	STE 306	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
195026	Fee-for-Service	1932790516	1932790516	1	1	PARADISE IN THE VALLEY	5/19/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13530 SHERMAN WAY	None	VAN NUYS	CA	91405	2830	19	06037	34.20115849	-118.4280165	Los Angeles County
195042	Fee-for-Service	1871607762	1871607762	1	118	PROVIDENCE MEDICAL FOUNDATIO	5/16/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	990 SONOMA AVENUE	SUITE 17	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
195053	Fee-for-Service	1386810315	1386810315	1	1	PATEL, POONAM J MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117146	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
195062	Fee-for-Service	1679553689	1679553689	1	1	PRETORIUS, EUGENE S MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52733	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
195103	Fee-for-Service	1598474538	1598474538	1	2	PICK N DROP TRANSPORTATION L	12/22/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LC	18239 RAYMOND CT	None	FONTANA	CA	92336	3356	36	06071	34.11615912	-117.4066638	San Bernardino County
195137	Fee-for-Service	1801015599	1801015599	1	1	POON, PETER MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	35568	22	Pathology (M.D. only)	0	In state provider	None	9817 ARKANSAS ST	None	BELLFLOWER	CA	90706	5913	19	06037	33.87937427	-118.1245762	Los Angeles County
195139	Fee-for-Service	1518618446	1518618446	1	1	PHILPOTT-JONES, STEPHANIE P	12/30/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SYD	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
195141	Fee-for-Service	1871607762	1871607762	1	65	PROVIDENCE MEDICAL FOUNDATIO	10/13/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
195193	Fee-for-Service	1720036163	1720036163	1	1	PAZ, AMY D MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89378	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
195210	Fee-for-Service	1396720629	1396720629	1	1	PIERCE, JONATHAN MD	6/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78407	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
195231	Fee-for-Service	1801667555	1801667555	1	1	PHARMHEALTH888 INC	4/12/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1227 E VALLEY BLVD	None	ALHAMBRA	CA	91801	5235	19	06037	34.07926357	-118.1108064	Los Angeles County
195236	Fee-for-Service	1548614811	1548614811	1	1	PLASCENCIA-MARTINEZ, JOSUE R	2/11/2020	207P00000X	NA	Other	026	PHYSICIANS	158056	08	Family Practice	0	In state provider	MD	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
195237	Fee-for-Service	1669671962	1669671962	1	1	PUGA, SERENA MD	6/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101321	36	Psychiatry	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
195248	Fee-for-Service	1043284813	1043284813	1	1	PECCI, CHRISTINE C MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56032	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
195307	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
195310	Fee-for-Service	1639138001	1639138001	1	1	PIDOUX, RENE E MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25274	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
195323	Fee-for-Service	1336316918	1336316918	1	1	PARASHETTE, KALYAN RAY MD	7/1/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	161298	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
195331	Fee-for-Service	1740410182	1740410182	1	15	PACIFIC DERMATOLOGY INSTITUT	10/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	E	850 E LATHAM AVE	201	HEMET	CA	92543	4391	33	06065	33.74941446	-116.963559	Riverside County
195353	Fee-for-Service	1184680365	1184680365	1	1	PETROFSKY, YOLANTA V MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76640	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
195413	Fee-for-Service	1831365279	1831365279	1	1	PARK, JOSEPH J MD	9/8/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	107054	30	Radiology	0	In state provider	None	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
195434	Fee-for-Service	1871607762	1871607762	1	89	PROVIDENCE MEDICAL FOUNDATIO	2/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	2323 BERTHARDS DRIVE	None	SANTA ROSA	CA	95405	8500	49	06097	38.427075	-122.6666655	Sonoma County
195437	Fee-for-Service	1730253709	1730253709	1	1	PAN, SOFIA W MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55999	40	Pediatrics	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
195461	Fee-for-Service	1013206440	1013206440	1	1	PANDYA, RITA M MD	1/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122779	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195489	Fee-for-Service	1194108084	1194108084	1	1	POOLSAAD, AARONSHAWN N OD	7/28/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4100 LONG BEACH BLVD	STE 108	LONG BEACH	CA	90807	2696	19	06037	33.832323	-118.1893205	Los Angeles County
195506	Fee-for-Service	1871607762	1871607762	1	52	PROVIDENCE MEDICAL FOUNDATIO	9/17/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	N	585 W COLLEGE AVE	STE A	SANTA ROSA	CA	95401	5060	49	06097	38.445903	-122.735601	Sonoma County
195520	Fee-for-Service	1316179492	1316179492	1	1	PACIFIC COAST EMERGENCY MEDI	9/1/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
195552	Fee-for-Service	1477628840	1477628840	1	2	PATEL, ARUN D MD	11/20/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	46567	01	General Practice	0	In state provider	None	907 W WILSHIRE AVE	None	FULLERTON	CA	92832	1635	30	06059	33.87222302	-117.9408154	Orange County
195585	Fee-for-Service	1164668786	1164668786	1	1	PREMIER FAMILY MEDICINE	4/17/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES, INC	1601 N MONTE VISTA AVE	#100	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
195595	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
195596	Fee-for-Service	1831575786	1831575786	1	1	PIMENTEL, ANA R LCSW	11/11/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
195600	Fee-for-Service	1033191531	1033191531	1	1	PILECKI, KRYSTYNA I MD	2/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144551	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
195612	Fee-for-Service	1336316918	1336316918	1	1	PARASHETTE, KALYAN RAY MD	7/1/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	161298	10	Gastroenterology (M.D. only)	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
195618	Fee-for-Service	1740410182	1740410182	1	15	PACIFIC DERMATOLOGY INSTITUT	10/25/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	E	850 E LATHAM AVE	201	HEMET	CA	92543	4391	33	06065	33.74941446	-116.963559	Riverside County
195625	Fee-for-Service	1740620079	1740620079	1	1	PEREZ, KATHLEEN A MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140684	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
195629	Fee-for-Service	1841226990	1841226990	1	15	PHYSICIAN FOUNDATION	6/16/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	101 ROWLAND WY	STE 220	NOVATO	CA	94945	5056	21	06041	38.09755172	-122.5591766	Marin County
195693	Fee-for-Service	1578747606	1578747606	1	1	PREMIER EMERGENCY	9/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PHYSICIANS OF CA MED GR	3350 W BALL RD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
195696	Fee-for-Service	1639432677	1639432677	1	1	PLANTMASON, LEE R MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131201	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2788	37	06073	32.8002375	-117.1546269	San Diego County
195768	Fee-for-Service	1174635361	1174635361	1	1	PREMIER DIAGNOSTICS INC	4/20/2007	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1851 HOLSER WALK	STE 210	OXNARD	CA	93036	2626	56	06111	34.22021697	-119.1556025	Ventura County
195777	Fee-for-Service	1841241585	1841241585	1	8	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	4700 SPRING ST.	SUITE 220	LA MESA	CA	92024	8704	37	06073	32.76503682	-117.0203822	San Diego County
195782	Fee-for-Service	1891713228	1891713228	2	2	PETRUS, EARL P MD	4/8/2021	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	19750	-	NOT APPLICABLE	0	In state provider	None	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4903	19	06037	34.24271597	-118.5915861	Los Angeles County
195797	Fee-for-Service	1740456912	1740456912	1	1	PIERONI, SABRINA MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106901	30	Radiology	0	In state provider	None	330 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
195798	Fee-for-Service	1871607762	1871607762	1	111	PROVIDENCE MEDICAL FOUNDATIO	3/22/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	19333 BEAR VALLEY RD	SUITE 101	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
195805	Fee-for-Service	1154569523	1154569523	1	1	PACIFIC COAST ANESTHESIA LLC	1/17/2017	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5 HOLLAND	STE 101	IRVINE	CA	92618	2568	30	06059	33.64596897	-117.7198362	Orange County
195826	Fee-for-Service	1770896011	1770896011	1	1	PARK, TRACY T OD	3/2/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12302 GARDEN GROVE BLVD	SUITE 6	GARDEN GROVE	CA	92843	1802	30	06059	33.77428392	-117.9181185	Orange County
195853	Fee-for-Service	1083635593	1083635593	1	1	PATANKAR, KAUSTUBH V MD	6/21/2000	174400000X	NA	Other	026	PHYSICIANS	43218	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3770 ELIZABETH ST	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
195874	Fee-for-Service	1164668786	1164668786	1	1	PREMIER FAMILY MEDICINE	2/5/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, INC	1601 N MONTE VISTA AVE	#100	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
195882	Fee-for-Service	1871607762	1871607762	1	61	PROVIDENCE MEDICAL FOUNDATIO	8/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE 304	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
195883	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	27	Psychiatry Neurology (D.O. only)	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
195892	Fee-for-Service	1518099597	1518099597	1	1	PROHEALTH PARTNERS, AMC	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3650 SOUTH ST	STE 103	LAKEWOOD	CA	90712	1530	19	06037	33.86019847	-118.149255	Los Angeles County
195897	Fee-for-Service	1114047917	1114047917	1	1	PURCELL, DERK D MD	12/16/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	90227	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195905	Fee-for-Service	1740298991	1740298991	1	1	PATERSON, BRUCE MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	45545	03	Allergy	0	In state provider	None	2485 HIGH SCHOOL AVE	SUITE 127	CONCORD	CA	94520	1841	07	06013	37.98507961	-122.034189	Contra Costa County
195908	Fee-for-Service	1912932914	1912932914	1	1	PATRAWALA, ROBIN A MD	11/30/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54594	41	Internal Medicine	0	In state provider	None	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	01	06001	37.54845774	-121.9773463	Alameda County
195916	Fee-for-Service	1841226990	1841226990	1	15	PHYSICIAN FOUNDATION	6/16/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	101 ROWLAND WY	STE 220	NOVATO	CA	94945	5056	21	06041	38.09755172	-122.5591766	Marin County
195921	Fee-for-Service	1295924470	1295924470	1	3	PACIFIC REDWOOD MEDICAL SERV	10/6/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
195934	Fee-for-Service	1487000725	1487000725	1	1	POND, PATRICE C LCSW	8/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
195944	Fee-for-Service	1053408278	1053408278	1	1	PRIMARY AND MULTI SPECIALTY	4/26/2005	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINICS OF ANAHEIM INC	710 N EUCLID ST	None	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
195949	Fee-for-Service	1144648957	1144648957	1	1	PHAM, HANNAH OD INC	4/25/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 N HARBOR BLVD	SUITE C4	SANTA ANA	CA	92703	3368	30	06059	33.74559419	-117.9202196	Orange County
195970	Fee-for-Service	1205985207	1205985207	1	1	PLEWAK, BETTY LCSW	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
195978	Fee-for-Service	1881830776	1881830776	1	1	PACHON, AMBER L MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101464	08	Family Practice	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
195982	Fee-for-Service	1871607762	1871607762	1	173	PROVIDENCE MEDICAL FOUNDATIO	5/4/2023	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1010 W LA VETA AVE	STE 250	ORANGE	CA	92868	4303	30	06059	33.78028244	-117.8635552	Orange County
195987	Fee-for-Service	1962713313	1962713313	1	1	PUENTES, ANABELLA M OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 THIRD STREET	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
196025	Fee-for-Service	1841000999	1841000999	1	1	PAYLESS ELITE PHARMACY	2/14/2025	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3109 DEL MAR AVE	None	ROSEMEAD	CA	91770	2366	19	06037	34.06473987	-118.0995734	Los Angeles County
196029	Fee-for-Service	1619955994	1619955994	1	1	PATEL, JASHVANT G MD	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75746	25	Physical Medicine and Rehabilitation	0	In state provider	None	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	7290	40	06079	35.29325417	-120.667547	San Luis Obispo County
196066	Fee-for-Service	1841241585	1841241585	1	8	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	4700 SPRING ST.	SUITE 220	LA MESA	CA	92024	8704	37	06073	32.76503682	-117.0203822	San Diego County
196080	Fee-for-Service	1841858594	1841858594	1	1	PACIFIC VISION SURGERY CENTE	11/3/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	R LLC	711 VAN NESS AVE	STE 230	SAN FRANCISCO	CA	94102	3272	38	06075	37.78218473	-122.4208156	San Francisco County
196093	Fee-for-Service	1437269909	1437269909	1	1	PRAKASH, ANANTH N MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	34133	45	Nephrology (Renal-Kidney)	0	In state provider	None	1801 EAST MARCH LANE	SUITE B265	STOCKTON	CA	95210	6655	39	06077	38.00315652	-121.2868715	San Joaquin County
196116	Fee-for-Service	1952427460	1952427460	1	2	POWELL, DESARAE LCSW	9/23/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 W WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
196138	Fee-for-Service	1427266352	1427266352	1	1	PATEL, TARAL A MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	114575	41	Internal Medicine	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
196155	Fee-for-Service	1831306414	1831306414	1	1	PRIETO, MARIA N MD	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96324	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
196169	Fee-for-Service	1871607762	1871607762	1	122	PROVIDENCE MEDICAL FOUNDATIO	3/20/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	17083 MAIN ST	None	HESPERIA	CA	92345	6075	36	06071	34.41986247	-117.2905272	San Bernardino County
196172	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
196203	Fee-for-Service	1841226990	1841226990	1	15	PHYSICIAN FOUNDATION	6/16/2009	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 ROWLAND WY	STE 220	NOVATO	CA	94945	5056	21	06041	38.09755172	-122.5591766	Marin County
196206	Fee-for-Service	1750677662	1750677662	1	1	PHELPS, JENISE K MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122635	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
196208	Fee-for-Service	1295924470	1295924470	1	3	PACIFIC REDWOOD MEDICAL SERV	10/6/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
196227	Fee-for-Service	1063830412	1063830412	1	1	PHAM, CHRISTINE T OD	6/3/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
196255	Fee-for-Service	1881953156	1881953156	1	1	PLASENCIA, SALVADOR	11/6/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	146508	None	None	0	In state provider	None	200 MED PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
196258	Fee-for-Service	1245567858	1245567858	1	1	PAUL, MARIAM A LMFT	12/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
196264	Fee-for-Service	1881830776	1881830776	1	1	PACHON, AMBER L MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101464	41	Internal Medicine	0	In state provider	None	450 E SPRING ST	STE 1	LONG BEACH	CA	90806	1625	19	06037	33.8099218	-118.1872346	Los Angeles County
196271	Fee-for-Service	1720120934	1720120934	1	1	PASTRAN, DAVID R MD	5/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103384	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
196364	Fee-for-Service	1386141984	1386141984	1	1	PARIVASH, SHERVEEN N MD	6/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163880	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196378	Fee-for-Service	1972943603	1972943603	1	1	PATEL, PRANJAL R MD	10/28/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144145	41	Internal Medicine	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
196398	Fee-for-Service	1467608406	1467608406	1	1	PARMAR, SIMA S MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116443	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
196403	Fee-for-Service	1164758751	1164758751	1	1	PRESTON, ANA M NP	4/1/2019	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
196457	Fee-for-Service	1871607762	1871607762	1	97	PROVIDENCE MEDICAL FOUNDATIO	1/26/2023	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	6340 IRVINE BLVD	None	IRVINE	CA	92620	2102	30	06059	33.69980974	-117.7402998	Orange County
196459	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
196500	Fee-for-Service	1295924470	1295924470	1	3	PACIFIC REDWOOD MEDICAL SERV	10/6/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
196507	Fee-for-Service	1225487846	1225487846	1	1	PARKER, REBECCA MD	7/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162326	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
196567	Fee-for-Service	1275544116	1275544116	1	1	PETRIE, BEVERLY A MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55817	None	None	0	In state provider	None	21840 NORMANDIE AVE	# 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
196570	Fee-for-Service	1871607762	1871607762	1	75	PROVIDENCE MEDICAL FOUNDATIO	7/30/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
196635	Fee-for-Service	1619061033	1619061033	1	1	PENG, SUSAN Y MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89076	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
196649	Fee-for-Service	1962630194	1962630194	1	1	PEREZ JR, MARIO MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115169	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
196687	Fee-for-Service	1588027213	1588027213	1	1	PHAN, RYAN H MD	7/20/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168006	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
196696	Fee-for-Service	1871962076	1871962076	1	1	PORTOLA MEDICAL SERVICES, PC	1/21/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25461 RANCHO NIGUEL ROAD	None	LAGUNA NIGUEL	CA	92677	7304	30	06059	33.55527857	-117.6857875	Orange County
196744	Fee-for-Service	1871607762	1871607762	1	97	PROVIDENCE MEDICAL FOUNDATIO	9/6/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	6340 IRVINE BLVD	None	IRVINE	CA	92620	2102	30	06059	33.69980974	-117.7402998	Orange County
196747	Fee-for-Service	1548735202	1548735202	1	1	PROGENY PSYCHIATRIC CLINIC A	2/18/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	A MEDICAL CORPORATION	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
196792	Fee-for-Service	1922013515	1922013515	1	1	PACIFIC NEPHROL MEDI GRP	2/29/1972	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	323 N PRAIRIE AVE	STE 334	INGLEWOOD	CA	90301	4502	19	06037	33.966333	-118.3439975	Los Angeles County
196820	Fee-for-Service	1790743250	1790743250	1	1	PATEL, SHAILESH P MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77763	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
196859	Fee-for-Service	1871607762	1871607762	1	75	PROVIDENCE MEDICAL FOUNDATIO	4/5/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
196889	Fee-for-Service	1386289973	1386289973	1	1	PARKER, ALEXANDRA J LCSW	5/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
196928	Fee-for-Service	1104261908	1104261908	1	1	PASHKOVA, ANNA MD	11/18/2022	207LP2900X	NA	Other	026	PHYSICIANS	176984	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
196962	Fee-for-Service	1164674644	1164674644	1	1	PAUL, NAVIN MD	11/7/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	106801	10	Gastroenterology (M.D. only)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
196987	Fee-for-Service	1871962076	1871962076	1	1	PORTOLA MEDICAL SERVICES, PC	10/5/2021	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25461 RANCHO NIGUEL ROAD	None	LAGUNA NIGUEL	CA	92677	7304	30	06059	33.55527857	-117.6857875	Orange County
196992	Fee-for-Service	1801984935	1801984935	1	1	PEDIATRIC PARTNERS	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MED PROFESSIONAL GROUP	27699 JEFFERSON AVE	STE 102	TEMECULA	CA	92590	2696	33	06065	33.51449799	-117.1593524	Riverside County
196993	Fee-for-Service	1033613765	1033613765	1	1	POOLE, DAVID M MD	9/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
197021	Fee-for-Service	1538400239	1538400239	1	1	PONCA DIALYSIS LLC	9/30/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1290 TULLY RD	SUITE 60	SAN JOSE	CA	95122	3069	43	06085	37.31599405	-121.8351241	Santa Clara County
197031	Fee-for-Service	1598903130	1598903130	1	1	PHARMA NOVA INC	4/2/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PARKSIDE PHARMACY	4404 DEL RIO BLVD	None	SACRAMENTO	CA	95822	1126	34	06067	38.536839	-121.504788	Sacramento County
197041	Fee-for-Service	1871607762	1871607762	1	161	PROVIDENCE MEDICAL FOUNDATIO	1/28/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	1140 LA VETA	STE 430	ORANGE	CA	92868	4226	30	06059	33.7802984	-117.8651669	Orange County
197058	Fee-for-Service	1851592745	1851592745	1	1	PAZ, ZOILA A CNM	5/23/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10917 MAGNOLIA	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
197063	Fee-for-Service	1619509155	1619509155	1	1	PARK, EUNG G	6/28/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
197077	Fee-for-Service	1164697173	1164697173	1	1	PAREDES, GUSTAVO A MD	12/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	112533	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
197081	Fee-for-Service	1922013515	1922013515	1	1	PACIFIC NEPHROL MEDI GRP	2/29/1972	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	323 N PRAIRIE AVE	STE 334	INGLEWOOD	CA	90301	4502	19	06037	33.966333	-118.3439975	Los Angeles County
197110	Fee-for-Service	1023352390	1023352390	1	1	POWERS, TANYA M CRNA	1/31/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
197111	Fee-for-Service	1689786469	1689786469	1	1	PRIMARY CARE CONSULTANTS	9/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC A MEDICAL GROUP	49063 ROAD 426	STE C&D&G	OAKHURST	CA	93644	9487	20	06039	37.33186891	-119.6510247	Madera County
197114	Fee-for-Service	1154611192	1154611192	1	1	PUJARA, SHREYA MD	9/21/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	172603	None	None	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
197115	Fee-for-Service	1215975594	1215975594	1	1	PARK, PATRICK T MD	1/22/2010	174400000X	NA	Other	026	PHYSICIANS	76980	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3000 W OLYMPIC BLVD	SUITE 203	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
197145	Fee-for-Service	1871607762	1871607762	1	75	PROVIDENCE MEDICAL FOUNDATIO	11/7/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
197158	Fee-for-Service	1659803906	1659803906	1	1	PASILIAO, JERIMARIE MD	9/3/2021	390200000X	NA	Other	026	PHYSICIANS	171258	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197221	Fee-for-Service	1063060101	1063060101	1	1	POMARICO, SARAH E PT	10/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
197233	Fee-for-Service	1588099873	1588099873	1	1	PEAKE, LAUREN M PSYD	8/4/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
197251	Fee-for-Service	1346322906	1346322906	1	1	PRICE, ROBERT LPCC	5/21/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	580 BEECH AVE	SUITE B	CARLSBAD	CA	92008	1657	37	06073	33.16283214	-117.3502553	San Diego County
197262	Fee-for-Service	1194803007	1194803007	1	1	PEREZ, VINCENT S MD	5/31/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	41729	25	Physical Medicine and Rehabilitation	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
197284	Fee-for-Service	1093893737	1093893737	1	1	PARK, MAUREEN R MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73877	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
197311	Fee-for-Service	1871607762	1871607762	1	99	PROVIDENCE MEDICAL FOUNDATIO	9/6/2016	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	8970 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	3211	30	06059	33.71571347	-117.972747	Orange County
197321	Fee-for-Service	1548540263	1548540263	1	1	PATEL, NIVA R MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141429	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
197340	Fee-for-Service	1871607762	1871607762	1	13	PROVIDENCE MEDICAL FOUNDATIO	12/19/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	24 W EL ROSE DRIVE	None	PETALUMA	CA	94952	4023	49	06097	38.22308352	-122.646555	Sonoma County
197351	Fee-for-Service	1922065150	1922065150	1	1	PETER SADOWITZ MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 E ADAMS ST	None	SYRACUSE	NY	13210	2306	00	None	43.041807	-76.1413275	Onondaga County
197377	Fee-for-Service	1710510078	1710510078	1	1	PATRICIA WAI OD INC	12/3/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12721 MORENO BEACH DR	None	MORENO VALLEY	CA	92555	4411	33	06065	33.935742	-117.1819035	Riverside County
197384	Fee-for-Service	1033160775	1033160775	1	2	PULMONARY ASSOCIATES BURLING	3/6/2024	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AME MEDICAL CORP	1750 EL CAMINO REAL	SUITE 307	BURLINGAME	CA	94010	4506	41	06081	37.59392355	-122.3819595	San Mateo County
197395	Fee-for-Service	1689786469	1689786469	1	1	PRIMARY CARE CONSULTANTS	9/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC A MEDICAL GROUP	49063 ROAD 426	STE C&D&G	OAKHURST	CA	93644	9487	20	06039	37.33186891	-119.6510247	Madera County
197462	Fee-for-Service	1871607762	1871607762	1	135	PROVIDENCE MEDICAL FOUNDATIO	12/24/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
197472	Fee-for-Service	1790282317	1790282317	1	1	PARK, LALA MD	7/16/2022	207P00000X	NA	Other	026	PHYSICIANS	174442	None	None	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
197494	Fee-for-Service	1083851703	1083851703	1	1	PERRIS VALLEY MEDICAL GROUP	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6023	None	None	0	In state provider	INC	126 AVOCADO AVE	STE 207	PERRIS	CA	92571	2605	33	06065	33.8102395	-117.2244465	Riverside County
197505	Fee-for-Service	1508932906	1508932906	1	1	PETERSEN, DAVID J MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	60655	None	None	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
197515	Fee-for-Service	1194021469	1194021469	1	1	PATEL, KOMAL G MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132872	41	Internal Medicine	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.741948	-121.848921	Butte County
197526	Fee-for-Service	1114031648	1114031648	1	1	PATTAMAKOM, SRISAWAI MD	9/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 N ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
197543	Fee-for-Service	1710922265	1710922265	1	1	PAREDES, RAISSA MAY T MD	9/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93930	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	# 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
197591	Fee-for-Service	1811233810	1811233810	1	1	PARKINSON, CHRISTINA LMFT	3/19/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
197592	Fee-for-Service	1689224909	1689224909	1	1	PHILLIPS, CHRISTOPHER D NP	2/5/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
197599	Fee-for-Service	1649202698	1649202698	2	1	PARK, STEVE S MD	10/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	71448	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3545 WILSHIRE BLVD	STE 247	LOS ANGELES	CA	90010	2389	19	06037	34.0617575	-118.301985	Los Angeles County
197600	Fee-for-Service	1871607762	1871607762	1	92	PROVIDENCE MEDICAL FOUNDATIO	4/22/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1450 MEDICAL CENTER DR	STE 3A	ROHNERT PARK	CA	94928	2933	49	06097	38.34758366	-122.6816633	Sonoma County
197615	Fee-for-Service	1134841356	1134841356	1	1	PROCARE RESIDENTIAL SERVICES	6/13/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	L TRANSPORT	1465 LATITUDES WAY	None	RICHMOND	CA	94804	4509	07	06013	37.92027049	-122.354811	Contra Costa County
197629	Fee-for-Service	1871607762	1871607762	1	119	PROVIDENCE MEDICAL FOUNDATIO	10/26/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	N	500 DOYLE PARK DR	STE G-05	SANTA ROSA	CA	95405	4555	49	06097	38.44332	-122.6985255	Sonoma County
197636	Fee-for-Service	1780992305	1780992305	1	1	PALERMO, CASSIE L PSYD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
197645	Fee-for-Service	1023360914	1023360914	1	1	PARK, YOUNGEUN M MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122681	40	Pediatrics	0	In state provider	None	10833 LECONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
197677	Fee-for-Service	1790107597	1790107597	1	1	PHAM, PETERSON Q LCSW	12/7/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
197692	Fee-for-Service	1467767939	1467767939	1	1	PALATNIK, KATHY MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120567	02	General Surgery	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
197706	Fee-for-Service	1528148020	1528148020	1	1	PICO RIVERA HEALTHCARE INC	11/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER	9140 VERNER ST	None	PICO RIVERA	CA	90660	2741	19	06037	33.99869648	-118.0826275	Los Angeles County
197721	Fee-for-Service	1174559108	1174559108	1	1	PANIGRAHY, ASHOK	7/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72055	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
197752	Fee-for-Service	1871607762	1871607762	1	90	PROVIDENCE MEDICAL FOUNDATIO	2/4/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	26795 PORTOLA PARKWAY	None	FOOTHILL RANCH	CA	92610	1713	30	06059	33.67841042	-117.6624735	Orange County
197780	Fee-for-Service	1144305632	1144305632	2	2	PARK, HAN MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	770 KAPIOLANI BLVD	STE 705	HONOLULU	HI	96813	5241	00	None	21.30051254	-157.8538506	Honolulu County
197857	Fee-for-Service	1447395561	1447395561	1	1	PATEL, PRANAV M. DO	10/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13128 N 94TH DR	STE 100	PEORIA	AZ	85381	4252	00	None	33.6033	-112.2629985	Maricopa County
197900	Fee-for-Service	1619136496	1619136496	1	1	PERNICIARO, JESSICA L MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135530	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
197964	Fee-for-Service	1396076808	1396076808	1	1	PLESS, DAVID C CRNA	10/13/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
197975	Fee-for-Service	1265664023	1265664023	1	1	PACIFIC MEDICAL, INC.	3/3/2023	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 SECRET RAVINE PKWY	SUITE 100	ROSEVILLE	CA	95661	3096	31	06061	38.7634713	-121.2456577	Placer County
197977	Fee-for-Service	1669790044	1669790044	1	1	PACIFIC HOSPITALIST ASSOCIAT	8/1/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ES A MEDICAL CORPORATION	16250 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.66136831	-117.7739731	Orange County
197984	Fee-for-Service	1922447242	1922447242	1	1	PATTERSON, JAMIE B MD	8/1/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	134357	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198040	Fee-for-Service	1871607762	1871607762	1	135	PROVIDENCE MEDICAL FOUNDATIO	12/24/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
198042	Fee-for-Service	1174043467	1174043467	1	1	PENDOLA, SHARON	11/1/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13220 JEFFERSON ST.	None	YUCAIPA	CA	92399	5170	36	06071	34.01191379	-117.0209165	San Bernardino County
198053	Fee-for-Service	1629102140	1629102140	1	1	PISCIONE, JAIME LMFT	3/8/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44916	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
198057	Fee-for-Service	1164616090	1164616090	2	1	POBEDA SERVICES INC	10/7/2014	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	10858 OXNARD ST	None	NORTH HOLLYWOOD	CA	91606	5021	19	06037	34.17939948	-118.36782	Los Angeles County
198134	Fee-for-Service	1265400824	1265400824	1	1	PIERSOL, PATRICIA E	2/28/1993	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	49	06097	38.62757555	-122.8638141	Sonoma County
198171	Fee-for-Service	1871607762	1871607762	1	160	PROVIDENCE MEDICAL FOUNDATIO	3/4/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	12942 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5809	30	06059	33.77554119	-117.9178077	Orange County
198206	Fee-for-Service	1699971028	1699971028	1	1	PARSONS, SARAH B MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124035	01	General Practice	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
198228	Fee-for-Service	1598906521	1598906521	1	2	PEDIATRIC HEART CENTER INC	4/15/2014	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	575 E HARDY ST	STE 201	INGLEWOOD	CA	90301	4033	19	06037	33.94909392	-118.3477665	Los Angeles County
198242	Fee-for-Service	1689687253	1689687253	1	1	PINKUS, ZHANNA M MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86909	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
198269	Fee-for-Service	1912112020	1912112020	1	1	PATTERSON, MARY E MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104058	67	Endocrinology	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
198297	Fee-for-Service	1841786498	1841786498	1	1	PATIMETEEPORN, TANYA LCSW	4/14/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA ROAD	SUITE 101	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
198309	Fee-for-Service	1841310398	1841310398	1	1	PALMER, JACQUES J MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31771	14	Neurological Surgery	0	In state provider	#561	26732 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6306	30	06059	33.56347704	-117.66546	Orange County
198330	Fee-for-Service	1174043467	1174043467	1	1	PENDOLA, SHARON	11/1/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13220 JEFFERSON ST.	None	YUCAIPA	CA	92399	5170	36	06071	34.01191379	-117.0209165	San Bernardino County
198353	Fee-for-Service	1669078663	1669078663	1	1	PERSONAL TOUCH HOSPICE CARE	11/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	17547 VENTURA BLVD	302A	ENCINO	CA	91316	3856	19	06037	34.16176929	-118.5157806	Los Angeles County
198379	Fee-for-Service	1255733234	1255733234	1	1	PEGASUS HH INC	9/6/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	105 W ALAMEDA AVENUE	SUITE 217	BURBANK	CA	91502	2209	19	06037	34.17127378	-118.303279	Los Angeles County
198384	Fee-for-Service	1841226990	1841226990	1	6	PHYSICIAN FOUNDATION	2/20/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	MEDICAL ASSOCIATES, INC	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
198419	Fee-for-Service	1881139483	1881139483	1	1	POPPE, CLARI LCSW	2/8/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
198439	Fee-for-Service	1396781969	1396781969	1	1	PAPPOE, VICTOR L MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46207	41	Internal Medicine	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
198483	Fee-for-Service	1083621379	1083621379	1	1	PRESIDENT, MARIE C MD	8/24/2004	207R00000X	NA	Other	026	PHYSICIANS	78841	41	Internal Medicine	0	In state provider	None	1100 LAUREL ST	STE B	SAN CARLOS	CA	94070	5000	41	06081	37.49983088	-122.2532086	San Mateo County
198512	Fee-for-Service	1508862749	1508862749	1	1	POLICASTRO, MICHAEL A MD	10/1/2022	207P00000X	NA	Other	026	PHYSICIANS	175786	None	None	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	36	06071	34.073505	-117.3505995	San Bernardino County
198551	Fee-for-Service	1871607762	1871607762	1	45	PROVIDENCE MEDICAL FOUNDATIO	9/12/2013	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2576 RENFREW ST	None	EUREKA	CA	95501	3345	12	06023	40.78539559	-124.1387085	Humboldt County
198557	Fee-for-Service	1912112020	1912112020	1	1	PATTERSON, MARY E MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104058	40	Pediatrics	0	In state provider	None	2650 ELM AVE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
198587	Fee-for-Service	1295026052	1295026052	1	1	PATEL, DHARMI B MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123827	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
198596	Fee-for-Service	1871999805	1871999805	1	1	PAN, JENNIFER T MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155329	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	200 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
198619	Fee-for-Service	1457612483	1457612483	1	1	PRASAD, PREETHI S MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137478	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
198624	Fee-for-Service	1588891972	1588891972	1	1	PETERSON, KIMBERLY C MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113998	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
198627	Fee-for-Service	1780203943	1780203943	1	1	PILLAY, YEOSHINA MD	8/25/2023	390200000X	NA	Other	026	PHYSICIANS	188620	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
198642	Fee-for-Service	1669078663	1669078663	1	1	PERSONAL TOUCH HOSPICE CARE	11/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	17547 VENTURA BLVD	302A	ENCINO	CA	91316	3856	19	06037	34.16176929	-118.5157806	Los Angeles County
198659	Fee-for-Service	1730213737	1730213737	1	1	PRESTON, ANDREW LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53409	-	NOT APPLICABLE	0	In state provider	None	1303 W WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
198677	Fee-for-Service	1942478524	1942478524	1	1	PANNARAJ, PIA S MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81791	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
198685	Fee-for-Service	1134161482	1134161482	1	1	PILLAI, DEWEY D MD	6/16/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	87833	08	Family Practice	0	In state provider	None	23838 VALENCIA BLVD	SUITE 205	VALENCIA	CA	91355	1339	19	06037	34.41337791	-118.5520369	Los Angeles County
198726	Fee-for-Service	1396781969	1396781969	1	1	PAPPOE, VICTOR L MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	46207	45	Nephrology (Renal-Kidney)	0	In state provider	None	1900 ROYALTY DR	STE 130	POMONA	CA	91767	3052	19	06037	34.07754346	-117.7463466	Los Angeles County
198746	Fee-for-Service	1114280211	1114280211	1	1	PAULL, PETER E MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121447	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	# 365	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
198763	Fee-for-Service	1841303260	1841303260	1	1	POSNER, GINA L MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88663	40	Pediatrics	0	In state provider	None	8787 HALL RD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
198772	Fee-for-Service	1871607762	1871607762	1	147	PROVIDENCE MEDICAL FOUNDATIO	4/14/2020	363LX0001X	NA	Nurse Practitioner	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	665 CAMINO DE LOS MARES	303	SAN CLEMENTE	CA	92673	2859	30	06059	33.45730192	-117.6483252	Orange County
198783	Fee-for-Service	1871607762	1871607762	1	14	PROVIDENCE MEDICAL FOUNDATIO	11/17/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE G-04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
198784	Fee-for-Service	1245766153	1245766153	1	1	PARNALL, TAYLOR MD	1/30/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	179059	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
198787	Fee-for-Service	1144780966	1144780966	1	1	PRESTWOOD, TYLER R MD	8/11/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179044	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
198788	Fee-for-Service	1811408602	1811408602	1	1	PHIPPS, JULIETTE E LCSW	3/24/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
198846	Fee-for-Service	1013481100	1013481100	1	1	PERRICONE, JILL A RCP	8/30/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
198849	Fee-for-Service	1629656921	1629656921	1	1	PINTO, MARISA	2/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186652	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
198858	Fee-for-Service	1801056676	1801056676	1	1	PAN, JANET MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104134	None	None	0	In state provider	None	18111 BROOKHURST ST	STE 6100	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
198876	Fee-for-Service	1457739161	1457739161	1	1	PATEL, MANDAKINI H MD	10/21/2019	207R00000X	NA	Other	026	PHYSICIANS	158658	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
198878	Fee-for-Service	1386162675	1386162675	1	1	PACOY, ARVI J NP	2/1/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
198893	Fee-for-Service	1477602647	1477602647	1	1	PIELOP, ALLYSON	2/8/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
198912	Fee-for-Service	1871607762	1871607762	1	37	PROVIDENCE MEDICAL FOUNDATIO	5/30/2013	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1100 TRANCAS ST	STE 205	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
198954	Fee-for-Service	1649323122	1649323122	1	1	PIER, VIRGINIA L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
198961	Fee-for-Service	1356531313	1356531313	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC ONCOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
198964	Fee-for-Service	1942478524	1942478524	1	1	PANNARAJ, PIA S MD	2/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81791	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
198989	Fee-for-Service	1871617027	1871617027	1	2	PARK, CHAN M	7/5/2022	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	109104	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
198991	Fee-for-Service	1831120237	1831120237	1	1	PARMET, DENNIS L MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34706	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
199016	Fee-for-Service	1760425862	1760425862	1	6	PROVIDENCE MEDICAL INSTITUTE	3/16/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5100 W GOLDLEAF CIR	200	LOS ANGELES	CA	90056	1658	19	06037	33.98872349	-118.3661021	Los Angeles County
199031	Fee-for-Service	1871607762	1871607762	1	152	PROVIDENCE MEDICAL FOUNDATIO	12/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 150	MISSION VIEJO	CA	92691	8018	30	06059	33.56286021	-117.6673449	Orange County
199038	Fee-for-Service	1831777564	1831777564	1	1	PERRIS HILLS HEALTHCARE LLC	2/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1335 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
199058	Fee-for-Service	1447447248	1447447248	1	2	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
199107	Fee-for-Service	1871563791	1871563791	1	1	PALMQUIST, DENNIS S	12/16/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
199109	Fee-for-Service	1669539862	1669539862	1	1	PALMER, MICHAEL A MD	12/24/1998	208600000X	NA	General Surgery	026	PHYSICIANS	65321	02	General Surgery	0	In state provider	None	2280 HARRISON AVE	STE D	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
199140	Fee-for-Service	1194746842	1194746842	1	1	PATEL, HEMANT D MD INC	11/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51751	08	Family Practice	0	In state provider	None	1968 N GAREY AVE	None	POMONA	CA	91767	2753	19	06037	34.08238225	-117.7528443	Los Angeles County
199149	Fee-for-Service	1528308780	1528308780	1	1	POOLE, SOOJIN H LMFT	1/27/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 CAMINO DEL RIO S	STE 112	SAN DIEGO	CA	92108	3509	37	06073	32.76144507	-117.1604009	San Diego County
199242	Fee-for-Service	1417919838	1417919838	1	1	PERLMAN, JANET MD	1/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56832	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
199248	Fee-for-Service	1356531313	1356531313	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	PEDIATRIC ONCOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
199257	Fee-for-Service	1134219660	1134219660	2	1	PATEL, HANSA M MD	5/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	30290	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 MT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4001	15	06029	35.382555	-118.970757	Kern County
199301	Fee-for-Service	1760425862	1760425862	1	6	PROVIDENCE MEDICAL INSTITUTE	3/16/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	5100 W GOLDLEAF CIR	200	LOS ANGELES	CA	90056	1658	19	06037	33.98872349	-118.3661021	Los Angeles County
199310	Fee-for-Service	1245550888	1245550888	1	1	PRAPTANI, SHAIZEEL MD	8/15/2017	207L00000X	NA	Other	026	PHYSICIANS	119125	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
199319	Fee-for-Service	1871607762	1871607762	1	152	PROVIDENCE MEDICAL FOUNDATIO	12/10/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 150	MISSION VIEJO	CA	92691	8018	30	06059	33.56286021	-117.6673449	Orange County
199334	Fee-for-Service	1871607762	1871607762	1	131	PROVIDENCE MEDICAL FOUNDATIO	10/25/2018	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	N	2321 HARRISON AVE	STE S	EUREKA	CA	95501	3216	12	06023	40.786857	-124.1396125	Humboldt County
199335	Fee-for-Service	1235245895	1235245895	1	1	PHAN, LINDA K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
199348	Fee-for-Service	1447447248	1447447248	1	2	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
199363	Fee-for-Service	1578010658	1578010658	1	1	PAVLISIN, EMILY L PSYD	3/26/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
199387	Fee-for-Service	1306887591	1306887591	1	1	PARADISE, MARK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11800 S STATE STREET	None	DRAPER	UT	84020	0001	00	None	40.5369877	-111.8914787	Salt Lake County
199391	Fee-for-Service	1700048378	1700048378	1	1	PINNAMANENI, APURVA S MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114984	08	Family Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
199397	Fee-for-Service	1669539862	1669539862	1	1	PALMER, MICHAEL A MD	12/24/1998	208600000X	NA	General Surgery	026	PHYSICIANS	65321	33	Thoracic Surgery	0	In state provider	None	2280 HARRISON AVE	STE D	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
199425	Fee-for-Service	1134290315	1134290315	1	1	PEREZ, ANA M LMFT	11/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	731 HALEY ST	None	SANTA BARBARA	CA	93103	3147	42	06083	34.42509225	-119.6867328	Santa Barbara County
199459	Fee-for-Service	1326108325	1326108325	1	1	PUTONG, LAWRENCE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
199472	Fee-for-Service	1770587115	1770587115	1	1	POON, EDWARD MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84293	30	Radiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
199512	Fee-for-Service	1609310416	1609310416	1	1	PATEL, DIPALEE D	5/19/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
199524	Fee-for-Service	1851948921	1851948921	1	1	PEREIRA, MARTHA LCSW	5/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
199544	Fee-for-Service	1730318973	1730318973	1	1	PAVLOVA, RIMMA MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109302	41	Internal Medicine	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.669562	-121.31379	Sacramento County
199559	Fee-for-Service	1790850279	1790850279	1	1	PEDIATRIC SUBSPECIALTY	10/19/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	79	Neurology-Child	0	In state provider	FACULTY INC	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
199567	Fee-for-Service	1497358915	1497358915	1	1	PEREZ, ALLYSSA M NP	10/28/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
199569	Fee-for-Service	1992888051	1992888051	1	1	PEPEZ, STAINISLAV, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
199574	Fee-for-Service	1215164967	1215164967	1	1	PARINI, SIERRA L	9/15/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4460 BLACK AVE	STE F	PLEASANTON	CA	94566	6139	01	06001	37.67215839	-121.8770704	Alameda County
199590	Fee-for-Service	1760425862	1760425862	1	6	PROVIDENCE MEDICAL INSTITUTE	3/16/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5100 W GOLDLEAF CIR	200	LOS ANGELES	CA	90056	1658	19	06037	33.98872349	-118.3661021	Los Angeles County
199605	Fee-for-Service	1871607762	1871607762	1	113	PROVIDENCE MEDICAL FOUNDATIO	5/22/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	600 NEWPORT CENTER DR	SUITE 150	NEWPORT BEACH	CA	92660	6417	30	06059	33.61777034	-117.8726548	Orange County
199607	Fee-for-Service	1437104197	1437104197	1	1	POLICAR, MICHAEL S MD	8/29/1981	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34711	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	BLDG 24	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
199626	Fee-for-Service	1043616428	1043616428	1	1	PLUMAS DISTRICT HOSPITAL	5/8/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9599	32	06063	39.93916024	-120.9619096	Plumas County
199637	Fee-for-Service	1730248469	1730248469	1	1	POLLOCK, STEVEN R OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44444 20TH ST WEST	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
199641	Fee-for-Service	1376009068	1376009068	1	1	PICIUCCO, ALEXIS PSYD	7/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9700 BUSINESS PARK DR	207	SACRAMENTO	CA	95827	1717	34	06067	38.568429	-121.3347375	Sacramento County
199682	Fee-for-Service	1871607762	1871607762	1	86	PROVIDENCE MEDICAL FOUNDATIO	1/22/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	N	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
199699	Fee-for-Service	1013142983	1013142983	1	1	PATEL, RATI N MD	8/20/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174190	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
199708	Fee-for-Service	1871607762	1871607762	1	22	PROVIDENCE MEDICAL FOUNDATIO	9/17/2014	207Q00000X	NA	Adult Primary Care	027	PODIATRISTS	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE 106A	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
199713	Fee-for-Service	1083359434	1083359434	1	1	PAN, LINDA NP	8/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
199715	Fee-for-Service	1144277633	1144277633	1	11	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	372 CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
199739	Fee-for-Service	1265543813	1265543813	1	1	PERRY, ALLAN W JR MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43094	24	Plastic Surgery	0	In state provider	None	1808 VERDUGO BLVD	STE 118	GLENDALE	CA	91208	1484	19	06037	34.2056211	-118.2154553	Los Angeles County
199740	Fee-for-Service	1649230079	1649230079	1	1	PADMAVATHY V TUMMALA, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5757 W THUNDERBIRD RD	STE E157	GLENDALE	AZ	85306	5601	00	None	33.609672	-112.182786	Maricopa County
199741	Fee-for-Service	1801444708	1801444708	1	2	PRESTIGE MEDICAL CLINIC AND	7/1/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	URGENT CARE INC	1984 INDIAN HILL BLVD	None	POMONA	CA	91767	3620	19	06037	34.07932777	-117.7191928	Los Angeles County
199748	Fee-for-Service	1396056453	1396056453	1	1	PATADIA, BIPIN C MD FACC INC	5/14/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	31085	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	630 N 13TH AVENUE	STE D	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
199795	Fee-for-Service	1356498935	1356498935	1	2	PARA LATINO MEDICAL CENTER I	11/1/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	NC	15717 PARAMOUNT BLVD.	None	PARAMOUNT	CA	90723	4377	19	06037	33.890355	-118.160178	Los Angeles County
199805	Fee-for-Service	1124057252	1124057252	1	1	PAO, ALAN C MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75186	45	Nephrology (Renal-Kidney)	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
199811	Fee-for-Service	1922397645	1922397645	1	1	PATEL, CHIRAG M MD	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122633	01	General Practice	0	In state provider	None	521 PARNASSUS AVE	C-646	SAN FRANCISCO	CA	94143	2206	38	06075	37.7634502	-122.4579779	San Francisco County
199818	Fee-for-Service	1821304403	1821304403	1	1	PEDIATRIC KIDNEY CENTER, INC	7/13/2010	2080P0210X	NA	Nephrology	026	PHYSICIANS	93348	45	Nephrology (Renal-Kidney)	0	In state provider	None	3933 COFFEE ROAD	STE A	BAKERSFIELD	CA	93308	5024	15	06029	35.395335	-119.092336	Kern County
199833	Fee-for-Service	1497051627	1497051627	1	2	PRODIGY HEALTHCARE, INC.	3/8/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1120 IRWIN ST	SUITE C	HANFORD	CA	93230	2928	16	06031	36.336348	-119.647699	Kings County
199846	Fee-for-Service	1205863784	1205863784	1	1	PATEL, DILIPKUMAR G MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37584	None	None	0	In state provider	INC	3131 SANTA ANITA AVE	STE 103	EL MONTE	CA	91733	1369	19	06037	34.064991	-118.0427595	Los Angeles County
199872	Fee-for-Service	1285734095	1285734095	1	1	POSNER, MARVIN D MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	44198	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27800 MEDICAL CENTER RD	STE 100	MISSION VIEJO	CA	92691	6407	30	06059	33.55952733	-117.6645199	Orange County
199939	Fee-for-Service	1801119813	1801119813	1	1	PRIORITY HEALTH SERIVCES	10/1/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OWNER/ADMINISTRATOR	753 WEST DUARTE RD	None	ARCADIA	CA	91007	7521	19	06037	34.12576757	-118.0571247	Los Angeles County
199969	Fee-for-Service	1871607762	1871607762	1	62	PROVIDENCE MEDICAL FOUNDATIO	8/11/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1194 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4802	49	06097	38.443302	-122.699133	Sonoma County
199998	Fee-for-Service	1871607762	1871607762	1	22	PROVIDENCE MEDICAL FOUNDATIO	4/29/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	500 DOYLE PARK DR	STE 106A	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
200003	Fee-for-Service	1144277633	1144277633	1	11	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	372 CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
200008	Fee-for-Service	1871607762	1871607762	1	31	PROVIDENCE MEDICAL FOUNDATIO	5/28/2013	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE 300	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
200009	Fee-for-Service	1326276528	1326276528	1	1	PATEL, NISHA A DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11705	41	Internal Medicine	0	In state provider	None	665 CAMINO DE LOS MARES	STE 210	SAN CLEMENTE	CA	92673	2828	30	06059	33.45730192	-117.6483252	Orange County
200031	Fee-for-Service	1801444708	1801444708	1	2	PRESTIGE MEDICAL CLINIC AND	6/2/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	URGENT CARE INC	1984 INDIAN HILL BLVD	None	POMONA	CA	91767	3620	19	06037	34.07932777	-117.7191928	Los Angeles County
200033	Fee-for-Service	1396056453	1396056453	1	1	PATADIA, BIPIN C MD FACC INC	5/14/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	31085	41	Internal Medicine	0	In state provider	None	630 N 13TH AVENUE	STE D	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
200067	Fee-for-Service	1396894762	1396894762	1	2	PETERSEN, JONI LYNN	3/1/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8038 LAUREL PARK CIRCLE	None	RIVERSIDE	CA	92509	4096	33	06065	33.99958197	-117.4589518	Riverside County
200084	Fee-for-Service	1356498935	1356498935	1	2	PARA LATINO MEDICAL CENTER I	11/1/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NC	15717 PARAMOUNT BLVD.	None	PARAMOUNT	CA	90723	4377	19	06037	33.890355	-118.160178	Los Angeles County
200101	Fee-for-Service	1922397645	1922397645	1	1	PATEL, CHIRAG M MD	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122633	02	General Surgery	0	In state provider	None	521 PARNASSUS AVE	C-646	SAN FRANCISCO	CA	94143	2206	38	06075	37.7634502	-122.4579779	San Francisco County
200121	Fee-for-Service	1952349987	1952349987	1	1	PENTHEROUDAKIS, ELENI MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75191	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
200156	Fee-for-Service	1063014868	1063014868	1	1	PALM SPRINGS HOSPICE AND	11/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	69-730 HIGHWAY 111	STE 204	RANCHO MIRAGE	CA	92270	2874	33	06065	33.7750795	-116.4496953	Riverside County
200195	Fee-for-Service	1861560476	1861560476	1	1	PURSLEY, RYAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
200197	Fee-for-Service	1669780128	1669780128	1	1	PINNEY, ELIZABETH L MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120163	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
200199	Fee-for-Service	1306933437	1306933437	1	1	PARTRIDGE, REBECCA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
200261	Fee-for-Service	1871607762	1871607762	1	95	PROVIDENCE MEDICAL FOUNDATIO	5/3/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
200283	Fee-for-Service	1871607762	1871607762	1	22	PROVIDENCE MEDICAL FOUNDATIO	7/2/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	N	500 DOYLE PARK DR	STE 106A	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
200324	Fee-for-Service	1992334098	1992334098	1	1	POUR, MOHAMMAD M MD	12/11/2023	207R00000X	NA	Other	026	PHYSICIANS	191500	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
200361	Fee-for-Service	1881314474	1881314474	1	1	POLARIS PHARMACY SERVICES OF	10/20/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3821 CALLE FORTUNADA	SUITE D	SAN DIEGO	CA	92123	4811	37	06073	32.81199432	-117.1209624	San Diego County
200362	Fee-for-Service	1871565788	1871565788	1	1	PETERSON, KENNETH A OD	6/24/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 OAK PARK BLVD	STE 104	PISMO BEACH	CA	93449	3406	40	06079	35.13435006	-120.6051746	San Luis Obispo County
200369	Fee-for-Service	1053601633	1053601633	1	2	PERRINS, STEVEN B JR MD	10/5/2018	208600000X	NA	General Surgery	026	PHYSICIANS	155169	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
200388	Fee-for-Service	1295943884	1295943884	1	1	PHILIP, ANCIL K MD	7/11/2017	208600000X	NA	General Surgery	026	PHYSICIANS	147208	02	General Surgery	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
200404	Fee-for-Service	1043398944	1043398944	1	1	PARDUN, JEFFREY D MD	6/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72013	24	Plastic Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
200438	Fee-for-Service	1629012372	1629012372	1	1	PASKIL, JEFFREY M MD	4/30/1994	207L00000X	NA	Other	026	PHYSICIANS	76742	05	Anesthesiology	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
200441	Fee-for-Service	1588849954	1588849954	1	1	PORTER, GREGORY J MD INC	2/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72310	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
200444	Fee-for-Service	1063014868	1063014868	1	1	PALM SPRINGS HOSPICE AND	11/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	69-730 HIGHWAY 111	STE 204	RANCHO MIRAGE	CA	92270	2874	33	06065	33.7750795	-116.4496953	Riverside County
200447	Fee-for-Service	1497950489	1497950489	1	1	PALMA, MONICA E NP	1/23/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	600 NORTH MOUNTAIN AVE	SUITE A104	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
200461	Fee-for-Service	1700346996	1700346996	1	1	PARK, STEPHEN J MD	1/13/2023	208600000X	NA	General Surgery	026	PHYSICIANS	182313	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
200475	Fee-for-Service	1598930059	1598930059	1	2	PARROTT, MEDIE NP	11/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
200482	Fee-for-Service	1730370594	1730370594	1	1	PLANNED PARENTHOOD	5/10/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES	1550 N GAREY AVE	None	POMONA	CA	91767	3826	19	06037	34.07356342	-117.7522392	Los Angeles County
200486	Fee-for-Service	1639614076	1639614076	1	1	PROHEALTH PARTNERS, A MEDICA	8/14/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP	1040 ELM AVE,	SUITE 303	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
200487	Fee-for-Service	1225428600	1225428600	1	1	PACIFIC CENTRAL COAST HEALTH	10/28/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	265 POSADA LANE	STE B	TEMPLETON	CA	93465	4056	40	06079	35.55354235	-120.7214149	San Luis Obispo County
200496	Fee-for-Service	1851345458	1851345458	1	1	PUN, JANE C NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200505	Fee-for-Service	1871607762	1871607762	1	60	PROVIDENCE MEDICAL FOUNDATIO	8/5/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	108 LYNCH CREEK WAY	STE 7	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
200506	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	12/23/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
200510	Fee-for-Service	1487640488	1487640488	2	1	PHARMILYCARE INC	10/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9200 E VALLEY BLVD	None	ROSEMEAD	CA	91770	1900	19	06037	34.08093925	-118.06938	Los Angeles County
200520	Fee-for-Service	1669905790	1669905790	1	1	PAN, GINA M MD	4/12/2024	207P00000X	NA	Other	026	PHYSICIANS	173614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20311 SW ACACIA ST	UNIT 140	NEWPORT BEACH	CA	92660	1733	30	06059	33.65825868	-117.8791294	Orange County
200542	Fee-for-Service	1679729289	1679729289	1	1	PENG, LYNN FU MD	1/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106186	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
200547	Fee-for-Service	1790819175	1790819175	1	1	POLLACK, RONALD D MD	9/24/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	36850	36	Psychiatry	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
200555	Fee-for-Service	1023271152	1023271152	1	1	PAN, JUDY MD	1/14/2020	2086S0122X	NA	General Surgery	026	PHYSICIANS	167418	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200559	Fee-for-Service	1639190895	1639190895	1	1	PABALAN, FRANCISCO J MD INC	12/14/2010	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6900 BROCKTON AVE	STE 203	RIVERSIDE	CA	92506	3818	33	06065	33.94872	-117.3967215	Riverside County
200568	Fee-for-Service	1659337277	1659337277	1	1	PAULS, JOHN D MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54171	01	General Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
200583	Fee-for-Service	1477638492	1477638492	1	1	PLOSS, DAVID R MD	11/30/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66128	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
200585	Fee-for-Service	1518924174	1518924174	1	1	PETERS, RICHARD OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AN OPTOMETRIC CORP	810 N AVALON BLVD	None	WILMINGTON	CA	90744	4502	19	06037	33.78041576	-118.2624535	Los Angeles County
200596	Fee-for-Service	1013148998	1013148998	1	1	PHAM, KIM T MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107882	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
200653	Fee-for-Service	1205377637	1205377637	1	1	PIAO, CINDY MD	8/11/2023	207R00000X	NA	Other	026	PHYSICIANS	157485	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
200692	Fee-for-Service	1598294837	1598294837	1	1	PRADO, VICTOR E MD	6/6/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	176564	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200704	Fee-for-Service	1407828429	1407828429	1	2	PASADENA HOSP ASSN, LTD	4/9/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	630 S RAYMOND AVE	SUITE 340	PASADENA	CA	91105	3206	19	06037	34.13505223	-118.1487761	Los Angeles County
200722	Fee-for-Service	1881699163	1881699163	1	1	PANDYA, GAURANG S MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44314	02	General Surgery	0	In state provider	None	555 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3286	54	06107	36.06956396	-119.0291153	Tulare County
200736	Fee-for-Service	1316221617	1316221617	1	2	PLANNED PARENTHOOD MAR MONTE	4/5/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	35 BAYWOOD AVE	None	SAN MATEO	CA	94402	1516	41	06081	37.5646848	-122.3290657	San Mateo County
200767	Fee-for-Service	1275858748	1275858748	1	1	PLAYFUL BEGINNINGS INC	11/14/2018	252Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1467 FORD ST	STE 104	REDLANDS	CA	92373	3911	36	06071	34.03759269	-117.1554568	San Bernardino County
200776	Fee-for-Service	1639614076	1639614076	1	1	PROHEALTH PARTNERS, A MEDICA	8/14/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	1040 ELM AVE,	SUITE 303	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
200780	Fee-for-Service	1750091021	1750091021	1	1	PORTLAND ADVENTIST MEDICAL C	4/29/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	2	Out of state provider	UP	10123 SE MARKET STREET	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
200798	Fee-for-Service	1871607762	1871607762	1	151	PROVIDENCE MEDICAL FOUNDATIO	9/26/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	N	500 DOYLE PARK	STE 205	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
200844	Fee-for-Service	1164793816	1164793816	1	1	PHUVADAKORN, CHAIVAT P MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122504	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
200848	Fee-for-Service	1639190895	1639190895	1	1	PABALAN, FRANCISCO J MD INC	12/14/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	6900 BROCKTON AVE	STE 203	RIVERSIDE	CA	92506	3818	33	06065	33.94872	-117.3967215	Riverside County
200850	Fee-for-Service	1104887447	1104887447	1	1	PATEL, PHILIP J MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78662	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
200858	Fee-for-Service	1659337277	1659337277	1	1	PAULS, JOHN D MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54171	03	Allergy	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
200867	Fee-for-Service	1912935123	1912935123	1	1	PARR, MICHAEL S MD INC	9/20/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	29651	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
200899	Fee-for-Service	1396823522	1396823522	1	2	PREGNANCY HELP CENTER	10/1/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	19000 HAWTHORNE BLVD	SUITE 200	TORRANCE	CA	90503	7921	19	06037	33.85789054	-118.3535468	Los Angeles County
200904	Fee-for-Service	1447206230	1447206230	1	1	PATRICIA BAYLESS MD	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
200919	Fee-for-Service	1326440579	1326440579	1	1	PERREIRA, ASHLEY R CPO	3/28/2016	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6011 N FRESNO	STE 115	FRESNO	CA	93710	5237	10	06019	36.823329	-119.7814395	Fresno County
200922	Fee-for-Service	1275737025	1275737025	1	1	PASADENA AREA TRANSPORTATION	5/3/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3103 N HIGHWAY 146	None	BAYTOWN	TX	77520	2669	00	None	29.75756162	-94.93938288	Harris County
200923	Fee-for-Service	1689990111	1689990111	1	1	PASCA, IOANA F MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117608	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
200934	Fee-for-Service	1275902967	1275902967	1	1	PARTIDA, VIVIANA NP	12/3/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
200979	Fee-for-Service	1962729673	1962729673	1	1	PENA, MARIASOL MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119968	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
200997	Fee-for-Service	1396186441	1396186441	1	1	PREFERRED CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11565 LAUREL CANYON BLVD	SUITE 202	SAN FERNANDO	CA	91340	4651	19	06037	34.28018218	-118.4549135	Los Angeles County
201006	Fee-for-Service	1477011732	1477011732	1	1	PATCHEN, ELIZAVETA K LCSW	6/20/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
201022	Fee-for-Service	1720304215	1720304215	1	1	PARO, JOHN A M MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117723	24	Plastic Surgery	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
201031	Fee-for-Service	1689650889	1689650889	1	1	PARKER, JEFFREY F MD	5/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50777	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3200 WALFORD AVE	STE A	EUREKA	CA	95503	4828	12	06023	40.77887445	-124.1378239	Humboldt County
201036	Fee-for-Service	1902208507	1902208507	1	4	PREMIER PHYSICAL THERAPY & A	9/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SSOCIATES INC	1601 VICTORIA AVE	200	OXNARD	CA	93035	2168	56	06111	34.185321	-119.2214155	Ventura County
201054	Fee-for-Service	1477647444	1477647444	1	1	PROVIDENCE HEALTH SYSTEM	5/1/1996	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	10425 MAGNOLIA BLVD	None	NORTH HOLLYWOOD	CA	91601	4109	19	06037	34.16493849	-118.357866	Los Angeles County
201075	Fee-for-Service	1124153945	1124153945	1	1	PALMER, JACK MD	12/26/2023	207R00000X	NA	Other	026	PHYSICIANS	43864	None	None	0	In state provider	None	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
201080	Fee-for-Service	1982735650	1982735650	1	1	PULSKAMP, JANET H MD	12/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74201	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
201082	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	12/23/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
201134	Fee-for-Service	1164793816	1164793816	1	1	PHUVADAKORN, CHAIVAT P MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122504	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
201137	Fee-for-Service	1598138711	1598138711	1	1	POWERS, COURTNEY N	3/8/2022	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
201160	Fee-for-Service	1932852829	1932852829	1	1	POPE, MELODY R OT	6/7/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3901 LAS POSAS RD	STE 8	CAMARILLO	CA	93010	1502	56	06111	34.2415821	-119.0183756	Ventura County
201164	Fee-for-Service	1104868611	1104868611	1	1	PLASTINO,JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 N MAIN STREET	None	COUPEVILLE	WA	98239	0000	00	None	48.213756	-122.686102	Island County
201193	Fee-for-Service	1043405830	1043405830	1	1	PORTUGAL, DENISE	7/21/2014	208600000X	NA	General Surgery	026	PHYSICIANS	108655	None	None	0	In state provider	None	2021 22ND STREET	None	BAKERSFIELD	CA	93301	1494	15	06029	35.37907949	-119.025603	Kern County
201203	Fee-for-Service	1871813105	1871813105	1	1	PATEL, AARTI R MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142110	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
201226	Fee-for-Service	1487946067	1487946067	1	1	PITTNER, ELIZABETH K PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
201240	Fee-for-Service	1780958462	1780958462	1	1	PEJMAN BAHARI-NEJAD A ROFESS	10/21/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7938	01	General Practice	0	In state provider	PROFESSIONAL MEDICAL C	20829 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	2319	19	06037	34.16639096	-118.586691	Los Angeles County
201252	Fee-for-Service	1962517797	1962517797	1	1	PAUL JOHN KOWALSKI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22101 MOROSS RD	None	DETROIT	MI	48236	2148	00	None	42.41918818	-82.91538222	Wayne County
201266	Fee-for-Service	1063591477	1063591477	1	1	PARTOVY, ROBERT	5/19/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	7033	None	None	0	In state provider	None	501 N MACLAY AVE	None	SAN FERNANDO	CA	91340	2424	19	06037	34.28782178	-118.4351701	Los Angeles County
201280	Fee-for-Service	1609263672	1609263672	1	1	PRATT, JULIA M MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134586	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
201287	Fee-for-Service	1396186441	1396186441	1	1	PREFERRED CARE HOSPICE INC	5/24/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11565 LAUREL CANYON BLVD	SUITE 202	SAN FERNANDO	CA	91340	4651	19	06037	34.28018218	-118.4549135	Los Angeles County
201299	Fee-for-Service	1245788793	1245788793	1	1	PANG, CAROL W Y	3/20/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
201300	Fee-for-Service	1326094269	1326094269	1	3	PLUMAS DISTRICT HOSP	2/25/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	127 CRESCENT ST	UNIT 3 AND 4	GREENVILLE	CA	95947	9507	32	06063	40.13935251	-120.9495465	Plumas County
201318	Fee-for-Service	1144455999	1144455999	2	1	PARTNER HEALTHCARE INC	12/24/2012	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 S.MYRTLE AVE	None	MONROVIA	CA	91016	4836	19	06037	34.127595	-118.0016555	Los Angeles County
201335	Fee-for-Service	1659406445	1659406445	1	1	PLAZA EYE & SURGERY CENTER	11/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL CORPORATION	1414 S GRAND AVE	STE 100	LOS ANGELES	CA	90015	3071	19	06037	34.03661142	-118.2657227	Los Angeles County
201356	Fee-for-Service	1144389230	1144389230	1	1	PERINATAL DIAGNOSTIC CENTER	11/30/2022	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2100 LYNN RD	STE 125	THOUSAND OAKS	CA	91360	8032	56	06111	34.2074907	-118.8854443	Ventura County
201367	Fee-for-Service	1023366457	1023366457	1	1	PEREZ, ERIC V LCSW	8/1/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
201371	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	3/27/2024	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
201385	Fee-for-Service	1144751983	1144751983	1	1	PIETERICK, RYAN	7/25/2024	207L00000X	NA	Other	026	PHYSICIANS	175733	05	Anesthesiology	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
201400	Fee-for-Service	1336336379	1336336379	1	1	PUN, STEPHANIE MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105024	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
201419	Fee-for-Service	1538288865	1538288865	1	1	PERRY, JOYCE D LMFT	10/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
201432	Fee-for-Service	1518164649	1518164649	1	1	PENFOLD, JASON T CRNA	12/20/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
201443	Fee-for-Service	1952489023	1952489023	1	1	PALMER, DONALD L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22518	02	General Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
201452	Fee-for-Service	1790948677	1790948677	1	1	PERRY, PAUL A MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124165	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
201462	Fee-for-Service	1417480930	1417480930	1	1	PATEL, AMY MD	9/21/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157263	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
201472	Fee-for-Service	1447419775	1447419775	1	1	PANDO, JOSEPH I	8/17/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8555 AERO DR	STE 308	SAN DIEGO	CA	92123	1746	37	06073	32.80957998	-117.143477	San Diego County
201613	Fee-for-Service	1700024536	1700024536	1	1	PAN, PATRICK MD	2/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114624	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
201615	Fee-for-Service	1083068787	1083068787	1	1	PHAM, EILEEN T MD	6/3/2019	208M00000X	NA	Other	026	PHYSICIANS	158539	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
201638	Fee-for-Service	1285125732	1285125732	1	1	PEREZ, PAOLA MD	12/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168149	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
201657	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	12/23/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
201716	Fee-for-Service	1003378647	1003378647	1	1	PETERSON, KRISTINA L LMFT	4/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
201732	Fee-for-Service	1679545388	1679545388	1	1	PETERS, STEPHEN R MD	9/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83285	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 175	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
201733	Fee-for-Service	1568981413	1568981413	1	1	PERILLA, MANJA NP	3/17/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
201737	Fee-for-Service	1619141298	1619141298	1	1	PRIME HEALTHCARE SRVS	6/1/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
201740	Fee-for-Service	1790948677	1790948677	1	1	PERRY, PAUL A MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124165	33	Thoracic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
201791	Fee-for-Service	1083140560	1083140560	1	5	PROFICIO SPEECH THERAPY GROU	2/4/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P, INC.	770 MASON ST	SUITE 100	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
201882	Fee-for-Service	1689626996	1689626996	1	1	POWERS, RICHARD J MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	38171	40	Pediatrics	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
201885	Fee-for-Service	1952581779	1952581779	1	1	PAN, STEPHEN MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105473	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
201929	Fee-for-Service	1063485563	1063485563	1	1	PETER CHASE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
201948	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	11/17/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
201959	Fee-for-Service	1578674149	1578674149	1	1	PARIKH, AKIK K MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65494	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
201966	Fee-for-Service	1417104282	1417104282	1	1	PARSAEI, NAZANIN MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112838	01	General Practice	0	In state provider	None	12100 VALLEY BLVD	SUITE 109A	EL MONTE	CA	91732	3161	19	06037	34.06130355	-118.0164048	Los Angeles County
201983	Fee-for-Service	1043282429	1043282429	1	1	PALFY, SHELLEY A MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104009	40	Pediatrics	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
202071	Fee-for-Service	1770566150	1770566150	1	1	PREGERSON, DAVID B MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63493	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
202083	Fee-for-Service	1104369123	1104369123	1	1	PHAM, JENNIFER OD	7/11/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 E WEBER AVENUE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
202162	Fee-for-Service	1861529786	1861529786	1	1	PEREIRA, PATRICIA LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
202171	Fee-for-Service	1689626996	1689626996	1	1	POWERS, RICHARD J MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	38171	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
202202	Fee-for-Service	1811423072	1811423072	1	1	PHAM, LILY M MD	11/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	191217	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
202234	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	12/23/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
202237	Fee-for-Service	1891721353	1891721353	2	1	PANTOJA, JOSE L MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43031	10	Gastroenterology (M.D. only)	0	In state provider	None	5750 DOWNEY AVE	STE 202	LAKEWOOD	CA	90712	1470	19	06037	33.859611	-118.1511435	Los Angeles County
202245	Fee-for-Service	1609127950	1609127950	1	1	PAREEK, ANIRUDH MD	2/14/2024	207R00000X	NA	Other	026	PHYSICIANS	178805	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
202268	Fee-for-Service	1982108841	1982108841	1	2	PATHFINDERS OF SAN DIEGO	5/24/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1530 DALE ST	None	SAN DIEGO	CA	92102	1519	37	06073	32.72192284	-117.131172	San Diego County
202293	Fee-for-Service	1285255570	1285255570	1	1	PARK, EDWARD DO	12/13/2023	208M00000X	NA	Other	026	PHYSICIANS	21915	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
202331	Fee-for-Service	1407813603	1407813603	1	1	PINNACLE HEALTH HOSPITALS	5/18/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	111 S FRONT ST	None	HARRISBURG	PA	17101	2010	00	None	40.25736915	-76.88076258	Dauphin County
202348	Fee-for-Service	1336187079	1336187079	1	1	PENSO, JERROLD L MD	5/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67126	01	General Practice	0	In state provider	None	2201 MISSION AVE	None	OCEANSIDE	CA	92054	2328	37	06073	33.20742226	-117.3612486	San Diego County
202354	Fee-for-Service	1730112426	1730112426	1	2	PREMIER FAMILY MEDICINE	9/21/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ASSOCIATES	3110 CHINO AVE	SUITE 150	CHINO HILLS	CA	91709	1211	36	06071	34.01077341	-117.738406	San Bernardino County
202357	Fee-for-Service	1184608481	1184608481	1	1	PARK, JASON A MD	5/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62812	02	General Surgery	0	In state provider	CAPITOL SURGICAL ASSOC	2800 L ST	STE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
202369	Fee-for-Service	1871607762	1871607762	1	54	PROVIDENCE MEDICAL FOUNDATIO	9/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	N	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
202397	Fee-for-Service	1205878360	1205878360	1	1	PARK, CATHERINE C MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72654	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
202403	Fee-for-Service	1518015338	1518015338	1	1	PARK, DENISE H MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80540	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
202421	Fee-for-Service	1447653340	1447653340	1	1	PARKSIDE HEALTHCARE INC	12/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	444 WEST LEXINGTON AVE	None	EL CAJON	CA	92020	4416	37	06073	32.79271851	-116.9672805	San Diego County
202427	Fee-for-Service	1891872164	1891872164	1	1	PARI, ANDREW G LCSW	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17962	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
202431	Fee-for-Service	1164519567	1164519567	1	1	PITTS, CHERYL A LCSW	10/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30131 TOWN CENTER DR	STE 280	LAGUNA NIGUEL	CA	92677	2086	30	06059	33.52530096	-117.7148334	Orange County
202478	Fee-for-Service	1083140560	1083140560	1	4	PROFICIO SPEECH THERAPY GROU	6/4/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P, INC.	1261 TRAVIS BLVD	SUITE 200	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
202501	Fee-for-Service	1588623870	1588623870	1	1	PATEL, RASHMI J MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73974	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
202510	Fee-for-Service	1427495894	1427495894	1	1	PAUL, MEGAN R MD	7/21/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	141572	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
202521	Fee-for-Service	1760827448	1760827448	1	1	PARK, SARAH S MD	3/1/2019	207R00000X	NA	Other	026	PHYSICIANS	16444	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
202522	Fee-for-Service	1871607762	1871607762	1	164	PROVIDENCE MEDICAL FOUNDATIO	4/19/2022	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	49	06097	38.442978	-122.6999565	Sonoma County
202523	Fee-for-Service	1255322202	1255322202	1	1	PERCELAY, JACK M MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66425	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
202524	Fee-for-Service	1891721353	1891721353	2	1	PANTOJA, JOSE L MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43031	01	General Practice	0	In state provider	None	5750 DOWNEY AVE	STE 202	LAKEWOOD	CA	90712	1470	19	06037	33.859611	-118.1511435	Los Angeles County
202529	Fee-for-Service	1063127744	1063127744	1	1	PUTMAN, CHELSEA CRNA	11/24/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
202540	Fee-for-Service	1427100882	1427100882	1	1	PANG, HYOSONG D MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66421	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
202552	Fee-for-Service	1104359439	1104359439	1	1	POMERANTZ, TALI MD	8/17/2023	390200000X	NA	Other	026	PHYSICIANS	180844	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
202556	Fee-for-Service	1174978852	1174978852	1	1	PORTOCARRERO CASTILLO, ANDRE	9/28/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	181751	None	None	0	In state provider	A MD	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202621	Fee-for-Service	1407813603	1407813603	1	1	PINNACLE HEALTH HOSPITALS	5/18/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	111 S FRONT ST	None	HARRISBURG	PA	17101	2010	00	None	40.25736915	-76.88076258	Dauphin County
202627	Fee-for-Service	1225579576	1225579576	1	1	PRITCHARD, DAVID MD	9/5/2023	207R00000X	NA	Other	026	PHYSICIANS	157539	None	None	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
202632	Fee-for-Service	1801086871	1801086871	1	1	PEDIATRIC SUBSPECIALTY	2/7/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	FACULTY INC	1201 W LA VETA AVE	STE 201	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
202649	Fee-for-Service	1013307404	1013307404	1	1	PARSONS, ANDREA LCSW	8/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
202653	Fee-for-Service	1831199181	1831199181	1	1	PARKER, ARIA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
202656	Fee-for-Service	1871607762	1871607762	1	54	PROVIDENCE MEDICAL FOUNDATIO	9/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	N	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
202666	Fee-for-Service	1871607762	1871607762	1	146	PROVIDENCE MEDICAL FOUNDATIO	3/4/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1100 TRANCAS ST	SUITE 213	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
202687	Fee-for-Service	1205878360	1205878360	1	1	PARK, CATHERINE C MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72654	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
202701	Fee-for-Service	1437241981	1437241981	1	1	PEPPERS, TIMOTHY A MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77254	20	Orthopedic Surgery	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
202702	Fee-for-Service	1679830756	1679830756	1	1	PATEL, NEERAJ MD	8/19/2024	207R00000X	NA	Other	026	PHYSICIANS	181548	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
202725	Fee-for-Service	1154732857	1154732857	1	1	POUYA, ARI PT	1/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
202741	Fee-for-Service	1033435953	1033435953	1	1	PRASSO, JASON E MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131298	41	Internal Medicine	0	In state provider	None	1680 E 120TH ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
202755	Fee-for-Service	1972012227	1972012227	1	1	PLANET HEALTH INC	10/16/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 E 4TH ST	STE 112	SANTA ANA	CA	92705	3916	30	06059	33.74826075	-117.8385386	Orange County
202793	Fee-for-Service	1104864792	1104864792	1	1	PETERDY, GERALDINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
202795	Fee-for-Service	1427495894	1427495894	1	1	PAUL, MEGAN R MD	7/21/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	141572	68	Hematology	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
202804	Fee-for-Service	1316226525	1316226525	2	1	PAULEY, KATHY A LMFT	7/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41130 CIRCLE D COURT	None	TEMECULA	CA	92592	8118	33	06065	33.52146318	-117.0453484	Riverside County
202811	Fee-for-Service	1871607762	1871607762	1	85	PROVIDENCE MEDICAL FOUNDATIO	10/7/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	445 MARCH AVE	SUITE A	HEALDSBURG	CA	95448	3383	49	06097	38.62593878	-122.8647643	Sonoma County
202838	Fee-for-Service	1043915788	1043915788	1	1	PACIFIC RETINA INC	6/1/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1109 S PARK VICTORIA DR	None	MILPITAS	CA	95035	6942	43	06085	37.41997296	-121.8762533	Santa Clara County
202849	Fee-for-Service	1437281615	1437281615	1	1	PARSA, CYRUS DO	5/9/2007	207ZP0102X	NA	Other	026	PHYSICIANS	3415	None	None	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
202850	Fee-for-Service	1376572784	1376572784	1	1	PETERS, ANNE L MD	10/8/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53070	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
202883	Fee-for-Service	1154365146	1154365146	1	1	PHAM, KIM R OD	7/15/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4848 SAN FELIPE RD	STE 140	SAN JOSE	CA	95135	1273	43	06085	37.30004393	-121.7719065	Santa Clara County
202890	Fee-for-Service	1679996755	1679996755	1	1	PEARCE, ELSA LMFT	4/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
202935	Fee-for-Service	1083645832	1083645832	1	1	PARK, JOE MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86588	05	Anesthesiology	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
202945	Fee-for-Service	1871607762	1871607762	1	54	PROVIDENCE MEDICAL FOUNDATIO	9/15/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	N	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
202946	Fee-for-Service	1154664837	1154664837	1	1	PATEL, ARPIT B MD	10/26/2020	208600000X	NA	General Surgery	026	PHYSICIANS	144333	02	General Surgery	0	In state provider	None	3838 SAN DIMAS ST	B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
202955	Fee-for-Service	1871607762	1871607762	1	136	PROVIDENCE MEDICAL FOUNDATIO	3/6/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	N	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
202961	Fee-for-Service	1356720098	1356720098	1	1	PHILLIPS, HAROLD W MD	8/17/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	150191	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
202972	Fee-for-Service	1972873834	1972873834	1	1	PICOS, JONATHAN A LMFT	9/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
202984	Fee-for-Service	1770841124	1770841124	1	1	PATEL, SUNAL S MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129835	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
203019	Fee-for-Service	1407536600	1407536600	1	1	PACUN, HANNAH I OT	8/18/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1251 E DYER RD	SUITE 150	SANTA ANA	CA	92705	5662	30	06059	33.70870351	-117.8551005	Orange County
203030	Fee-for-Service	1124055041	1124055041	2	1	PHAM, ERIC H MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78428	02	General Surgery	0	In state provider	None	17542 E 17TH STREET	SUITE 410	TUSTIN	CA	92780	1959	30	06059	33.75966953	-117.8261065	Orange County
203039	Fee-for-Service	1336591742	1336591742	1	1	PIVAZYAN, AZA OD	6/27/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6765 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91606	1696	19	06037	34.19368795	-118.3878213	Los Angeles County
203070	Fee-for-Service	1649776915	1649776915	1	1	PANZARINI, BRUNO P MD	7/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
203073	Fee-for-Service	1184839482	1184839482	1	1	PRASAD, JUSTIN H OD APO	8/18/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	LONG BEACH FAMILY OPTOME	6332 E SPRING ST	None	LONG BEACH	CA	90815	1424	19	06037	33.81039154	-118.108764	Los Angeles County
203078	Fee-for-Service	1871509372	1871509372	1	1	PYKA, WALTER R MD	10/31/1984	174400000X	NA	Other	026	PHYSICIANS	46127	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
203095	Fee-for-Service	1053608133	1053608133	1	1	PARMAR, SAROJBEN N MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125473	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE #450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
203100	Fee-for-Service	1154322691	1154322691	1	1	PATEL, SHREETI H MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72604	01	General Practice	0	In state provider	None	11539 HAWTHORNE BLVD	FL 6	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
203115	Fee-for-Service	1144245267	1144245267	1	1	PEREZ, MONICA M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86208	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
203124	Fee-for-Service	1134762305	1134762305	1	1	PARKS, POLLY LCSW	1/10/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
203136	Fee-for-Service	1871607762	1871607762	1	47	PROVIDENCE MEDICAL FOUNDATIO	4/25/2014	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	27800 MEDICAL CENTER RD	STE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
203139	Fee-for-Service	1376572784	1376572784	1	1	PETERS, ANNE L MD	10/8/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53070	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
203162	Fee-for-Service	1194820688	1194820688	1	1	PASTERNAK, GARY A MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	55926	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
203188	Fee-for-Service	1841615036	1841615036	1	1	PATEL, RONAKKUMAR D MD	8/15/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	139151	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
203217	Fee-for-Service	1316988652	1316988652	1	1	PARNELL, DANIEL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65497	None	None	0	In state provider	None	127 SYDNEY LN	None	REDWOOD CITY	CA	94063	5503	41	06081	37.49725747	-122.2242637	San Mateo County
203229	Fee-for-Service	1275762858	1275762858	1	1	PRUSHANI, AMIR MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135091	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
203236	Fee-for-Service	1649208463	1649208463	1	1	PACIFIC HEART & VASCULAR	11/2/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1801 E MARCH LN	STE D400	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
203249	Fee-for-Service	1821760059	1821760059	1	1	PRZYTULA, RIKI L NP	11/1/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203254	Fee-for-Service	1275989964	1275989964	1	1	PEREZ VELEZ, WILBERT MD	4/15/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151975	08	Family Practice	0	In state provider	None	1601 N MONTE VISTA AVE	STE 190	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
203255	Fee-for-Service	1811568678	1811568678	1	1	PULDA, MEGHANN LMFT	4/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
203261	Fee-for-Service	1891716544	1891716544	1	1	PARK, SOON J MD	2/20/2004	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	87055	33	Thoracic Surgery	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
203289	Fee-for-Service	1750689378	1750689378	1	1	PARSI, HOOMAN MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145107	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
203297	Fee-for-Service	1184696007	1184696007	1	1	PRAKASH, OM MD INC	10/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39024	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18056 WIKA RD	STE B	APPLE VALLEY	CA	92307	2125	36	06071	34.54061851	-117.2701017	San Bernardino County
203299	Fee-for-Service	1285175075	1285175075	1	1	POWER, ANTON DO	9/10/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18699	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
203306	Fee-for-Service	1033578786	1033578786	1	1	PALOMERO, RUFUS RAPHAEL PT	1/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
203373	Fee-for-Service	1710437082	1710437082	1	1	PEOPLE COORDINATED SERVICES	6/13/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	OF SOUTHERN CALIFORNIA	1319 S MANHATTAN PL	None	LOS ANGELES	CA	90019	4702	19	06037	34.046568	-118.310186	Los Angeles County
203374	Fee-for-Service	1003037722	1003037722	1	2	PARADISE VALLEY MEDICAL	5/20/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	GROUP, INC	6719 ALVARADO RD	STE 108	SAN DIEGO	CA	92120	5254	37	06073	32.77684978	-117.055137	San Diego County
203383	Fee-for-Service	1104379627	1104379627	1	1	PARK, JANET K	12/14/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
203400	Fee-for-Service	1326151465	1326151465	1	1	PAUL, FRANK MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
203409	Fee-for-Service	1871607762	1871607762	1	42	PROVIDENCE MEDICAL FOUNDATIO	7/12/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1550 PROFESSIONAL DR	STE 100	PETALUMA	CA	94954	6655	49	06097	38.25631812	-122.6300782	Sonoma County
203419	Fee-for-Service	1326363862	1326363862	1	1	PATEL, SUPRIYA S MD	8/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110750	02	General Surgery	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
203427	Fee-for-Service	1730142282	1730142282	1	1	PEIRIS, RALPH S MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8157	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
203448	Fee-for-Service	1194820688	1194820688	1	1	PASTERNAK, GARY A MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	55926	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
203458	Fee-for-Service	1992809412	1992809412	2	3	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	1	Border provider	EVADA	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
203493	Fee-for-Service	1215690318	1215690318	1	1	PALMA HERRERA, WENDY J LMFT	3/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
203509	Fee-for-Service	1497827505	1497827505	1	1	PREMIER MEDICAL, INC.	11/4/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	PREMIER MEDICAL, INC.	1200 W WALNUT HILL LN	#2210	IRVING	TX	75038	3029	00	None	32.88487247	-96.9673275	Dallas County
203514	Fee-for-Service	1871607762	1871607762	1	126	PROVIDENCE MEDICAL FOUNDATIO	4/13/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3443 VILLA LANE	SUITE 10	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
203517	Fee-for-Service	1891189064	1891189064	1	1	PUNEKY, DANIEL MD	5/15/2019	207R00000X	NA	Other	026	PHYSICIANS	159276	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
203518	Fee-for-Service	1922175819	1922175819	1	1	PHAN, CHRISTINE MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40651	25	Physical Medicine and Rehabilitation	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
203528	Fee-for-Service	1548557671	1548557671	1	1	PALEJWALA, SHERI MD	8/30/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	145902	14	Neurological Surgery	0	In state provider	None	2888 LONG BEACH BLVD	STE 240	LONG BEACH	CA	90806	1570	19	06037	33.809706	-118.189343	Los Angeles County
203541	Fee-for-Service	1770691859	1770691859	1	3	PREMIER ANESTHESIA OF CALIFO	1/16/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	RNIA, PC	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
203544	Fee-for-Service	1104019462	1104019462	1	1	PARTOVI, IRIS MD	10/25/2018	208M00000X	NA	Other	026	PHYSICIANS	153168	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
203551	Fee-for-Service	1699883694	1699883694	1	1	PAUL, SIMON MD	3/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51044	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
203577	Fee-for-Service	1750689378	1750689378	1	1	PARSI, HOOMAN MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145107	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
203596	Fee-for-Service	1063075695	1063075695	1	1	PAGULAYAN-SY, MYCHALL RAYMON	8/21/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	D C MD	3160 FOLSOM BLVD	STE 2500	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
203618	Fee-for-Service	1760425862	1760425862	1	2	PROVIDENCE MEDICAL INSTITUTE	6/15/2010	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 W ALAMEDA AVENUE	SUITE 212	BURBANK	CA	91505	4818	19	06037	34.15783817	-118.3293969	Los Angeles County
203645	Fee-for-Service	1669968293	1669968293	1	1	PARSONS, ALANE R LMFT	3/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1536 OPECHEE WAY	None	GLENDALE	CA	91208	1956	19	06037	34.18065084	-118.2323747	Los Angeles County
203660	Fee-for-Service	1548878317	1548878317	1	1	PROVISION HOME HEALTH CARE	6/4/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	5311 TOPANGA CANYON BLVD	UNIT 308C	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
203662	Fee-for-Service	1003037722	1003037722	1	2	PARADISE VALLEY MEDICAL	5/20/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	6719 ALVARADO RD	STE 108	SAN DIEGO	CA	92120	5254	37	06073	32.77684978	-117.055137	San Diego County
203708	Fee-for-Service	1629086236	1629086236	1	1	PATWELL, STEVEN W MD	9/22/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58209	None	None	0	In state provider	None	866 PLUMAS ST	None	YUBA CITY	CA	95991	4022	51	06101	39.14154171	-121.6177237	Sutter County
203709	Fee-for-Service	1780002055	1780002055	1	1	PHAN, JENNIFER T MD	10/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141019	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
203744	Fee-for-Service	1992809412	1992809412	2	3	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	EVADA	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
203791	Fee-for-Service	1275583395	1275583395	1	1	PUNEET SETHI MD	1/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8840 CALUMET AVE	STE 203	MUNSTER	IN	46321	2546	00	None	41.5521	-87.509475	Lake County
203831	Fee-for-Service	1437441565	1437441565	1	1	PEARLMAN, EMILY MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136302	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
203865	Fee-for-Service	1043284235	1043284235	1	1	PUCKETT, MICHAEL L	9/30/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64723	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
203917	Fee-for-Service	1518573955	1518573955	1	1	PROPITIOUS CARE HOSPICE INC	10/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	356 E OLIVE AVE	STE 112	BURBANK	CA	91502	1260	19	06037	34.18278666	-118.3066979	Los Angeles County
203921	Fee-for-Service	1619747623	1619747623	1	1	PREMIUM URGENT CARE, INC.	4/22/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1069 E CHAMPLAIN DR	None	FRESNO	CA	93720	4223	10	06019	36.87198602	-119.7645172	Fresno County
203927	Fee-for-Service	1215375183	1215375183	1	1	PADE, KATHRYN H MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126029	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
203963	Fee-for-Service	1912235482	1912235482	1	1	PIPER, SAMANTHA L MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110326	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
203965	Fee-for-Service	1053663096	1053663096	1	1	PATEL, DHAVAL H MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136932	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
204009	Fee-for-Service	1235298811	1235298811	1	1	PENG, DEAN MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81285	68	Hematology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204014	Fee-for-Service	1801819479	1801819479	1	1	PHILIPPI, KAREN M MD	3/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	45775	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
204016	Fee-for-Service	1679823504	1679823504	1	1	PINA, MELISSA J CCC-SLP	9/8/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
204017	Fee-for-Service	1841865839	1841865839	1	1	PICO RIVERA WOMENS AND CHILD	7/22/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	RENS MEDICAL CENTER	8854 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.0017374	-118.0851088	Los Angeles County
204026	Fee-for-Service	1548648827	1548648827	1	1	PAI, JASON MD	6/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144078	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
204053	Fee-for-Service	1245241991	1245241991	1	1	PETRA, ALEXIS MD	4/23/2020	207P00000X	NA	Other	026	PHYSICIANS	87698	66	Emergency Medicine (Urgent Care)	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
204056	Fee-for-Service	1366500209	1366500209	2	1	PORTER, SAMUEL J MD	12/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	22916	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	321 N LARCHMONT BLVD	SUITE 618	LOS ANGELES	CA	90004	6406	19	06037	34.0769016	-118.323663	Los Angeles County
204080	Fee-for-Service	1649493818	1649493818	1	1	PATTON, CECILIA M DC	4/4/2005	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	785 E WASHINGTON BLVD	STE 6	CRESCENT CITY	CA	95531	8372	08	06015	41.77266892	-124.1928045	Del Norte County
204087	Fee-for-Service	1477715944	1477715944	1	1	PILLSBURY, KINSEY R MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2874 N CARSON STREET	SUITE 215	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
204099	Fee-for-Service	1992969331	1992969331	1	1	PARKE, CHONG Y MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117183	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
204106	Fee-for-Service	1528471927	1528471927	1	1	PIAWAH, SORBARIKOR MD	8/14/2020	207RX0202X	NA	Oncology	026	PHYSICIANS	149915	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204162	Fee-for-Service	1295919686	1295919686	1	1	PHAN, HOA T DO	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9763	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
204163	Fee-for-Service	1154658615	1154658615	1	1	PARCHMAN, LORINN M	3/9/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90003	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
204172	Fee-for-Service	1598993313	1598993313	1	1	PRASAD, CHAITHRA MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135586	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204181	Fee-for-Service	1801387493	1801387493	1	1	PATANWALA, MARIA Y MD	2/10/2022	207R00000X	NA	Other	026	PHYSICIANS	174589	None	None	0	In state provider	None	1245 16TH STREET	STE 225	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
204196	Fee-for-Service	1396062402	1396062402	1	1	PUGH, ASHLEY T LMFT	4/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
204198	Fee-for-Service	1821301425	1821301425	1	1	PENGEL, MACHTEL M LCSW	1/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
204205	Fee-for-Service	1518573955	1518573955	1	1	PROPITIOUS CARE HOSPICE INC	10/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	356 E OLIVE AVE	STE 112	BURBANK	CA	91502	1260	19	06037	34.18278666	-118.3066979	Los Angeles County
204207	Fee-for-Service	1669490603	1669490603	1	2	PERSHING GENERAL HOSPITAL	5/28/2023	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NURSING HOME	855 6TH ST.	None	LOVELOCK	NV	89419	0661	00	None	40.17659153	-118.482093	Pershing County
204223	Fee-for-Service	1376925727	1376925727	1	1	PALLIS, LAUREN MD	10/30/2017	390200000X	NA	Other	026	PHYSICIANS	146797	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
204244	Fee-for-Service	1740410182	1740410182	1	1	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	INSTITUTE INC	770 MAGNOLIA AVE	STE 1H	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
204286	Fee-for-Service	1407288756	1407288756	1	1	PHILIPSON, TYRONE MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137903	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1633 SOUTH COURT STREET	None	VISALIA	CA	93277	4945	54	06107	36.315972	-119.292237	Tulare County
204296	Fee-for-Service	1235298811	1235298811	1	1	PENG, DEAN MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81285	78	Neoplastic Diseases/Oncology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
204330	Fee-for-Service	1275856403	1275856403	1	1	PANCHAL, HEENA D MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144576	36	Psychiatry	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
204336	Fee-for-Service	1760820708	1760820708	1	1	PIGOTT, MATTHEW T MD	6/13/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	153933	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
204353	Fee-for-Service	1801147707	1801147707	1	1	PLANNED PARENTHOOD SHASTA	3/25/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIABLO INC	14671 OLYMPIC DR	None	CLEARLAKE	CA	95422	9516	17	06033	38.9618304	-122.6382453	Lake County
204354	Fee-for-Service	1215132790	1215132790	1	1	PONTHENKANDATH, SASIDHARAN	1/23/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	144096	40	Pediatrics	0	In state provider	MD	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
204360	Fee-for-Service	1528588134	1528588134	1	1	PASTORE, SIMONE D DO	9/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19239	None	None	0	In state provider	None	4150 REGENTS PARK ROW	STE 355	LA JOLLA	CA	92037	9102	37	06073	32.87272099	-117.2175656	San Diego County
204376	Fee-for-Service	1477715944	1477715944	1	1	PILLSBURY, KINSEY R MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2874 N CARSON STREET	SUITE 215	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
204387	Fee-for-Service	1992969331	1992969331	1	1	PARKE, CHONG Y MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117183	45	Nephrology (Renal-Kidney)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
204406	Fee-for-Service	1912185059	1912185059	1	1	POON, YUKIKO K MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105711	40	Pediatrics	0	In state provider	None	5151 F STREET	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
204428	Fee-for-Service	1841226990	1841226990	1	14	PHYSICIAN FOUNDATION	4/1/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL ASSOCIATES	3880 S BASCOM AVE	STE 113	SAN JOSE	CA	95124	2662	43	06085	37.25942826	-121.9471504	Santa Clara County
204461	Fee-for-Service	1215375175	1215375175	1	1	PROHEALTH HOME CARE INC	11/8/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1375 EXPOSITION BLVD	SUITE 250A	SACRAMENTO	CA	95815	5115	34	06067	38.596554	-121.4393445	Sacramento County
204493	Fee-for-Service	1669490603	1669490603	1	2	PERSHING GENERAL HOSPITAL	5/28/2023	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NURSING HOME	855 6TH ST.	None	LOVELOCK	NV	89419	0661	00	None	40.17659153	-118.482093	Pershing County
204514	Fee-for-Service	1760796460	1760796460	1	1	PIOCHE, EUNICE	5/3/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
204517	Fee-for-Service	1114322716	1114322716	1	1	POKHAREL, DINESH K MD	7/24/2018	207R00000X	NA	Other	026	PHYSICIANS	145977	41	Internal Medicine	0	In state provider	None	5255 ELKHORN BLVD	None	SACRAMENTO	CA	95840	2506	34	06067	38.687364	-121.3417035	Sacramento County
204531	Fee-for-Service	1740410182	1740410182	1	1	PACIFIC DERMATOLOGY INSTITUT	11/2/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INSTITUTE INC	770 MAGNOLIA AVE	STE 1H	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
204551	Fee-for-Service	1821148883	1821148883	1	1	PACIFIC PATH INC	5/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
204556	Fee-for-Service	1265567853	1265567853	1	1	PLETT, EUGENE R MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37272	08	Family Practice	0	In state provider	None	2580 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14842672	-122.2180085	Tehama County
204571	Fee-for-Service	1871286427	1871286427	1	4	PIEDMONT ADVANCED CARE INC	2/28/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AL CORPORATION	516 WILLOW ST	None	ALAMEDA	CA	94501	6132	01	06001	37.76011202	-122.2549417	Alameda County
204594	Fee-for-Service	1215455779	1215455779	1	1	PREMIUM URGENT CARE, INC.	4/22/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3000 FLORAL AVE	A	SELMA	CA	93662	9414	10	06019	36.57635971	-119.6317081	Fresno County
204614	Fee-for-Service	1104023977	1104023977	1	1	PATEL, ASHISH B MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82228	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39 CONGRESS	STE 301	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
204622	Fee-for-Service	1295185254	1295185254	1	1	PAGLER, ELIZABETH S MD	5/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163137	None	None	0	In state provider	None	18564 US HWY 18	104	APPLE VALLEY	CA	92307	2321	36	06071	34.53926652	-117.2592564	San Bernardino County
204656	Fee-for-Service	1477652410	1477652410	1	1	PARSA, A THOMAS MD	4/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55914	01	General Practice	0	In state provider	None	2864 E IMPERIAL HWY	None	BREA	CA	92821	6714	30	06059	33.91098368	-117.8585825	Orange County
204667	Fee-for-Service	1669515235	1669515235	1	1	PHARMEX, INC	8/14/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	4215 N 16TH ST	STE 4	PHOENIX	AZ	85016	5346	00	None	33.497046	-112.0469805	Maricopa County
204688	Fee-for-Service	1649347402	1649347402	1	1	PHAM, KRISTINE D MD	12/11/2007	207R00000X	NA	Other	026	PHYSICIANS	71418	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
204696	Fee-for-Service	1992214597	1992214597	1	1	PERRY, JOANN LMFT	9/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11025 PIONEER TRAIL	SUITE 110	TRUCKEE	CA	96161	0250	29	06057	39.33584965	-120.1819445	Nevada County
204726	Fee-for-Service	1083293112	1083293112	1	1	PARK, MOON MD	2/28/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
204769	Fee-for-Service	1225476989	1225476989	1	1	PAN, SHU MD	10/22/2020	208800000X	NA	Other	026	PHYSICIANS	160005	None	None	0	In state provider	None	2700 GRANT ST	STE 316	CONCORD	CA	94520	2272	07	06013	37.98417931	-122.0361585	Contra Costa County
204775	Fee-for-Service	1871607762	1871607762	1	15	PROVIDENCE MEDICAL FOUNDATIO	11/22/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
204779	Fee-for-Service	1871607762	1871607762	1	124	PROVIDENCE MEDICAL FOUNDATIO	12/19/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	1621 W IMOLA AVE	None	NAPA	CA	94559	4721	28	06055	38.28190003	-122.2926629	Napa County
204787	Fee-for-Service	1972508430	1972508430	1	1	PAIGE H LEMASTERS, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2150 CEDAR ST	None	ABILENE	TX	79601	2332	00	None	32.47429755	-99.73303104	Taylor County
204792	Fee-for-Service	1801259957	1801259957	1	1	PINGREE, CHRISTIAN S MD	8/8/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	175857	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
204812	Fee-for-Service	1861474561	1861474561	1	1	PERRY, JAMES C MD	4/29/1999	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	76012	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
204852	Fee-for-Service	1477830032	1477830032	1	1	PAYNE, DIANA L PHD	7/21/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
204904	Fee-for-Service	1104023977	1104023977	1	1	PATEL, ASHISH B MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82228	41	Internal Medicine	0	In state provider	None	39 CONGRESS	STE 301	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
204938	Fee-for-Service	1063445781	1063445781	1	1	PATANKAR, KAVITA S MD	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91827	41	Internal Medicine	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
204940	Fee-for-Service	1871659961	1871659961	1	1	PENALVER, MELANIE A CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
205006	Fee-for-Service	1447402599	1447402599	1	1	PROSTHETIC SOLUTIONS INC	4/12/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	191 SAN FELIPE ROAD	SUITE M1	HOLLISTER	CA	95023	3064	35	06069	36.85956134	-121.4015635	San Benito County
205010	Fee-for-Service	1871102988	1871102988	1	1	POULOS, EMILY M LPCC	11/14/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
205060	Fee-for-Service	1790281145	1790281145	1	1	PATEL, AMIE S DO	8/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	17733	None	None	0	In state provider	None	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
205062	Fee-for-Service	1871607762	1871607762	1	30	PROVIDENCE MEDICAL FOUNDATIO	4/29/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	4750 HOEN AVE	SUITE B	SANTA ROSA	CA	95405	7824	49	06097	38.442744	-122.6629485	Sonoma County
205063	Fee-for-Service	1467128876	1467128876	1	1	PANKAU, THOMAS PHD	12/2/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
205074	Fee-for-Service	1952341125	1952341125	1	1	PULLEY, DOUGLAS B MD INC	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	24242	18	Ophthalmology	0	In state provider	None	393 BLOSSOM HILL RD	STE 265	SAN JOSE	CA	95123	1655	43	06085	37.25148009	-121.8269584	Santa Clara County
205075	Fee-for-Service	1447385711	1447385711	1	1	PROBER, CHARLES, G MD	9/30/1985	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	30382	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
205096	Fee-for-Service	1548826340	1548826340	1	1	PIERCE, ELIZABETH L CNP	1/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
205099	Fee-for-Service	1871607762	1871607762	1	71	PROVIDENCE MEDICAL FOUNDATIO	11/22/2022	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
205121	Fee-for-Service	1376587352	1376587352	1	1	PATEL, SAURABH K MD	6/1/2003	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70005	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
205187	Fee-for-Service	1780146183	1780146183	1	1	PARR, ASHLEY DO	8/8/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21072	None	None	0	In state provider	None	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
205258	Fee-for-Service	1336428614	1336428614	1	1	PAN, KATHY MD	12/17/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	124335	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
205308	Fee-for-Service	1083620330	1083620330	1	1	PIERCE, WILLIAM J MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86834	02	General Surgery	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
205316	Fee-for-Service	1861114324	1861114324	1	1	PARTHASARATHY, JACQUELINE N	12/14/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
205318	Fee-for-Service	1750347159	1750347159	1	1	POROT, MARC J MD	6/19/2015	207LP2900X	NA	Other	026	PHYSICIANS	42809	05	Anesthesiology	0	In state provider	None	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
205352	Fee-for-Service	1871607762	1871607762	1	15	PROVIDENCE MEDICAL FOUNDATIO	11/21/2011	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
205357	Fee-for-Service	1609467422	1609467422	1	1	PEARCE, MONIQUE L	2/23/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	135 E DEL AMO BLVD	APT 304	CARSON	CA	90745	3839	19	06037	33.84634901	-118.275946	Los Angeles County
205360	Fee-for-Service	1336637099	1336637099	1	1	PATEL, JIMMY MD	12/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176018	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
205364	Fee-for-Service	1447385711	1447385711	1	1	PROBER, CHARLES, G MD	9/30/1985	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	30382	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
205369	Fee-for-Service	1417031717	1417031717	1	1	PENA, CYNTHIA L MD	11/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88607	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
205387	Fee-for-Service	1871607762	1871607762	1	71	PROVIDENCE MEDICAL FOUNDATIO	7/8/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
205392	Fee-for-Service	1083893317	1083893317	1	1	PRICE, ERIKA L MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97019	41	Internal Medicine	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
205396	Fee-for-Service	1841723327	1841723327	1	8	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	477 AINSLEY AVENUE	None	YUBA CITY	CA	95991	4105	51	06101	39.14428412	-121.6200723	Sutter County
205410	Fee-for-Service	1497998082	1497998082	1	1	PAN, JENNY H MD	7/21/2020	204F00000X	NA	General Surgery	026	PHYSICIANS	143311	02	General Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
205421	Fee-for-Service	1164070868	1164070868	1	1	PRECISION EYECARE OPTOMETRY	6/3/2021	261Q00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PLACERVILLE INC	118 MAIN ST	None	PLACERVILLE	CA	95667	5508	09	06017	38.72750767	-120.8058005	El Dorado County
205441	Fee-for-Service	1871607762	1871607762	1	162	PROVIDENCE MEDICAL FOUNDATIO	1/19/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	805 LA VETA	STE 101	ORANGE	CA	98268	3901	30	06059	33.78064152	-117.8606475	Orange County
205450	Fee-for-Service	1730619032	1730619032	1	1	PARK, JIN LAC	7/6/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1096 N WESTERN AVE	STE 107	LOS ANGELES	CA	90029	2340	19	06037	34.090524	-118.309141	Los Angeles County
205486	Fee-for-Service	1437545506	1437545506	1	1	POLAND, MYESHA M MD	10/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151822	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
205497	Fee-for-Service	1215082235	1215082235	1	1	PAULO, JOSEPHINE A MD	10/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37056	36	Psychiatry	0	In state provider	None	13710 STUDEBAKER RD	STE 100	NORWALK	CA	90650	3585	19	06037	33.90695527	-118.0993434	Los Angeles County
205547	Fee-for-Service	1316441173	1316441173	1	1	POSADAS, EDMUND MD	8/23/2023	390200000X	NA	Other	026	PHYSICIANS	163646	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
205644	Fee-for-Service	1609467422	1609467422	1	1	PEARCE, MONIQUE L	2/23/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	135 E DEL AMO BLVD	APT 304	CARSON	CA	90745	3839	19	06037	33.84634901	-118.275946	Los Angeles County
205660	Fee-for-Service	1710960893	1710960893	1	1	PAUL, SUMITA MD	11/25/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	183090	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 S CENTRAL AVENUE	200,210,250	GLENDALE	CA	91204	4614	19	06037	34.13746423	-118.2578296	Los Angeles County
205671	Fee-for-Service	1871607762	1871607762	1	11	PROVIDENCE MEDICAL FOUNDATIO	12/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	4900 PROSPECT AVE	None	YORBA LINDA	CA	92886	2128	30	06059	33.88961003	-117.8379389	Orange County
205676	Fee-for-Service	1871607762	1871607762	1	71	PROVIDENCE MEDICAL FOUNDATIO	3/27/2015	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
205682	Fee-for-Service	1841723327	1841723327	1	8	PEACH TREE HEALTHCARE	2/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	477 AINSLEY AVENUE	None	YUBA CITY	CA	95991	4105	51	06101	39.14428412	-121.6200723	Sutter County
205756	Fee-for-Service	1063496651	1063496651	1	47	PACIFIC CENTRAL COAST HEALTH	11/1/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3807 UNION AVE	SUITE B	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
205767	Fee-for-Service	1245475334	1245475334	1	1	POON, CHARLES MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103158	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	270 INTERNATIONAL CICLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
205795	Fee-for-Service	1073783684	1073783684	1	1	PATEL, HIRAL K MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10737	05	Anesthesiology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
205801	Fee-for-Service	1407458599	1407458599	1	1	PITMAN, CALLIE CRNA	5/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
205832	Fee-for-Service	1811990013	1811990013	1	1	PAUL H DEUTSCH	10/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	86 NEW LONDON TPKE	None	NORWICH	CT	06360	2636	00	None	41.54275022	-72.096016	Southeastern Connecticut Planning Region
205880	Fee-for-Service	1245348820	1245348820	1	1	PRIMARY CARE ASSOCIATES	4/11/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	REDWOOD EMPIRE MED GROUP	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
205896	Fee-for-Service	1457333478	1457333478	1	1	PRASERTHDAM, WIDCHANUN W	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72984	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
205918	Fee-for-Service	1467606368	1467606368	1	2	PERKINS, KRISTIN LCSW	5/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 MAIN ST	SUITE D1	FORTUNA	CA	95540	2150	12	06023	40.59800573	-124.1553951	Humboldt County
205927	Fee-for-Service	1265416184	1265416184	1	1	PIKUL, BRIAN K MD	8/31/1995	174400000X	NA	Other	026	PHYSICIANS	84039	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
205934	Fee-for-Service	1598702029	1598702029	1	1	PAPALEO, STEPHEN PHD	11/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7200 PARKWAY DRIVE	STE 113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
205964	Fee-for-Service	1871607762	1871607762	1	71	PROVIDENCE MEDICAL FOUNDATIO	4/30/2021	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	N	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
205970	Fee-for-Service	1598882052	1598882052	1	1	PARDO, KARINA LMFT	2/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
206020	Fee-for-Service	1992809412	1992809412	2	2	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	1	Border provider	EVADA	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
206037	Fee-for-Service	1982976866	1982976866	1	1	POTTUKALAM, ROBIN J	3/29/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
206040	Fee-for-Service	1306604335	1306604335	1	1	PEARL CARE ASSISTED LIVING	11/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	8523 WINDING WAY	None	FAIR OAKS	CA	95628	6236	34	06067	38.645838	-121.241106	Sacramento County
206051	Fee-for-Service	1346378106	1346378106	1	1	PANJABI, VARSHA S MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206071	Fee-for-Service	1881807006	1881807006	1	1	PERLROTH, JOSHUA D MD	5/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86369	41	Internal Medicine	0	In state provider	None	365 LENNON LN	STE 200	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
206092	Fee-for-Service	1689961302	1689961302	1	3	PEOPLES COMMUNITY CLINIC	3/6/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4139 VERDUGO ROAD	SUITE A	LOS ANGELES	CA	90065	3820	19	06037	34.1261475	-118.2319835	Los Angeles County
206097	Fee-for-Service	1205163037	1205163037	1	1	PHAM, MICHELLE MD	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109768	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
206154	Fee-for-Service	1225474133	1225474133	1	1	PEDERSEN, ROSE C MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135121	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
206164	Fee-for-Service	1578939013	1578939013	1	1	PARR, BRANDI L NP	2/26/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
206167	Fee-for-Service	1245348820	1245348820	1	1	PRIMARY CARE ASSOCIATES	4/11/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	REDWOOD EMPIRE MED GROUP	500 DOYLE PARK DR	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
206179	Fee-for-Service	1770906836	1770906836	1	1	PRIME NEUROLOGY INC	8/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118232	13	Neurology (M.D. only)	0	In state provider	None	16350 VENTURA BLVD	STE D323	ENCINO	CA	91436	5300	19	06037	34.15710102	-118.489263	Los Angeles County
206184	Fee-for-Service	1811289168	1811289168	1	1	PECK, JESSICA	7/31/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
206185	Fee-for-Service	1457333478	1457333478	1	1	PRASERTHDAM, WIDCHANUN W	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72984	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
206194	Fee-for-Service	1619086162	1619086162	1	1	PAYLESS DRUG STORE 6043	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	2805 BELL RD	None	AUBURN	CA	95603	2539	31	06061	38.940264	-121.095027	Placer County
206199	Fee-for-Service	1245624097	1245624097	1	1	PIPER, LAURA E MD	6/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128586	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
206285	Fee-for-Service	1346327293	1346327293	1	1	PARK, ANNA J MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60955	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
206302	Fee-for-Service	1447521182	1447521182	1	1	P.A.L. LOVING CARE HOME	8/21/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	2829 N SAN FERNANDO RD	SUITE 211	LOS ANGELES	CA	90065	1343	19	06037	34.11119067	-118.2434149	Los Angeles County
206309	Fee-for-Service	1992809412	1992809412	2	2	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	EVADA	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
206316	Fee-for-Service	1114245271	1114245271	1	1	PAUL, TINA M MD	5/25/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	107210	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	979 GEM STREET	None	TULARE	CA	93274	2127	54	06107	36.22172245	-119.339865	Tulare County
206361	Fee-for-Service	1881807006	1881807006	1	1	PERLROTH, JOSHUA D MD	5/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86369	77	Infectious Disease	0	In state provider	None	365 LENNON LN	STE 200	WALNUT CREEK	CA	94598	5910	07	06013	37.92784983	-122.0301444	Contra Costa County
206369	Fee-for-Service	1831395102	1831395102	1	1	PHAM, LIZA M MD	11/5/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	100406	40	Pediatrics	0	In state provider	P MD	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
206393	Fee-for-Service	1609222942	1609222942	1	1	PROHEALTH PARTNERS A MEDICAL	10/31/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	3816 WOODRUFF AVE	STE 406	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
206443	Fee-for-Service	1356818660	1356818660	1	1	PARKSIDE CONGREGATE LIVING	11/13/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	304 HAGGIN STREET	None	BAKERSFIELD	CA	93309	1972	15	06029	35.35728636	-119.0711987	Kern County
206450	Fee-for-Service	1831118686	1831118686	1	1	PHAM, NGA V MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69545	41	Internal Medicine	0	In state provider	None	2470 ALVIN AVE	STE 50	SAN JOSE	CA	95121	1664	43	06085	37.31946663	-121.8268813	Santa Clara County
206477	Fee-for-Service	1154492197	1154492197	1	1	PURI, RITA MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	41732	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
206479	Fee-for-Service	1760570600	1760570600	1	13	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP	4617 FREEPORT BLVD	B	SACRAMENTO	CA	95822	2015	34	06067	38.533311	-121.4939295	Sacramento County
206496	Fee-for-Service	1346297660	1346297660	1	1	PARK, TAE J MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90047	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
206504	Fee-for-Service	1639480247	1639480247	1	1	PENKAR, MANEESH S MD	3/23/2021	207R00000X	NA	Other	026	PHYSICIANS	167686	None	None	0	In state provider	None	23430 HAWTHORNE BLVD	SUITE 325	TORRANCE	CA	90505	4720	19	06037	33.81316465	-118.3510077	Los Angeles County
206526	Fee-for-Service	1891220109	1891220109	1	1	PETRU, VIVIANA MD	10/23/2020	207R00000X	NA	Other	026	PHYSICIANS	167437	41	Internal Medicine	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
206569	Fee-for-Service	1730112426	1730112426	1	1	PREMIER FAMILY MEDICINE	3/1/2001	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ASSOCIATES INC	2140 GRAND AVE	STE 125	CHINO HILLS	CA	91709	6802	36	06071	33.99623518	-117.7579477	San Bernardino County
206586	Fee-for-Service	1376038232	1376038232	1	1	PERKIS, ELIZABETH M DO	11/23/2022	207P00000X	NA	Other	026	PHYSICIANS	20177	None	None	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
206649	Fee-for-Service	1245733112	1245733112	1	1	PITNEY, CHRISTIE M	11/13/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	12586 AVENUE 408	None	OROSI	CA	93647	9454	54	06107	36.53030229	-119.2915122	Tulare County
206680	Fee-for-Service	1871607762	1871607762	1	174	PROVIDENCE MEDICAL FOUNDATIO	5/3/2023	2251P0200X	NA	Physical Therapist	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	26800 CROWN VALLEY PKWY	STE 540	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
206742	Fee-for-Service	1710140561	1710140561	1	1	PATEL, SAPNA S MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106326	45	Nephrology (Renal-Kidney)	0	In state provider	None	2785 PACIFIC AVE	STE A	LONG BEACH	CA	90806	2641	19	06037	33.807861	-118.193748	Los Angeles County
206759	Fee-for-Service	1760570600	1760570600	1	13	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	4617 FREEPORT BLVD	B	SACRAMENTO	CA	95822	2015	34	06067	38.533311	-121.4939295	Sacramento County
206760	Fee-for-Service	1962247668	1962247668	1	1	PLANNED PARENTHOOD CALIFORNI	1/29/2025	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	501 E CHAPEL ST	None	SANTA MARIA	CA	93454	4519	42	06083	34.9543265	-120.4298955	Santa Barbara County
206787	Fee-for-Service	1508259698	1508259698	1	1	PTACEK, KALE L DC	12/2/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206830	Fee-for-Service	1689873382	1689873382	1	1	PATEL, AKTA M MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 NORTH LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206843	Fee-for-Service	1801800909	1801800909	1	1	PALEY, BLAIR PHD	10/1/2000	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
206880	Fee-for-Service	1235668971	1235668971	1	1	P CHENG MD INC	5/1/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
206916	Fee-for-Service	1861549040	1861549040	1	1	PLACER CO OFF OF ED	11/18/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1400 WEST STANFORD RANCH	ROAD	ROCKLIN	CA	95765	3750	31	06061	38.81536853	-121.2856121	Placer County
206919	Fee-for-Service	1720693054	1720693054	1	1	PHAN, ANDREW T CRNA	2/20/2021	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
206927	Fee-for-Service	1063762656	1063762656	1	1	PINN, JODI L PHD	9/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S. BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206979	Fee-for-Service	1538171095	1538171095	1	1	PATEL, RAHUL R MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97304	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
206980	Fee-for-Service	1427069160	1427069160	1	1	PAUL C COSTELLO, MD	11/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	550 16TH AVE	STE 100	SEATTLE	WA	98122	5636	00	None	47.60743396	-122.311502	King County
207000	Fee-for-Service	1396066205	1396066205	1	1	PARK, ANDREA M MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148086	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
207030	Fee-for-Service	1710140561	1710140561	1	1	PATEL, SAPNA S MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106326	41	Internal Medicine	0	In state provider	None	2785 PACIFIC AVE	STE A	LONG BEACH	CA	90806	2641	19	06037	33.807861	-118.193748	Los Angeles County
207041	Fee-for-Service	1639337074	1639337074	1	1	PELLEGRINO, KRISTEN E MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122503	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
207050	Fee-for-Service	1841262763	1841262763	1	1	PEREZ, FRANCISCO S MD	4/11/2019	208M00000X	NA	Other	026	PHYSICIANS	53915	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	100	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
207056	Fee-for-Service	1659343945	1659343945	1	1	PRICE, MATTHEW J MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67714	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
207080	Fee-for-Service	1013140474	1013140474	1	1	PIH HEALTH COMMUNITY PHARMAC	5/25/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y LLC	12462 PUTNAM STREET.	SUITE. 105	WHITTIER	CA	90602	1006	19	06037	33.9709236	-118.0460596	Los Angeles County
207083	Fee-for-Service	1891050001	1891050001	1	1	PATEL, MINAL J MD	11/1/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
207084	Fee-for-Service	1114005832	1114005832	1	1	PATEL, JIGNESH K MD	3/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78447	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
207195	Fee-for-Service	1376876912	1376876912	1	3	PINNACLE MEDICAL GROUP INC	4/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	300 S HIGHLAND SPRINGS	STE 2D	BANNING	CA	92220	6503	33	06065	33.92503257	-116.9467329	Riverside County
207219	Fee-for-Service	1861933079	1861933079	1	1	PHOO, WUT YI MD	5/17/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
207310	Fee-for-Service	1770639809	1770639809	1	1	PROVIDENCE HEALTH SYSTEM	3/23/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1322 W 6TH ST	None	SAN PEDRO	CA	90732	3501	19	06037	33.73885446	-118.3060485	Los Angeles County
207328	Fee-for-Service	1639337074	1639337074	1	1	PELLEGRINO, KRISTEN E MD	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122503	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
207337	Fee-for-Service	1366799868	1366799868	1	1	PARRISH, AARON B MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128270	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
207358	Fee-for-Service	1841619509	1841619509	1	1	PATEL, KIRAN G MD	12/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	145974	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
207373	Fee-for-Service	1114005832	1114005832	1	1	PATEL, JIGNESH K MD	3/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78447	45	Nephrology (Renal-Kidney)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
207378	Fee-for-Service	1336328244	1336328244	1	1	PRIME HLTHCARE CENTINELA LLC	2/1/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTINELA HOSP MED CTR	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
207429	Fee-for-Service	1346668837	1346668837	1	1	PATEL, JASMINE D MD	8/11/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155408	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
207440	Fee-for-Service	1376636845	1376636845	1	1	PINEDO, NANCY MD	7/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55438	01	General Practice	0	In state provider	None	1913 E 17TH ST	STE 101	SANTA ANA	CA	92705	8627	30	06059	33.76000545	-117.8399925	Orange County
207470	Fee-for-Service	1518264746	1518264746	1	1	PASKI, SHIRLEY C MD	9/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151207	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90051	0717	19	06037	34.07671715	-118.3799413	Los Angeles County
207473	Fee-for-Service	1497949937	1497949937	1	1	PRUITT, JENNIFER M PSYD	2/12/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
207523	Fee-for-Service	1437290533	1437290533	1	1	PESQUEIRA, DALIA V LMFT	10/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	92688	-	NOT APPLICABLE	0	In state provider	None	1295 W STATE ST	SUITE 101-106	EL CENTRO	CA	92243	2881	13	06025	32.79169087	-115.5674379	Imperial County
207547	Fee-for-Service	1447607551	1447607551	1	1	POURNAKI, SANAM M MD	11/25/2019	207R00000X	NA	Other	026	PHYSICIANS	161254	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
207550	Fee-for-Service	1841241585	1841241585	1	12	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	5353 MISSION CENTER RD	SUITE 224	SAN DIEGO	CA	92108	1306	37	06073	32.77207362	-117.154699	San Diego County
207563	Fee-for-Service	1285950949	1285950949	1	1	PRAHALAD, PRIYA MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120955	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
207566	Fee-for-Service	1013948256	1013948256	1	1	PRECIADO, JOSEPHINE P MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75900	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
207571	Fee-for-Service	1518278266	1518278266	1	1	PATHAK, NEIL J MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125931	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
207573	Fee-for-Service	1295930451	1295930451	1	2	PARTNERS N CARE, LLC	1/17/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5920 COPPERFIELD AVE	None	RIVERSIDE	CA	92506	4510	33	06065	33.94425467	-117.3684734	Riverside County
207640	Fee-for-Service	1679097166	1679097166	1	1	PARK, HYEHYUN J LCSW	2/26/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
207645	Fee-for-Service	1487270120	1487270120	1	1	PAPNEJA, KOYELLE MD	10/30/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163452	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
207655	Fee-for-Service	1306037528	1306037528	1	1	PETTAWAY, BERTHA LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
207664	Fee-for-Service	1346291986	1346291986	1	1	PARKWAY CLINICAL LABORATORIE	5/9/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	S, INC.	3494 PROGRESS DRIVE	None	BENSALEM	PA	19020	5815	00	None	40.08586348	-74.92620194	Bucks County
207666	Fee-for-Service	1336328244	1336328244	1	1	PRIME HLTHCARE CENTINELA LLC	2/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTINELA HOSP MED CTR	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
207676	Fee-for-Service	1184370934	1184370934	1	1	PRESUEL, O'NEIL	1/8/2024	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
207707	Fee-for-Service	1619307410	1619307410	1	1	PALMYRA MEDICAL GROUP INC	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110080	41	Internal Medicine	0	In state provider	None	2701 S BRISTOL	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
207717	Fee-for-Service	1871607762	1871607762	1	57	PROVIDENCE MEDICAL FOUNDATIO	8/25/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	3555 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
207721	Fee-for-Service	1093758047	1093758047	1	1	PAINE, JOEL E MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89016	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
207765	Fee-for-Service	1679539530	1679539530	1	1	POGREL, MICHAEL A	11/30/1992	204E00000X	NA	Dental Provider	026	PHYSICIANS	52418	None	None	0	In state provider	None	513 PARNASSUS AVE	RM S738	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
207768	Fee-for-Service	1538723119	1538723119	1	1	PATEL, RUSHIN M MD	9/28/2022	207R00000X	NA	Other	026	PHYSICIANS	176011	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
207791	Fee-for-Service	1902919111	1902919111	1	1	PICKETT, ROBERTA L MD	7/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81828	None	None	0	In state provider	None	2650 S BRISTOL ST	STE 101&103	SANTA ANA	CA	92704	5751	30	06059	33.71118647	-117.885452	Orange County
207810	Fee-for-Service	1528314515	1528314515	1	1	PARK, SAMUEL MD AMC	9/14/2012	207LP2900X	NA	Other	026	PHYSICIANS	75650	05	Anesthesiology	0	In state provider	None	22 ODYSSEY	STE 155	IRVINE	CA	92618	3194	30	06059	33.66719598	-117.7642461	Orange County
207843	Fee-for-Service	1841241585	1841241585	1	12	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	5353 MISSION CENTER RD	SUITE 224	SAN DIEGO	CA	92108	1306	37	06073	32.77207362	-117.154699	San Diego County
207850	Fee-for-Service	1285950949	1285950949	1	1	PRAHALAD, PRIYA MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120955	67	Endocrinology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
207852	Fee-for-Service	1831294339	1831294339	1	1	PATTANAIK, ANJALIKA MD	12/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34253	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
207865	Fee-for-Service	1053364034	1053364034	1	1	PLANNED PARENTHOOD	1/1/1995	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	316 N MAIN ST	None	SALINAS	CA	93901	2855	27	06053	36.682749	-121.6533777	Monterey County
207872	Fee-for-Service	1285150714	1285150714	1	1	PARASHAR, POOJA S LMFT	8/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
207879	Fee-for-Service	1114139490	1114139490	1	1	PADUA, ERIC M MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113551	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
207888	Fee-for-Service	1992102255	1992102255	1	1	POPE, CHRYSTINA LMFT	1/31/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
207893	Fee-for-Service	1649298084	1649298084	1	1	PARK, SUNG U	6/28/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	48704	None	None	0	In state provider	None	3055 W ORANGE AVE	STE 101	ANAHEIM	CA	92804	3152	30	06059	33.8247435	-117.99621	Orange County
207923	Fee-for-Service	1235438235	1235438235	1	1	PIGNATARO, KATHLEEN M LMFT	10/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	235 NEW YORK RANCH RD ST	None	JACKSON	CA	95642	9328	03	06005	38.35435951	-120.7677827	Amador County
207927	Fee-for-Service	1528298775	1528298775	1	1	PROMED MEDICAL SUPPLIES	11/5/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PROMED MEDICAL SUPPLIES	10200 VENICE BLVD	SUITE 109	CULVER CITY	CA	90232	3347	19	06037	34.02136545	-118.4020771	Los Angeles County
207946	Fee-for-Service	1265400824	1265400824	1	2	PIERSOL, PATRICIA E	7/10/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	8465 OLD REDWOOD HWY	STE 320	WINDSOR	CA	95495	9244	49	06097	38.5435006	-122.8006981	Sonoma County
207971	Fee-for-Service	1467836098	1467836098	1	1	PEDIATRIC INFECTOLOGY GROUP	10/27/2015	2080P0208X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
207973	Fee-for-Service	1174810972	1174810972	1	1	PEREZ-MARCIA, PERLITA A MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	119689	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	SUITE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
207977	Fee-for-Service	1497761985	1497761985	1	1	PODLONE, MICHAEL D MD	1/1/1994	207R00000X	NA	Other	026	PHYSICIANS	23177	01	General Practice	0	In state provider	None	2448 STORY RD	None	SAN JOSE	CA	95122	1029	43	06085	37.34771126	-121.8314181	Santa Clara County
207992	Fee-for-Service	1841241585	1841241585	1	10	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	9620 CHESAPEAKE DR.	SUITE 206	SAN DIEGO	CA	92123	1324	37	06073	32.83378776	-117.1237922	San Diego County
207999	Fee-for-Service	1447735048	1447735048	1	1	PURCELL, GENEVIEVE A NP	11/19/2021	367A00000X	NA	Certified Nurse Midwife	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
208003	Fee-for-Service	1871607762	1871607762	1	5	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	500 W CENTRAL AVE	STE B	BREA	CA	92821	3036	30	06059	33.93191041	-117.9042105	Orange County
208034	Fee-for-Service	1801838230	1801838230	1	1	PARIMOO, NAKUL MD	7/5/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	155563	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
208046	Fee-for-Service	1780637645	1780637645	1	1	PLANNED PARENTHOOD	8/7/1986	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3131 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2902	43	06085	37.36639819	-121.8272112	Santa Clara County
208074	Fee-for-Service	1134562333	1134562333	1	1	PAULSSON, ANNA K U MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136094	78	Neoplastic Diseases/Oncology	0	In state provider	None	110 LYNCH CREEK WAY	SUITE A	PETALUMA	CA	94952	2337	49	06097	38.25171165	-122.6351052	Sonoma County
208084	Fee-for-Service	1194398453	1194398453	1	1	PHUNG, SYLVIA OD	10/10/2024	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 RIVERSIDE AVE	SUITE 220	RIALTO	CA	92376	8082	36	06071	34.132905	-117.3704675	San Bernardino County
208091	Fee-for-Service	1871665695	1871665695	1	1	PATEL, RITABEN V MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52539	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
208145	Fee-for-Service	1881665743	1881665743	1	1	PHAM, BRIAN TO OD	6/13/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	QUALITY EYE CARE OPT	619 PINE AVE	None	LONG BEACH	CA	90802	1331	19	06037	33.774588	-118.192416	Los Angeles County
208167	Fee-for-Service	1114139490	1114139490	1	1	PADUA, ERIC M MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113551	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
208213	Fee-for-Service	1346391240	1346391240	1	1	PHAN, HIEUCAM MD	7/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81167	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208259	Fee-for-Service	1467836098	1467836098	1	1	PEDIATRIC INFECTOLOGY GROUP	10/27/2015	2080P0208X	NA	HIV/AIDS/Infectious Disease	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
208261	Fee-for-Service	1265622674	1265622674	1	1	PABBATHI, MADHUSUDHAN MD	4/27/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	157298	None	None	0	In state provider	None	12000 GAZEBO CT	None	BAKERSFIELD	CA	93311	8759	15	06029	35.32457128	-119.135323	Kern County
208270	Fee-for-Service	1265561237	1265561237	1	1	PETITT, SYLVIA LMFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41532	-	NOT APPLICABLE	0	In state provider	None	1401 L STREET	None	BAKERSFIELD	CA	93301	4522	15	06029	35.37071435	-119.0164657	Kern County
208280	Fee-for-Service	1841241585	1841241585	1	10	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	9620 CHESAPEAKE DR.	SUITE 206	SAN DIEGO	CA	92123	1324	37	06073	32.83378776	-117.1237922	San Diego County
208286	Fee-for-Service	1760422067	1760422067	1	1	PARIKH, JAGDISHCHANDRA P MD	5/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50485	01	General Practice	0	In state provider	None	3114 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
208303	Fee-for-Service	1154590958	1154590958	1	1	PALM DRIVE HOSPITAL	3/9/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 PALM AVE	SUITE D	SEBASTOPOL	CA	95472	4235	49	06097	38.39602719	-122.8185446	Sonoma County
208319	Fee-for-Service	1871607762	1871607762	1	148	PROVIDENCE MEDICAL FOUNDATIO	7/23/2020	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	27799 MEDICAL CENTER RD	STE 460	MISSION VIEJO	CA	92691	6400	30	06059	33.55993179	-117.6654941	Orange County
208322	Fee-for-Service	1336532167	1336532167	1	1	PREMIUM CARE SERVICES INC	12/20/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5301 LAUREL CANYON BLVD	SUITE 201	VALLEY VILLAGE	CA	91607	5301	19	06037	34.166907	-118.396546	Los Angeles County
208338	Fee-for-Service	1487879979	1487879979	1	1	PLACER CO HEALTH &	12/1/1977	No Taxonomy Provided	NA	None	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL SVS	11484 B AVE	BLDG 108	AUBURN	CA	95603	2603	31	06061	38.93912413	-121.1056109	Placer County
208351	Fee-for-Service	1730686148	1730686148	1	1	PYNES, MALISSA L MD	7/7/2022	2084A2900X	NA	Neurology	026	PHYSICIANS	178272	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
208353	Fee-for-Service	1366196511	1366196511	1	1	PHAM, NANCY M CRNA	6/23/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
208364	Fee-for-Service	1134562333	1134562333	1	1	PAULSSON, ANNA K U MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136094	30	Radiology	0	In state provider	None	110 LYNCH CREEK WAY	SUITE A	PETALUMA	CA	94952	2337	49	06097	38.25171165	-122.6351052	Sonoma County
208388	Fee-for-Service	1891821187	1891821187	1	1	POURTEYMOUR, ARSALAN MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52564	01	General Practice	0	In state provider	None	724 E FOOTHILL BLVD	None	RIALTO	CA	92376	5265	36	06071	34.1068263	-117.3566459	San Bernardino County
208397	Fee-for-Service	1225113988	1225113988	1	1	PALATHUMPAT, MARY V MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43413	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
208412	Fee-for-Service	1265080949	1265080949	1	1	PADILLA ARECHIGA, MAYRA L NP	9/3/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	21091 RIDER ST	SUITE 218	PERRIS	CA	92570	8878	33	06065	33.8298049	-117.2941212	Riverside County
208417	Fee-for-Service	1336227438	1336227438	1	1	PARK, ANTHONY K MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70693	None	None	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
208471	Fee-for-Service	1629038971	1629038971	1	1	PRETORIUS, JAMES F MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39386	08	Family Practice	0	In state provider	None	8201 WEST RD	None	POTTER VALLEY	CA	95469	8700	23	06045	39.27038193	-123.1025115	Mendocino County
208492	Fee-for-Service	1902892391	1902892391	1	1	PEACE HEALTH	7/1/1999	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1340 BIRCH AVE	None	COTTAGE GROVE	OR	97424	1415	00	None	43.79933475	-123.0710805	Lane County
208496	Fee-for-Service	1669567061	1669567061	1	1	PADMAVATHI KODURI, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
208497	Fee-for-Service	1275854507	1275854507	1	1	PHAM, MANH D MD	8/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122553	08	Family Practice	0	In state provider	None	7551 MADISON AVENUE	None	SACRAMENTO	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento
208499	Fee-for-Service	1346391240	1346391240	1	1	PHAN, HIEUCAM MD	7/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81167	66	Emergency Medicine (Urgent Care)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208517	Fee-for-Service	1972530988	1972530988	1	1	PERENS, GREGORY S MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73878	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
208545	Fee-for-Service	1780763797	1780763797	1	1	PROFFITT-ALLISON, M C LCSW	11/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
208548	Fee-for-Service	1811084973	1811084973	1	1	PRICE CHIROPRACTIC INC	5/1/2003	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	466 DEL NORTE AVE	None	YUBA CITY	CA	95991	4125	51	06101	39.14347627	-121.6200408	Sutter County
208569	Fee-for-Service	1841241585	1841241585	1	10	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IEGO INC MEDICAL GROUP	9620 CHESAPEAKE DR.	SUITE 206	SAN DIEGO	CA	92123	1324	37	06073	32.83378776	-117.1237922	San Diego County
208595	Fee-for-Service	1033134861	1033134861	1	1	PATAKI, CAROLY S MD	11/30/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50066	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
208616	Fee-for-Service	1578264867	1578264867	1	1	PREMIER DIAGNOSTIC & INTERVE	11/15/2023	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	NTIONAL SPECIALISTS	15031 RINALDI ST	None	MISSION HILLS	CA	91345	9134	19	06037	34.27904453	-118.459944	Los Angeles County
208617	Fee-for-Service	1154543676	1154543676	1	1	PIRSAHELI, REZA MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101368	13	Neurology (M.D. only)	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
208629	Fee-for-Service	1154696706	1154696706	1	1	PLATT, CATHERINE R MD	7/8/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176121	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
208653	Fee-for-Service	1356378699	1356378699	1	1	PODER, LIINA MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82930	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208664	Fee-for-Service	1750843314	1750843314	2	3	PANTHERX SPECIALTY, LLC	7/27/2022	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1120 STEVENSON MILL RD.	SUITE 400	CORAOPOLIS	PA	15108	2446	00	None	40.50818664	-80.23682717	Allegheny County
208675	Fee-for-Service	1881214187	1881214187	1	1	PANDEY, TRISHA A DO	7/1/2023	207R00000X	NA	Other	026	PHYSICIANS	20989	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
208685	Fee-for-Service	1225113988	1225113988	1	1	PALATHUMPAT, MARY V MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43413	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
208704	Fee-for-Service	1245269802	1245269802	2	1	PEZESHKI, BABAK MD	12/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60224	41	Internal Medicine	0	In state provider	None	520 SUPERIOR AVENUE	SUITE 280	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
208711	Fee-for-Service	1932169950	1932169950	1	1	PAULS VALLEY GENERAL HOSP	4/18/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 VALLEY DRIVE	None	PAULS VALLEY	OK	73075	6613	00	None	34.71969994	-97.21556617	Garvin County
208712	Fee-for-Service	1306349188	1306349188	1	1	PARTIDA, VIVIAN DO	4/8/2020	390200000X	NA	Other	026	PHYSICIANS	17996	41	Internal Medicine	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
208743	Fee-for-Service	1366555708	1366555708	1	1	PENDELTON, DANIEL L MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
208745	Fee-for-Service	1295750941	1295750941	1	1	PILLAR, EDWARD A DO	11/6/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5842	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
208781	Fee-for-Service	1902892391	1902892391	1	1	PEACE HEALTH	7/1/1999	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1340 BIRCH AVE	None	COTTAGE GROVE	OR	97424	1415	00	None	43.79933475	-123.0710805	Lane County
208803	Fee-for-Service	1972530988	1972530988	1	1	PERENS, GREGORY S MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73878	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
208822	Fee-for-Service	1255778619	1255778619	1	1	PANTELL, MATTHEW S MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136506	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208831	Fee-for-Service	1376199422	1376199422	1	1	PICO DE LORO INC	7/17/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	620 N PERRIS BLVD	None	PERRIS	CA	92571	2816	33	06065	33.792201	-117.226159	Riverside County
208836	Fee-for-Service	1578615936	1578615936	1	1	PETRUZZO, ROBERT T JR DO	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	4255	None	None	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
208855	Fee-for-Service	1316498421	1316498421	1	1	PANSMART INC	11/3/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2557 MOWRY AVE	STE 11	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
208856	Fee-for-Service	1144334228	1144334228	1	1	PERERA-THANGARATNAM, MD	11/1/2001	207L00000X	NA	Other	026	PHYSICIANS	70242	05	Anesthesiology	0	In state provider	INC	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
208883	Fee-for-Service	1033134861	1033134861	1	1	PATAKI, CAROLY S MD	11/30/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50066	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
208909	Fee-for-Service	1306296876	1306296876	1	1	POSITIVE METHODS MINDFUL COU	6/17/2022	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NSELING & WELLNESS	2741 HAMNER AVENUE	202	NORCO	CA	92860	3628	33	06065	33.92216844	-117.5591658	Riverside County
208931	Fee-for-Service	1942216957	1942216957	1	1	PALOMARES, CARLOS CRNA	11/21/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	18000 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2149	36	06071	34.54048272	-117.2713367	San Bernardino County
208964	Fee-for-Service	1265622898	1265622898	1	1	PATEL, ADITI H DO	2/8/2015	208M00000X	NA	Other	026	PHYSICIANS	10584	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
208970	Fee-for-Service	1255762167	1255762167	1	1	PAI, SARAH A NP	2/28/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
208991	Fee-for-Service	1245269802	1245269802	2	1	PEZESHKI, BABAK MD	12/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60224	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	520 SUPERIOR AVENUE	SUITE 280	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
209001	Fee-for-Service	1356903082	1356903082	1	1	PARADIS, SAMANTHA	1/9/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95024872	-	NOT APPLICABLE	0	In state provider	None	376 HARTNELL AVENUE	SUITE A	REDDING	CA	96002	1881	45	06089	40.56518339	-122.3683085	Shasta County
209003	Fee-for-Service	1932169950	1932169950	1	1	PAULS VALLEY GENERAL HOSP	4/18/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 VALLEY DRIVE	None	PAULS VALLEY	OK	73075	6613	00	None	34.71969994	-97.21556617	Garvin County
209004	Fee-for-Service	1528758091	1528758091	1	1	PSYCH THERAPY PROFESSIONALS	12/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 BRAND BLVD	210	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
209058	Fee-for-Service	1982069837	1982069837	1	1	PLASCENCIA, ESMERALDA A LCSW	5/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
209060	Fee-for-Service	1407802069	1407802069	1	1	PATHWAY MEDICAL GRP, INC	7/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	12462 BROOKHURST ST	STE A&B	GARDEN GROVE	CA	92840	4759	30	06059	33.78155073	-117.9584596	Orange County
209096	Fee-for-Service	1518038413	1518038413	1	1	PINDUR, ALES MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51304	22	Pathology (M.D. only)	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
209123	Fee-for-Service	1912085127	1912085127	1	1	PIENKNY, ANDREW J MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71078	34	Urology and Urological Surgery	0	In state provider	None	2999 REGENT ST	STE 612	BERKELEY	CA	94705	2121	01	06001	37.85592021	-122.2566436	Alameda County
209197	Fee-for-Service	1306296876	1306296876	1	1	POSITIVE METHODS MINDFUL COU	4/8/2021	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NSELING & WELLNESS	2741 HAMNER AVENUE	202	NORCO	CA	92860	3628	33	06065	33.92216844	-117.5591658	Riverside County
209200	Fee-for-Service	1871607762	1871607762	1	182	PROVIDENCE MEDICAL FOUNDATIO	10/21/2019	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	N	1010 W LA VETA AVE	SUITE 200	ORANGE	CA	92868	4301	30	06059	33.78028244	-117.8635552	Orange County
209239	Fee-for-Service	1285138230	1285138230	1	2	PATHFINDERS OF SAN DIEGO	5/24/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2952 CEDAR ST	None	SAN DIEGO	CA	92102	1599	37	06073	32.72236881	-117.1307233	San Diego County
209254	Fee-for-Service	1760775704	1760775704	1	1	PANIAGUA, EILEEN PSYD	12/2/2022	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30 CORPORATE PARK	STE 201	IRVINE	CA	92606	5131	30	06059	33.68877068	-117.8283449	Orange County
209293	Fee-for-Service	1801086871	1801086871	1	2	PEDIATRIC SUBSPECIALTY	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	455 S MAIN STREET	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
209303	Fee-for-Service	1396372470	1396372470	1	1	PANNU, JAIBIR	3/21/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188513	84	Surgery-Head and Neck	0	In state provider	None	6848 MAGNOLIA AVE	STE 220	RIVERSIDE	CA	92506	2858	33	06065	33.94954856	-117.3989256	Riverside County
209319	Fee-for-Service	1245320704	1245320704	1	1	POPOVICH, MARK J MD	7/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57995	30	Radiology	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
209332	Fee-for-Service	1588681498	1588681498	1	1	PAGUIA, RICHARD ALBERT S MD	12/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55309	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
209351	Fee-for-Service	1407802069	1407802069	1	1	PATHWAY MEDICAL GRP, INC	7/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	12462 BROOKHURST ST	STE A&B	GARDEN GROVE	CA	92840	4759	30	06059	33.78155073	-117.9584596	Orange County
209356	Fee-for-Service	1831208891	1831208891	1	1	PIANO, FLORINDA M MD	3/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56267	08	Family Practice	0	In state provider	None	2121 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1706	19	06037	34.17309265	-118.3314784	Los Angeles County
209369	Fee-for-Service	1396773685	1396773685	1	1	PATEL, PRAKASH V MD	4/30/1993	207R00000X	NA	Other	026	PHYSICIANS	52039	41	Internal Medicine	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
209382	Fee-for-Service	1518038413	1518038413	1	1	PINDUR, ALES MD	10/20/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51304	01	General Practice	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
209398	Fee-for-Service	1710169099	1710169099	1	1	PATRICK RYAN HUNGERFORD M.D.	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 DOCTORS PARK DR	None	MEDFORD	OR	97504	8198	00	None	42.31853735	-122.827673	Jackson County
209405	Fee-for-Service	1326220039	1326220039	1	1	PREZANT, SHERRIE L LCSW	11/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	220 OYSTER POINT BLVD	None	S SAN FRANCISCO	CA	94080	1911	41	06081	37.66234961	-122.3918346	San Mateo County
209496	Fee-for-Service	1306342472	1306342472	1	2	PROHEALTH PARTNERS A MEDICAL	10/25/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP INC	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
209510	Fee-for-Service	1831636083	1831636083	1	1	PELOQUIN, JOSHUA P DO	7/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15330	41	Internal Medicine	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
209520	Fee-for-Service	1518042167	1518042167	1	1	PO, TEDMUND G MD	2/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83322	08	Family Practice	0	In state provider	None	17500 FOOTHILL BLVD	STE A2	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
209579	Fee-for-Service	1871607762	1871607762	1	23	PROVIDENCE MEDICAL FOUNDATIO	6/30/2012	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1335 N DUTTON AVE	None	SANTA ROSA	CA	95401	4609	49	06097	38.449431	-122.734035	Sonoma County
209580	Fee-for-Service	1801086871	1801086871	1	2	PEDIATRIC SUBSPECIALTY	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	455 S MAIN STREET	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
209601	Fee-for-Service	1245322908	1245322908	1	1	PAAS, JOHN T MD	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84828	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
209604	Fee-for-Service	1457315178	1457315178	1	1	PACELLI, LORENZO L MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75723	20	Orthopedic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
209605	Fee-for-Service	1245320704	1245320704	1	1	POPOVICH, MARK J MD	7/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57995	01	General Practice	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
209628	Fee-for-Service	1427501162	1427501162	1	1	PATEL, ASHISH A NP	2/17/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
209681	Fee-for-Service	1023460870	1023460870	1	1	PHILLIPS, CHERRIE LMFT	11/15/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
209690	Fee-for-Service	1083304604	1083304604	1	1	POWER WHEELS MEDICAL SUPPLY	1/29/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1647 W AVENUE J	105	LANCASTER	CA	93534	2881	19	06037	34.6894773	-118.160027	Los Angeles County
209728	Fee-for-Service	1942289889	1942289889	1	1	POTTMEYER, EDWARD W MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51597	02	General Surgery	0	In state provider	REDDING CARDIAC & VASC	2240 COURT ST	None	REDDING	CA	96001	2528	45	06089	40.57611561	-122.3927716	Shasta County
209735	Fee-for-Service	1740705862	1740705862	1	1	PASKO, KAILIE M PT	10/24/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
209756	Fee-for-Service	1003251430	1003251430	1	1	PANOWICZ, MICHAEL J MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135036	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
209805	Fee-for-Service	1609372150	1609372150	1	1	PHAN, JENNIFER T NP	4/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
209809	Fee-for-Service	1447447248	1447447248	1	14	PACIFIC INPATIENT MEDICAL GR	2/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1359 PINE ST	None	SAN FRANCISCO	CA	94109	4807	38	06075	37.7898738	-122.4183401	San Francisco County
209814	Fee-for-Service	1932321643	1932321643	1	1	PENNER, MONTE W MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	71997	None	None	0	In state provider	None	275 W HERNDON	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
209834	Fee-for-Service	1659460475	1659460475	1	1	PARMAR, PARVEEN K MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95404	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
209853	Fee-for-Service	1811480940	1811480940	1	1	PI, JUNG-HSIEN	8/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
209869	Fee-for-Service	1003012907	1003012907	1	1	PHAN, TERESA T MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106671	08	Family Practice	0	In state provider	None	2710 MIDDLEFIELD ROAD	None	REDWOOD CITY	CA	94063	3404	41	06081	37.47644946	-122.2110919	San Mateo County
209885	Fee-for-Service	1841306412	1841306412	1	1	PAJARO VALLEY NEUROLOGY	8/28/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MED ASSOC, INC	64 ASPEN WAY	STE 101	WATSONVILLE	CA	95076	3084	44	06087	36.93085993	-121.7799849	Santa Cruz County
209915	Fee-for-Service	1073672820	1073672820	1	1	POVEROMO, SARAH K	1/12/2011	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
209974	Fee-for-Service	1447480140	1447480140	1	1	PINKERTON, ANDREA PSYD	7/16/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	505 SAN MARIN DR	SUITE A150	NOVATO	CA	94945	1309	21	06041	38.12144894	-122.5842153	Marin County
210011	Fee-for-Service	1801802210	1801802210	1	1	PHARMACY CORP OF AMERICA	11/5/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1100 WILSON WAY	STE 500	SMYNA	GA	30082	7218	00	None	33.832449	-84.50881796	Cobb County
210019	Fee-for-Service	1942289889	1942289889	1	1	POTTMEYER, EDWARD W MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51597	33	Thoracic Surgery	0	In state provider	REDDING CARDIAC & VASC	2240 COURT ST	None	REDDING	CA	96001	2528	45	06089	40.57611561	-122.3927716	Shasta County
210058	Fee-for-Service	1811377963	1811377963	1	1	PHAM, BRIAN MD	10/18/2023	207RX0202X	NA	Oncology	026	PHYSICIANS	157599	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
210061	Fee-for-Service	1851927867	1851927867	1	1	PARK, LIDIA MD	8/9/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	182789	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
210065	Fee-for-Service	1639444748	1639444748	1	1	PATEL, DEVIKA M MD	9/20/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	148974	07	Dermatology	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
210072	Fee-for-Service	1881608909	1881608909	1	1	PETERS, ALLEN H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	16945	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
210096	Fee-for-Service	1447447248	1447447248	1	14	PACIFIC INPATIENT MEDICAL GR	2/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1359 PINE ST	None	SAN FRANCISCO	CA	94109	4807	38	06075	37.7898738	-122.4183401	San Francisco County
210103	Fee-for-Service	1467568170	1467568170	1	1	PECK, JAMES A MD	6/10/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MED PLAZA STE 1200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
210195	Fee-for-Service	1891371563	1891371563	1	1	POPOVA, ELLENA MD	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	188787	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
210220	Fee-for-Service	1740367671	1740367671	1	1	PHAN, JEFFREY MD	10/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78243	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
210241	Fee-for-Service	1841359171	1841359171	1	1	PETERSON, BOBBY D MD	9/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66903	08	Family Practice	0	In state provider	None	26617 STATE HWY	STE 120	ESCALON	CA	95320	0000	39	06077	0	0	None
210266	Fee-for-Service	1407026768	1407026768	1	1	PIGG-NORIEGA, ERIKA PHD	2/10/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
210275	Fee-for-Service	1972651768	1972651768	1	1	PATEL, ROHINI A MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72858	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
210284	Fee-for-Service	1629331418	1629331418	1	1	PETRICK, KIMBERLY R MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133212	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
210329	Fee-for-Service	1326080417	1326080417	1	1	PETOKIAN, ARTIN	6/13/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
210360	Fee-for-Service	1881608909	1881608909	1	1	PETERS, ALLEN H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	16945	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
210434	Fee-for-Service	1831573781	1831573781	1	1	PROHEALTH PARTNERS A MEDICAL	12/14/2015	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	5122 KATELLA AVE	STE 308	LOS ALAMITOS	CA	90720	2826	30	06059	33.80290311	-118.0433422	Orange County
210469	Fee-for-Service	1922333939	1922333939	1	1	PAREDES, NICOLE M LCSW	6/28/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
210478	Fee-for-Service	1407997406	1407997406	1	1	PANDHI, JAY MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56015	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 MEDICAL CENTER COURT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
210485	Fee-for-Service	1699962993	1699962993	1	1	PALMA, JONATHAN P MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96611	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
210507	Fee-for-Service	1194596403	1194596403	1	1	PEREZ CERVANTES, SHEILA	4/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
210508	Fee-for-Service	1912991597	1912991597	1	3	PATHOLOGY ASSOCIATES OF	1/1/1984	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOUTHERN CALIFORNIA	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
210510	Fee-for-Service	1992989990	1992989990	1	1	PENDLETON, JILL S PT	3/11/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1620 ALPINE BLVD	STE 211	ALPINE	CA	91901	1105	37	06073	32.83781579	-116.7799366	San Diego County
210562	Fee-for-Service	1063601045	1063601045	1	1	PHILIP, RAJIV T MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112464	66	Emergency Medicine (Urgent Care)	0	In state provider	None	959 E WALNUT ST	SUITE 120	PASADENA	CA	91106	5364	19	06037	34.14962102	-118.1305187	Los Angeles County
210578	Fee-for-Service	1447552054	1447552054	1	1	PEREZ, MARTIN G MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148965	02	General Surgery	0	In state provider	None	7117 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
210583	Fee-for-Service	1053434548	1053434548	1	1	PAVLOV-KRAUSE, ELLIE M	6/22/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
210585	Fee-for-Service	1801942776	1801942776	1	1	PARK, TONY C OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39275 MISSION BLVD	STE 102	FREMONT	CA	94539	3061	01	06001	37.56249949	-121.9589332	Alameda County
210612	Fee-for-Service	1063411460	1063411460	1	1	PALM IMAGING INSTITUTE A	3/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	399 E 21ST ST	None	SAN BERNARDINO	CA	92404	4815	36	06071	34.13403047	-117.2767275	San Bernardino County
210623	Fee-for-Service	1245257708	1245257708	1	1	PLANNED PARENTHOOD OF THE	9/22/1983	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	1964 VIA CENTRE DR	None	VISTA	CA	92081	6056	37	06073	33.18400138	-117.283827	San Diego County
210688	Fee-for-Service	1568670917	1568670917	1	1	PENTA, MRUDULA MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130188	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
210735	Fee-for-Service	1861035586	1861035586	1	1	PERKINS, ANDREA M LCSW	5/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	50	06099	37.66353653	-120.9564675	Stanislaus County
210762	Fee-for-Service	1245265230	1245265230	1	1	PLANNED PARENTHOOD OF THE	7/3/1984	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	220 EUCLID AVE	SUITE 30	SAN DIEGO	CA	92114	3617	37	06073	32.706387	-117.085098	San Diego County
210792	Fee-for-Service	1770691859	1770691859	1	2	PREMIER ANESTHESIA OF CALIFO	2/13/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
210822	Fee-for-Service	1659957090	1659957090	1	1	POPE, ZACHARY R MD	5/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181765	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
210824	Fee-for-Service	1790887495	1790887495	1	1	PAULA V HENDRYX, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1900	00	None	41.46242416	-81.69888235	Cuyahoga County
210833	Fee-for-Service	1841241585	1841241585	1	2	PSYCHIATRIC CENTERS AT SAN D	12/31/2018	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DIEGO	328 ENCINITAS BLVD	STE 100	ENCINITAS	CA	92024	8704	37	06073	33.04815637	-117.2842827	San Diego County
210850	Fee-for-Service	1063601045	1063601045	1	1	PHILIP, RAJIV T MD	2/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112464	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	959 E WALNUT ST	SUITE 120	PASADENA	CA	91106	5364	19	06037	34.14962102	-118.1305187	Los Angeles County
210860	Fee-for-Service	1134477565	1134477565	1	1	PATEL, PRANAY B MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147993	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
210903	Fee-for-Service	1063411460	1063411460	1	1	PALM IMAGING INSTITUTE A	3/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	399 E 21ST ST	None	SAN BERNARDINO	CA	92404	4815	36	06071	34.13403047	-117.2767275	San Bernardino County
210912	Fee-for-Service	1942613898	1942613898	1	1	PERSON, BRITTANY A	6/9/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
210914	Fee-for-Service	1578009106	1578009106	1	1	PARK, YUJIN LMFT	4/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6 CENTERPOINTE DR	STE 700	LA PALMA	CA	90621	4229	30	06059	33.86052378	-118.0296232	Orange County
210917	Fee-for-Service	1003835976	1003835976	1	1	PARKER, LAURA MFT	2/12/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3756 GRAND AVE	STE 406	OAKLAND	CA	94610	1545	01	06001	37.81709222	-122.245177	Alameda County
210948	Fee-for-Service	1093847782	1093847782	1	1	PINCUS, LAURA B MD	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94083	07	Dermatology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
211011	Fee-for-Service	1942460506	1942460506	1	2	POURMEHR, SHARONA LMFT	4/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19348 LONDELIUS STREET	4	NORTHRIDGE	CA	91324	3509	19	06037	34.22984551	-118.5553665	Los Angeles County
211074	Fee-for-Service	1942532262	1942532262	1	1	PEPPERMINT RIDGE	11/29/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4289 SHOALCREEK DRIVE	None	CORONA	CA	92883	0724	33	06065	33.81434554	-117.5361003	Riverside County
211092	Fee-for-Service	1245320860	1245320860	1	1	PACHECO-ORTIZ, CLARIVETTE MD	12/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1525 WEST 2100 SOUTH	None	SALT LAKE CITY	UT	84119	1401	00	None	40.72588117	-111.933134	Salt Lake County
211094	Fee-for-Service	1295787158	1295787158	1	1	PENG, LYNNUS F MD	3/31/1995	207L00000X	NA	Other	026	PHYSICIANS	61398	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
211116	Fee-for-Service	1750439873	1750439873	1	1	PANG, KATIE R MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84059	07	Dermatology	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
211120	Fee-for-Service	1841241585	1841241585	1	2	PSYCHIATRIC CENTERS AT SAN D	12/31/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	DIEGO	328 ENCINITAS BLVD	STE 100	ENCINITAS	CA	92024	8704	37	06073	33.04815637	-117.2842827	San Diego County
211121	Fee-for-Service	1083907372	1083907372	1	1	PARK, LAURA H MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135695	05	Anesthesiology	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3651	30	06059	33.60848903	-117.7079742	Orange County
211143	Fee-for-Service	1316964240	1316964240	1	1	PHUNG, TIEU O MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88010	38	Geriatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
211151	Fee-for-Service	1306012992	1306012992	1	1	PETERS, ARTHUR S MD	1/2/1979	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	19308	04	Otology, Laryngology, Rhinology	0	In state provider	None	3081 LOMA VISTA RD	None	VENTURA	CA	93003	2916	56	06111	34.27581347	-119.2550504	Ventura County
211155	Fee-for-Service	1558374520	1558374520	1	1	PATTERSON, SCOTT E MD	12/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86244	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
211157	Fee-for-Service	1487696506	1487696506	1	1	POWELL, JOSEPH S OD	9/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19746 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2988	30	06059	33.675831	-117.9884835	Orange County
211196	Fee-for-Service	1295744076	1295744076	1	1	PATEL, ANISHA I MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84097	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
211216	Fee-for-Service	1871607762	1871607762	1	114	PROVIDENCE MEDICAL FOUNDATIO	11/10/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
211250	Fee-for-Service	1154618288	1154618288	1	1	PHAMLE, NHUSUONG T OD	10/11/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
211259	Fee-for-Service	1285134148	1285134148	1	1	PIGUILLEM, ANDREA A NP	11/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
211276	Fee-for-Service	1053427823	1053427823	1	1	PRESS, MARCELLA A MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120911	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
211293	Fee-for-Service	1457576738	1457576738	1	1	PERLA, RICHARD PHD ASSOC	9/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12627 B SANTA GERTRUDES	None	LA MIRADA	CA	90638	1226	19	06037	33.916572	-117.9943885	Los Angeles County
211316	Fee-for-Service	1003883562	1003883562	1	1	PRAGER, DIANE J MD	10/28/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	49254	68	Hematology	0	In state provider	None	5215 TORRANCE BLVD	None	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
211320	Fee-for-Service	1558528372	1558528372	1	1	PRASAD, VINOY S MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112282	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
211363	Fee-for-Service	1790771053	1790771053	1	1	PRUETZ, JAY D MD	11/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81000	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
211383	Fee-for-Service	1295787158	1295787158	1	1	PENG, LYNNUS F MD	3/31/1995	207L00000X	NA	Other	026	PHYSICIANS	61398	05	Anesthesiology	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
211411	Fee-for-Service	1841241585	1841241585	1	2	PSYCHIATRIC CENTERS AT SAN D	10/27/2011	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	DIEGO	328 ENCINITAS BLVD	STE 100	ENCINITAS	CA	92024	8704	37	06073	33.04815637	-117.2842827	San Diego County
211440	Fee-for-Service	1770902637	1770902637	1	1	PANEK, DAVID S MD	7/16/2021	2080P0214X	NA	Pulmonology	026	PHYSICIANS	167871	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
211444	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	2/15/2024	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
211457	Fee-for-Service	1003102617	1003102617	1	1	PHAM, NHAT-LONG L MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126086	78	Neoplastic Diseases/Oncology	0	In state provider	None	7257 N FRESNO ST	None	FRESNO	CA	93720	2950	10	06019	36.84225164	-119.7833937	Fresno County
211498	Fee-for-Service	1386025757	1386025757	1	1	PARUPIA, YASEER Y DPM	5/4/2020	213ES0103X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
211505	Fee-for-Service	1871607762	1871607762	1	114	PROVIDENCE MEDICAL FOUNDATIO	12/5/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	N	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
211513	Fee-for-Service	1497210868	1497210868	1	1	PARIKH, CHANDNI PSYD	7/31/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
211527	Fee-for-Service	1871607762	1871607762	1	1	PROVIDENCE MEDICAL FOUNDATIO	4/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	30	06059	33.89443025	-117.9288328	Orange County
211544	Fee-for-Service	1912061045	1912061045	1	1	PAUL, RANDALL J MD	7/27/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	26361	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVE	STE A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
211574	Fee-for-Service	1871607762	1871607762	1	165	PROVIDENCE MEDICAL FOUNDATIO	4/5/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	N	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
211585	Fee-for-Service	1275884736	1275884736	2	1	PALOMAR HEALTH	6/19/2015	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
211590	Fee-for-Service	1659538858	1659538858	1	1	PRIME HEALTHCARE SERVICES	7/1/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE LLC	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
211604	Fee-for-Service	1003883562	1003883562	1	1	PRAGER, DIANE J MD	10/28/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	49254	41	Internal Medicine	0	In state provider	None	5215 TORRANCE BLVD	None	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
211664	Fee-for-Service	1114420478	1114420478	1	3	PIER ANESTHESIA GROUP, INC.	9/21/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1350 COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
211677	Fee-for-Service	1326094269	1326094269	1	1	PLUMAS DISTRICT HOSP	12/1/1977	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE RD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
211684	Fee-for-Service	1255673828	1255673828	1	1	PHIPPS, ASHLEY M DO	12/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14781	01	General Practice	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
211704	Fee-for-Service	1417904574	1417904574	1	2	PREMIER INFUSION AND	11/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE SERVICES INC	19500 NORMANDIE AVE	SUITE B	TORRANCE	CA	90502	1108	19	06037	33.85398111	-118.2992036	Los Angeles County
211705	Fee-for-Service	1376962035	1376962035	1	1	PENG, SHEPPARD DO	6/24/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	16949	04	Otology, Laryngology, Rhinology	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
211712	Fee-for-Service	1376510420	1376510420	1	1	PATLOSER,LIBOR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEACE HEALTH MED GROUP	1200 HILYARD ST STE 200	None	EUGENE	OR	97401	0000	00	None	44.04616862	-123.082151	Lane County
211719	Fee-for-Service	1083771398	1083771398	1	1	PHELAN, PATRICK E MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173151	None	None	0	In state provider	None	82934 CIVIC CENTER DR	None	INDIO	CA	92201	4308	33	06065	33.71864703	-116.2178997	Riverside County
211721	Fee-for-Service	1831108901	1831108901	1	1	PRIVATE HOSPITALIST MEDICAL	2/23/2011	193400000X	NA	Other	026	PHYSICIANS	55272	None	None	0	In state provider	GROUP	26671 ALISO CREEK	STE 205	ALISO VIEJO	CA	92656	4810	30	06059	33.576831	-117.7255935	Orange County
211745	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	1/6/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
211769	Fee-for-Service	1205464658	1205464658	1	1	PROACTIVE CARE PHARMACY, LLC	3/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DICAL SUPPLIES	7345 LINDA VISTA RD	E	SAN DIEGO	CA	92111	5800	37	06073	32.79296985	-117.1644378	San Diego County
211786	Fee-for-Service	1801985049	1801985049	1	2	PLANNED PARENTHOOD LA-	8/9/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1057 KINGSTON AVENUE	None	LOS ANGELES	CA	90033	1310	19	06037	34.05708747	-118.209555	Los Angeles County
211791	Fee-for-Service	1871607762	1871607762	1	114	PROVIDENCE MEDICAL FOUNDATIO	3/14/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
211820	Fee-for-Service	1982720942	1982720942	1	1	PATEL, KARUNA D PT	10/31/2024	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1124 CLEMENT ST	None	SAN FRANCISCO	CA	94118	2115	38	06075	37.78264658	-122.4713323	San Francisco County
211833	Fee-for-Service	1104285626	1104285626	1	1	PADILLA-JOHNSON, GISSELLE L	3/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	77 ASPEN WAY	103	WATSONVILLE	CA	95076	6040	44	06087	36.93112743	-121.7802608	Santa Cruz County
211835	Fee-for-Service	1871607762	1871607762	1	78	PROVIDENCE MEDICAL FOUNDATIO	7/31/2015	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	26800 CROWN VALLEY PARKW	SUITE 120	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
211838	Fee-for-Service	1811926058	1811926058	1	1	PLANNED PARENTHOOD	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA CENTRAL COAST	518 GARDEN ST	None	SANTA BARBARA	CA	93101	1606	42	06083	34.42054634	-119.6928135	Santa Barbara County
211839	Fee-for-Service	1790743466	1790743466	1	1	PRIMARY CRITICAL CARE	9/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
211866	Fee-for-Service	1871607762	1871607762	1	177	PROVIDENCE MEDICAL FOUNDATIO	11/16/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	24321 AVENIDA DE LA CARL	H6 & H7	LAGUNA HILLS	CA	92653	3681	30	06059	33.56681764	-117.7056147	Orange County
211870	Fee-for-Service	1376876912	1376876912	1	1	PINNACLE MEDICAL GROUP INC	2/1/1998	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1850 N RIVERSIDE AVE	None	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
211876	Fee-for-Service	1659538858	1659538858	1	1	PRIME HEALTHCARE SERVICES	7/1/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE LLC	12601 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1908	30	06059	33.77450951	-117.913014	Orange County
211901	Fee-for-Service	1831258565	1831258565	1	1	PRESTON, JOCELYN R NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5620 MESMER AVE	None	CULVER CITY	CA	90230	6315	19	06037	33.98561217	-118.4005283	Los Angeles County
211929	Fee-for-Service	1164901302	1164901302	1	2	PINNACLE SURGICAL ASSOCIATES	6/19/2019	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	3175 COLLINS DR	None	MERCED	CA	95348	3133	24	06047	37.32106749	-120.4764781	Merced County
211956	Fee-for-Service	1962497149	1962497149	1	1	PARK, KERRY MD	7/1/2003	174400000X	NA	Other	026	PHYSICIANS	77252	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5238 E. BEVERLY BLVD	None	LOS ANGELES	CA	90022	2824	19	06037	34.03136608	-118.1524713	Los Angeles County
211957	Fee-for-Service	1881874683	1881874683	1	1	PANSOPHY, INC	12/4/2006	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	SOLANO ADULT DAY HEALTH	100 CORPORATE PL	None	VALLEJO	CA	94590	6957	48	06095	38.09510648	-122.2487825	Solano County
211964	Fee-for-Service	1326094269	1326094269	1	1	PLUMAS DISTRICT HOSP	12/1/1977	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE RD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
211981	Fee-for-Service	1821693573	1821693573	1	2	P&L TRANSPORTATION, INC	9/30/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4100 WEST ALAMEDA AVE	STE 384	BURBANK	CA	91505	4143	19	06037	34.1526111	-118.3447742	Los Angeles County
212023	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
212024	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	11/2/2018	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
212035	Fee-for-Service	1407411903	1407411903	1	1	PERPETUAL HELP HOSPICE, INC	6/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 204B	CANOGA PARK	CA	91303	3209	19	06037	34.1994564	-118.5884133	Los Angeles County
212054	Fee-for-Service	1417066192	1417066192	1	1	PARADISE ANESTHESIA	3/1/2001	174400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOC MED GROUP INC	5749 PENTZ RD	None	PARADISE	CA	95969	6040	04	06007	39.74879093	-121.572597	Butte County
212060	Fee-for-Service	1427014091	1427014091	1	1	PENINSULA ANESTHESIA	4/12/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GROUP INC	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
212067	Fee-for-Service	1437837630	1437837630	1	1	PRECISE PHARMACY, INC.	8/1/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5240 IRWINDALE AVE	UNIT B	BALDWIN PARK	CA	91706	0000	19	06037	34.10811668	-117.9340103	Los Angeles County
212071	Fee-for-Service	1598957045	1598957045	1	1	POOL, KATHLEEN NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
212086	Fee-for-Service	1952304842	1952304842	1	1	PRAGER, STEVEN S MD	3/1/1993	174400000X	NA	Other	026	PHYSICIANS	72539	40	Pediatrics	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
212138	Fee-for-Service	1295839751	1295839751	1	1	PERRICH, KILEY D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL STREET	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
212142	Fee-for-Service	1407416738	1407416738	1	1	PICHARDO-GOMEZ, DAVID R MD	7/8/2022	390200000X	NA	Other	026	PHYSICIANS	180224	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
212149	Fee-for-Service	1871607762	1871607762	1	165	PROVIDENCE MEDICAL FOUNDATIO	7/13/2023	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
212175	Fee-for-Service	1861852402	1861852402	1	1	PLYMIRE, BRADLEY LMFT	6/18/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2525 NORTH CHESTER AVE	STE C TOWER BLDG	BAKERSFIELD	CA	93308	1717	15	06029	35.429463	-119.0213795	Kern County
212176	Fee-for-Service	1083715627	1083715627	1	1	PUROHIT, SWATI M MD	4/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77856	40	Pediatrics	0	In state provider	ATTN MGA OFFICE	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
212196	Fee-for-Service	1154819548	1154819548	1	1	PLACENSIO-GUZMAN, MARIBEL C	5/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	11883 AMETHYST RD	203	VICTORVILLE	CA	92392	9224	36	06071	34.466292	-117.3643015	San Bernardino County
212203	Fee-for-Service	1255536850	1255536850	1	1	PIDGEON, LESLIE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 E BROAD ST	None	MANSFIELD	TX	76063	5899	00	None	32.56919125	-97.09562468	Tarrant County
212245	Fee-for-Service	1962497149	1962497149	1	1	PARK, KERRY MD	7/1/2003	174400000X	NA	Other	026	PHYSICIANS	77252	01	General Practice	0	In state provider	None	5238 E. BEVERLY BLVD	None	LOS ANGELES	CA	90022	2824	19	06037	34.03136608	-118.1524713	Los Angeles County
212248	Fee-for-Service	1851765515	1851765515	1	1	PARADISE POINT CARE	10/30/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	13636 VOSE STREET	None	VALLEY GLEN	CA	91405	3420	19	06037	34.19846789	-118.429828	Los Angeles County
212251	Fee-for-Service	1326094269	1326094269	1	1	PLUMAS DISTRICT HOSP	1/1/1984	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1065 BUCKS LAKE RD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
212287	Fee-for-Service	1801020599	1801020599	1	1	PERELMUTER, PELEG MD	8/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108011	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
212300	Fee-for-Service	1871607762	1871607762	1	46	PROVIDENCE MEDICAL FOUNDATIO	3/20/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	27231 LA PAZ RD	STE A	LAGUNA NIGUEL	CA	92677	3627	30	06059	33.56889655	-117.7077443	Orange County
212305	Fee-for-Service	1083266233	1083266233	1	1	PIH HEALTH PHYSICIANS	3/2/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12214 LAKEWOOD BLVD	110	DOWNEY	CA	90242	2662	19	06037	33.92368787	-118.1326218	Los Angeles County
212310	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	12/8/2018	101YM0800X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
212313	Fee-for-Service	1871607762	1871607762	1	18	PROVIDENCE MEDICAL FOUNDATIO	4/9/2012	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	N	141 LYNCH CREEK WAY	STE C	PETALUMA	CA	94954	2390	49	06097	38.25192092	-122.6341929	Sonoma County
212322	Fee-for-Service	1407411903	1407411903	1	1	PERPETUAL HELP HOSPICE, INC	6/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 204B	CANOGA PARK	CA	91303	3209	19	06037	34.1994564	-118.5884133	Los Angeles County
212347	Fee-for-Service	1720061641	1720061641	1	1	PISARSKA, MARGARETA D MD	1/1/2000	174400000X	NA	Other	026	PHYSICIANS	85377	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
212370	Fee-for-Service	1831296185	1831296185	1	1	PARK, PETER J MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141849	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
212376	Fee-for-Service	1235327644	1235327644	1	1	PATEL, RAMESH R MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	42669	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	MCMF 18111 BROOKHURST ST	STE 4600	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
212384	Fee-for-Service	1760916951	1760916951	1	1	PINERIDGE OBSTETRIX	7/3/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	11716	None	None	0	In state provider	& GYNECOLOGY INC	2137 HERNDON AVE	STE 102	CLOVIS	CA	93611	6306	10	06019	36.83753304	-119.6766193	Fresno County
212390	Fee-for-Service	1104831247	1104831247	1	1	PLODKOWSKI, RAYMOND A MD	11/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64845	67	Endocrinology	0	In state provider	None	12395 EL CAMINO REAL	None	SAN DIEGO	CA	92130	3082	37	06073	32.94324259	-117.2396525	San Diego County
212423	Fee-for-Service	1598150146	1598150146	1	1	PIERCE, LOGAN MD	7/29/2020	208M00000X	NA	Other	026	PHYSICIANS	145855	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
212439	Fee-for-Service	1871607762	1871607762	1	165	PROVIDENCE MEDICAL FOUNDATIO	11/20/2023	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	N	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
212467	Fee-for-Service	1174107551	1174107551	1	1	PHAN, ANDREW	7/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21461	08	Family Practice	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
212468	Fee-for-Service	1457668592	1457668592	1	1	POSITIVE CHANGE COUNSELING S	6/25/2024	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ERVICES, A PROFESSIONA	2050 PEABODY RD	SUITE 300	VACAVILLE	CA	95687	6695	48	06095	38.333556	-121.9704855	Solano County
212482	Fee-for-Service	1457872764	1457872764	1	1	PEREZ HERNANDEZ, JARITZA M M	7/2/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	177136	None	None	0	In state provider	D	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
212506	Fee-for-Service	1770528994	1770528994	1	2	PENTEC HEALTH INC	8/11/2022	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	4 CREEK PKWY	None	BOOTHWYN	PA	19061	3132	00	None	39.85534511	-75.46173286	Delaware County
212508	Fee-for-Service	1508038837	1508038837	1	1	POGOSIAN, LILIT MD	5/19/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	102054	-	NOT APPLICABLE	0	In state provider	None	5950 CEDROS AVENUE	None	VAN NUYS	CA	91411	3115	19	06037	34.17909915	-118.4530807	Los Angeles County
212597	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	8/11/2017	101YM0800X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
212606	Fee-for-Service	1114096740	1114096740	1	1	PAN AMERICAN LABORATORY	3/30/2011	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ROJO, JAVIER	10656 ROSECRANS AVE	STE D	NORWALK	CA	90650	3463	19	06037	33.90173664	-118.1063645	Los Angeles County
212608	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	3/25/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
212628	Fee-for-Service	1003138298	1003138298	1	1	POLLOCK, ADAM E PHD	11/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	18081 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	1304	30	06059	33.69987737	-117.9892394	Orange County
212649	Fee-for-Service	1851614523	1851614523	1	1	PALM DRIVE HEALTH CARE DIST	3/9/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	EMERGENCY MEDICAL SRVS	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
212665	Fee-for-Service	1255531570	1255531570	1	1	PROHEALTH HOME CARE, INC	12/18/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2700 ZANKER RD	SUITE 180	SAN JOSE	CA	95134	2140	43	06085	37.39134766	-121.9264991	Santa Clara County
212700	Fee-for-Service	1467887091	1467887091	1	1	PING ON PHARMACY INC	12/26/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	650 N BROADWAY	SUITE B	LOS ANGELES	CA	90012	2802	19	06037	34.06003557	-118.2394613	Los Angeles County
212704	Fee-for-Service	1548569197	1548569197	1	1	PROKUPEK, DALE A MD INC	4/1/2000	207R00000X	NA	Other	026	PHYSICIANS	71035	10	Gastroenterology (M.D. only)	0	In state provider	None	8641 WILSHIRE BLVD	ST 100	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
212706	Fee-for-Service	1497296404	1497296404	1	1	PROHEALTH PARTNERS A MEDICAL	4/4/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3300 E SOUTH STREET	SUITE 205	LAKEWOOD	CA	90805	4587	19	06037	33.86018093	-118.1537163	Los Angeles County
212724	Fee-for-Service	1871607762	1871607762	1	165	PROVIDENCE MEDICAL FOUNDATIO	4/5/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
212750	Fee-for-Service	1457668592	1457668592	1	1	POSITIVE CHANGE COUNSELING S	6/25/2024	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERVICES, A PROFESSIONA	2050 PEABODY RD	SUITE 300	VACAVILLE	CA	95687	6695	48	06095	38.333556	-121.9704855	Solano County
212806	Fee-for-Service	1730582321	1730582321	1	1	PARK, ANGELA S DO	9/30/2022	207R00000X	NA	Other	026	PHYSICIANS	18529	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
212834	Fee-for-Service	1609826361	1609826361	1	1	PRESIDIO SURGERY CENTER	7/24/2006	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1635 DIVISADERO ST	STE 200	SAN FRANCISCO	CA	94115	3043	38	06075	37.78487142	-122.4398095	San Francisco County
212860	Fee-for-Service	1275726176	1275726176	1	1	PARSA, MIRIAM F MD	8/6/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97393	01	General Practice	0	In state provider	None	5333 HOLISTER AVE	SUITE #250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
212867	Fee-for-Service	1801824222	1801824222	1	1	PATHWAY HEALTHCARE	1/6/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	BLDG 2	190 S OAK AVE	STE 1	OAKDALE	CA	95361	3528	50	06099	37.75958945	-120.8613916	Stanislaus County
212877	Fee-for-Service	1437282167	1437282167	1	1	PROHEALTH PARTNERS	2/15/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	911 EAST SAN ANTONIO DR	SUITE 1	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
212886	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
212887	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	11/2/2018	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
212920	Fee-for-Service	1578576450	1578576450	1	1	PONCE, RICHARD MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	70883	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
212941	Fee-for-Service	1255413720	1255413720	1	1	PRAKASHPATHY, DEEPA MD	11/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97307	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
212951	Fee-for-Service	1245493097	1245493097	1	1	PLANNED PARENTHOOD MAR	6/1/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MONTE	1441 N TRACY BLVD	None	TRACY	CA	95386	3445	39	06077	37.744731	-121.4350375	San Joaquin County
212955	Fee-for-Service	1255531570	1255531570	1	1	PROHEALTH HOME CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2700 ZANKER RD	SUITE 180	SAN JOSE	CA	95134	2140	43	06085	37.39134766	-121.9264991	Santa Clara County
212975	Fee-for-Service	1437114451	1437114451	1	1	PARK, MATTHEW MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	305 HOSPITAL DR	STE 305	GLEN BURNIE	MD	21061	5862	00	None	39.13927851	-76.62379552	Anne Arundel County
212986	Fee-for-Service	1184656688	1184656688	1	1	PIRKLE, ROSS A MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60017	41	Internal Medicine	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
212992	Fee-for-Service	1548569197	1548569197	1	1	PROKUPEK, DALE A MD INC	4/1/2000	207R00000X	NA	Other	026	PHYSICIANS	71035	41	Internal Medicine	0	In state provider	None	8641 WILSHIRE BLVD	ST 100	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
213007	Fee-for-Service	1467892059	1467892059	1	1	PANDYA, BHAVI P MD	4/22/2022	207RC0200X	NA	Other	026	PHYSICIANS	172401	None	None	0	In state provider	None	8330 RED OAK ST	STE 201	RANCHO CUCAMONGA	CA	91730	0602	36	06071	34.10217525	-117.5693231	San Bernardino County
213012	Fee-for-Service	1871607762	1871607762	1	165	PROVIDENCE MEDICAL FOUNDATIO	4/5/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	N	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	36	06071	33.96437546	-117.6900161	San Bernardino County
213030	Fee-for-Service	1568504678	1568504678	1	1	PHAM, CHUNG T LCSW	2/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12555 MARIPOSA ROAD	SUITE J	VICTORVILLE	CA	92395	6010	36	06071	34.47849471	-117.3394137	San Bernardino County
213037	Fee-for-Service	1457668592	1457668592	1	1	POSITIVE CHANGE COUNSELING S	6/25/2024	101YP2500X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ERVICES, A PROFESSIONA	2050 PEABODY RD	SUITE 300	VACAVILLE	CA	95687	6695	48	06095	38.333556	-121.9704855	Solano County
213048	Fee-for-Service	1467541284	1467541284	1	2	PRESSER, HARVEY M MD	7/15/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	28716	-	NOT APPLICABLE	0	In state provider	None	104 EAST AVENUE K4	SUITE B	LANCASTER	CA	93535	4678	19	06037	34.67124977	-118.1296005	Los Angeles County
213097	Fee-for-Service	1679617930	1679617930	1	1	POLGREEN, LYNDA E MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133183	40	Pediatrics	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
213098	Fee-for-Service	1871044404	1871044404	1	1	PATTERSON, PAULA J PT	8/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
213119	Fee-for-Service	1194394064	1194394064	1	1	PIH HEALTH PHYSICIANS	9/29/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
213132	Fee-for-Service	1336160845	1336160845	1	1	PEARSON, ERIC D MD	3/27/1994	207L00000X	NA	Other	026	PHYSICIANS	69495	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
213149	Fee-for-Service	1275726176	1275726176	1	1	PARSA, MIRIAM F MD	8/6/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97393	40	Pediatrics	0	In state provider	None	5333 HOLISTER AVE	SUITE #250	GOLETA	CA	93111	2466	42	06083	34.43491982	-119.8105484	Santa Barbara County
213157	Fee-for-Service	1124154448	1124154448	1	1	PALMER, MARTIN C MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52444	78	Neoplastic Diseases/Oncology	0	In state provider	None	1240 S WESTLAKE BLVD	STE 117	WESTLAKE VILLAGE	CA	91361	1978	56	06111	34.14966879	-118.8378084	Ventura County
213164	Fee-for-Service	1437282167	1437282167	1	1	PROHEALTH PARTNERS	2/15/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	A MEDICAL GROUP INC	911 EAST SAN ANTONIO DR	SUITE 1	LONG BEACH	CA	90807	2204	19	06037	33.83829601	-118.1824972	Los Angeles County
213165	Fee-for-Service	1174576607	1174576607	1	1	PEAK HEALTH MEDICAL	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP INC	2143 S SEPULVEDA BLVD	STE 300	LOS ANGELES	CA	90025	5733	19	06037	34.04052772	-118.4382228	Los Angeles County
213170	Fee-for-Service	1992725980	1992725980	1	1	PHAN, TRENT V DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12034	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
213174	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	10/16/2012	101YM0800X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
213175	Fee-for-Service	1871607762	1871607762	1	132	PROVIDENCE MEDICAL FOUNDATIO	11/2/2018	332BX2000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
213209	Fee-for-Service	1689745937	1689745937	1	1	PARKS, JEFFREY D MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	81062	05	Anesthesiology	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
213212	Fee-for-Service	1013100023	1013100023	1	1	PREGNANCY RESOURCE CENTER	8/29/2008	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF MARIN	1320A GRANT AVE	None	NOVATO	CA	94945	3152	21	06041	38.10837086	-122.5740543	Marin County
213239	Fee-for-Service	1730718503	1730718503	1	1	PEREZ, CRISTINA MD	10/13/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186712	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
213240	Fee-for-Service	1255531570	1255531570	1	1	PROHEALTH HOME CARE, INC	12/21/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2700 ZANKER RD	SUITE 180	SAN JOSE	CA	95134	2140	43	06085	37.39134766	-121.9264991	Santa Clara County
213256	Fee-for-Service	1063893816	1063893816	1	1	PROSERVRX INC	9/1/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3828 SCHAUFELE AVE	SUITE 260	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
213292	Fee-for-Service	1942208426	1942208426	1	1	PROTHRO, DAVID L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	NEVADA ARRHYTHMIA SVCS	236 W 6TH ST	STE 201	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
213294	Fee-for-Service	1700181799	1700181799	1	1	PLEITEZ, NURIA F MD INC	10/31/1992	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40248	40	Pediatrics	0	In state provider	None	430 W BADILLO ST	None	COVINA	CA	91723	1829	19	06037	34.08628272	-117.8976273	Los Angeles County
213330	Fee-for-Service	1871607762	1871607762	1	130	PROVIDENCE MEDICAL FOUNDATIO	10/17/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	2675 HARRIS ST	None	EUREKA	CA	95503	4806	12	06023	40.78053022	-124.1369379	Humboldt County
213370	Fee-for-Service	1477666352	1477666352	2	1	PEDIATRIC MEDICAL GROUP OF	8/15/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN FRANCISCO INC	901 CAMPUS DR	STE 207	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
213384	Fee-for-Service	1679617930	1679617930	1	1	POLGREEN, LYNDA E MD	2/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133183	67	Endocrinology	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
213407	Fee-for-Service	1194394064	1194394064	1	1	PIH HEALTH PHYSICIANS	11/7/2024	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
213449	Fee-for-Service	1093803769	1093803769	1	1	PHILOMINA WALKERNWARUEZE	6/26/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PHILOMINA MED EQPMT DIST	1430 E COOLEY DR	STE 200	COLTON	CA	92324	3936	36	06071	34.05447053	-117.304542	San Bernardino County
213462	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	5/24/2017	101YM0800X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
213471	Fee-for-Service	1871607762	1871607762	1	72	PROVIDENCE MEDICAL FOUNDATIO	4/3/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	101 ROWLAND WAY	SUITE 320	NOVATO	CA	94949	5056	21	06041	38.09755172	-122.5591766	Marin County
213479	Fee-for-Service	1295231959	1295231959	1	1	POULOS, SAMANTHA K	7/29/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2344 BUTANO	SUITE C3	SACRAMENTO	CA	95825	0616	34	06067	38.606562	-121.379805	Sacramento County
213492	Fee-for-Service	1396904975	1396904975	1	1	PATHAK, NIMESH J MD	9/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113231	18	Ophthalmology	0	In state provider	None	1045 ATLANTIC AVE	STE 1007	LONG BEACH	CA	90813	3470	19	06037	33.780267	-118.1850795	Los Angeles County
213495	Fee-for-Service	1386278455	1386278455	1	1	PRUEITT, STEVEN DO	10/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23139	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
213529	Fee-for-Service	1346426996	1346426996	1	1	PANNELL, JEFFREY S MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120161	14	Neurological Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213557	Fee-for-Service	1871749556	1871749556	1	1	PLATT, KATRINA J DO	7/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10988	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
213591	Fee-for-Service	1346558772	1346558772	1	1	PROVINSE, JENNAFER LCSW	10/6/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
213619	Fee-for-Service	1205984663	1205984663	1	1	PLASTINO, JOAN LAC	7/6/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ER	4340 REDWOOD HWY	F155	SAN RAFAEL	CA	94903	2121	21	06041	38.01609176	-122.5407011	Marin County
213627	Fee-for-Service	1992768345	1992768345	1	1	PABALAN, FRANCISCO J	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	68449	18	Ophthalmology	0	In state provider	None	12980 FREDERICK ST	STE G	MORENO VALLEY	CA	92553	5263	33	06065	33.931872	-117.2613835	Riverside County
213648	Fee-for-Service	1932254570	1932254570	1	1	PROFFETT, GARY J MD	12/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31780	08	Family Practice	0	In state provider	None	2930 AVENIDA DE AUTLAN	None	CAMARILLO	CA	93010	7472	56	06111	34.24486617	-119.0877039	Ventura County
213653	Fee-for-Service	1114119914	1114119914	1	1	PATEL, NIMISH MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107644	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	14350 WHITTIER BLVD	SUITE 315	WHITTIER	CA	90605	2150	19	06037	33.95501294	-118.0185665	Los Angeles County
213660	Fee-for-Service	1265810972	1265810972	1	1	PARRISH GARCIA, ASHLEY	12/5/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
213678	Fee-for-Service	1932345410	1932345410	1	1	PREMIER HEALTHCARE OF PLACER	8/28/2019	208VP0000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1980 BROADWAY	None	PLACERVILLE	CA	95667	9001	09	06017	38.73176974	-120.7561716	El Dorado County
213679	Fee-for-Service	1114306685	1114306685	1	1	PLAZA RESIDENTIAL	3/19/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ENTERPRISES INC	6951 LENNOX AVE	None	VAN NUYS	CA	91405	4034	19	06037	34.19724362	-118.4454791	Los Angeles County
213690	Fee-for-Service	1427204494	1427204494	1	1	PARK, EUNICE Y MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123137	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
213691	Fee-for-Service	1700611910	1700611910	1	1	PEDRAM KOHAN MD INC	1/9/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVE	604	CULVER CITY	CA	90232	2751	19	06037	34.02243278	-118.3981492	Los Angeles County
213694	Fee-for-Service	1194394064	1194394064	1	1	PIH HEALTH PHYSICIANS	9/29/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
213697	Fee-for-Service	1134207848	1134207848	1	1	POSUNIAK, EDWARD A JR DO	10/18/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	5341	25	Physical Medicine and Rehabilitation	0	In state provider	None	253 COHASSET RD	None	CHICO	CA	95926	2209	04	06007	39.75181864	-121.8526095	Butte County
213735	Fee-for-Service	1023230729	1023230729	1	1	PETERSON, DAVID A MD	8/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87648	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
213745	Fee-for-Service	1730684853	1730684853	1	1	PRESBYTERIAN HEALTHCARE SERV	10/25/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	L CENTER	4801 BECKNER ROAD	None	SANTA FE	NM	87507	3641	00	None	35.61504022	-106.0241364	Santa Fe County
213749	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	2/5/2019	101YM0800X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
213750	Fee-for-Service	1699799338	1699799338	1	1	PERRY, STANTON B MD	3/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50814	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
213758	Fee-for-Service	1730138694	1730138694	1	1	PEUKER, BARRY M PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
213761	Fee-for-Service	1881980704	1881980704	1	1	PACHECO, KEVIN J DO	9/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 SOUTH STREET	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
213779	Fee-for-Service	1922464056	1922464056	1	1	PAIK, PATRICIA Y NP	3/29/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213793	Fee-for-Service	1144334228	1144334228	1	2	PERERA-THANGARATNAM, D LALAN	11/1/2001	207L00000X	NA	Other	026	PHYSICIANS	70242	None	None	0	In state provider	MD	1111 LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
213800	Fee-for-Service	1093396707	1093396707	1	1	PHAN, JIMMY	10/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190525	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
213819	Fee-for-Service	1982087391	1982087391	1	1	PHAM, JIMMY T DO	11/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91346	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
213863	Fee-for-Service	1730240052	1730240052	1	2	POUSTI, SHEIVA L	5/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3560 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	3420	37	06073	32.74323873	-117.1010132	San Diego County
213935	Fee-for-Service	1932254570	1932254570	1	1	PROFFETT, GARY J MD	12/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31780	01	General Practice	0	In state provider	None	2930 AVENIDA DE AUTLAN	None	CAMARILLO	CA	93010	7472	56	06111	34.24486617	-119.0877039	Ventura County
213963	Fee-for-Service	1922397892	1922397892	1	1	PAIKA, HUMA M MD	1/9/2018	207R00000X	NA	Other	026	PHYSICIANS	152609	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
214004	Fee-for-Service	1194715912	1194715912	1	1	PAK, LAURA K MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60365	02	General Surgery	0	In state provider	None	2 BON AIR RD	STE 200	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
214029	Fee-for-Service	1730684853	1730684853	1	1	PRESBYTERIAN HEALTHCARE SERV	10/25/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	L CENTER	4801 BECKNER ROAD	None	SANTA FE	NM	87507	3641	00	None	35.61504022	-106.0241364	Santa Fe County
214031	Fee-for-Service	1568574713	1568574713	1	1	PILLOR, EVELYN NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214037	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	2/5/2019	101YM0800X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
214040	Fee-for-Service	1699799338	1699799338	1	1	PERRY, STANTON B MD	3/27/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50814	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
214047	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	2/5/2019	163WG0000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
214054	Fee-for-Service	1376876912	1376876912	1	4	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	10431 LEMON ST	UNIT N	RANCHO CUCAMONGA	CA	91737	3700	36	06071	34.13966252	-117.5775255	San Bernardino County
214089	Fee-for-Service	1871607762	1871607762	1	4	PROVIDENCE MEDICAL FOUNDATIO	4/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	5475 E LA PALMA AVE	STE 200	ANAHEIM	CA	92807	2075	30	06059	33.85997926	-117.7958236	Orange County
214093	Fee-for-Service	1851409981	1851409981	1	1	POST, MICHAEL C MD	9/1/2006	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	70217	47	Miscellaneous	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214105	Fee-for-Service	1801846407	1801846407	1	1	PROMES, ZAHRA G MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134259	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
214107	Fee-for-Service	1497011316	1497011316	1	1	PANDYA, TEJAL G MD	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128754	89	Surgery-Traumatic	0	In state provider	None	555 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3286	54	06107	36.06956396	-119.0291153	Tulare County
214115	Fee-for-Service	1316031818	1316031818	1	1	PHILLIPS, TRACY T MD MEDICAL	9/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84062	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	2089 VALE RD	STE 10	SAN PABLO	CA	94806	3848	07	06013	37.95396781	-122.3375393	Contra Costa County
214179	Fee-for-Service	1912907114	1912907114	1	1	PREMIER FAMILY MEDICINE	9/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ASSOCIATES, INC	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
214185	Fee-for-Service	1508058371	1508058371	1	1	PAIKAL, MICHAEL E MD	5/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107873	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
214209	Fee-for-Service	1497793384	1497793384	1	1	PULLARKAT, SHEEJA T MD	4/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82257	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
214235	Fee-for-Service	1093873978	1093873978	1	1	PETERSEN, TERRY P MD	5/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77847	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
214267	Fee-for-Service	1750749271	1750749271	1	1	PARADISE POST ACUTE LLC	9/27/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7419 SKYWAY	None	PARADISE	CA	95969	3230	04	06007	39.76814732	-121.6130918	Butte County
214279	Fee-for-Service	1639225261	1639225261	2	1	PROGRESSIVE MEDICAL	11/23/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2720 LOCKER AVENUE	STE P	CARLSBAD	CA	92010	6606	37	06073	33.13338884	-117.2590168	San Diego County
214281	Fee-for-Service	1689603557	1689603557	1	1	PAXTON, VENUS C MD	10/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94802	26	Psychiatry (child)	0	In state provider	None	7850 VISTA HILL AVENUE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
214291	Fee-for-Service	1407261001	1407261001	1	1	PROUDFOOT, JACQUELINE J MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141233	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
214309	Fee-for-Service	1043579501	1043579501	1	1	PHAM, NHAT M DO	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12992	40	Pediatrics	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
214320	Fee-for-Service	1700935822	1700935822	1	1	PISTORESI AMBULANCE SRVS	1/8/1997	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	113 N R ST	None	MADERA	CA	93637	4465	20	06039	36.95320296	-120.0735476	Madera County
214328	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	6/16/2017	101YM0800X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
214336	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	11/30/2018	163WG0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
214338	Fee-for-Service	1538381967	1538381967	1	1	PATTERSON UNIFIED SD	12/4/1994	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	510 KEYSTONE BLVD	None	PATTERSON	CA	95363	8861	50	06099	37.4737497	-121.160976	Stanislaus County
214345	Fee-for-Service	1376876912	1376876912	1	4	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	10431 LEMON ST	UNIT N	RANCHO CUCAMONGA	CA	91737	3700	36	06071	34.13966252	-117.5775255	San Bernardino County
214377	Fee-for-Service	1841485331	1841485331	1	1	PTASZNY, MAGDALENA E MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95078	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
214381	Fee-for-Service	1134312812	1134312812	1	2	PARTOVI, SUSAN M MD	2/26/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	55312	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
214382	Fee-for-Service	1851409981	1851409981	1	1	POST, MICHAEL C MD	9/1/2006	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	70217	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
214389	Fee-for-Service	1194875526	1194875526	1	1	PRIDE, DAVID T MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91401	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
214402	Fee-for-Service	1013275700	1013275700	1	1	PONCE MEJIA, LUCIDO LUCIANO	5/6/2019	2084A2900X	NA	Neurology	026	PHYSICIANS	153824	30	Radiology	0	In state provider	MD	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
214421	Fee-for-Service	1437539988	1437539988	1	1	PHAN, VU DO	7/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14347	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
214422	Fee-for-Service	1992809412	1992809412	2	6	POKROY MEDICAL GROUP OF NEVA	5/21/2024	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	A	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
214469	Fee-for-Service	1912907114	1912907114	1	1	PREMIER FAMILY MEDICINE	2/6/2024	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, INC	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
214486	Fee-for-Service	1023230893	1023230893	1	1	POSALSKI, JANA D MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90375	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1749	19	06037	34.0696407	-118.3836988	Los Angeles County
214502	Fee-for-Service	1114235124	1114235124	1	1	PENDYALA, SWAROOP MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	880 RYLAND ST	None	RENO	NV	89502	1603	00	None	39.52378631	-119.8009873	Washoe County
214512	Fee-for-Service	1649347287	1649347287	1	1	PLYMALE, WILLIAM S LCSW	7/14/2015	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	350 TOWNSEND STREET	SUITE 636	SAN FRANCISCO	CA	94107	1697	38	06075	37.7761061	-122.396307	San Francisco County
214541	Fee-for-Service	1477656395	1477656395	1	1	PHAN, DENISE A MD	12/31/1991	207R00000X	NA	Other	026	PHYSICIANS	73973	08	Family Practice	0	In state provider	None	15211 VANOWEN ST	STE 206	VAN NUYS	CA	91405	3620	19	06037	34.19395411	-118.4642527	Los Angeles County
214569	Fee-for-Service	1689603557	1689603557	1	1	PAXTON, VENUS C MD	10/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94802	36	Psychiatry	0	In state provider	None	7850 VISTA HILL AVENUE	None	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
214572	Fee-for-Service	1669544581	1669544581	1	1	PAPADAKIS, KONSTANTINOS	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61776	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
214613	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	12/30/2015	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
214626	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	11/26/2016	163WG0000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
214627	Fee-for-Service	1538381967	1538381967	1	1	PATTERSON UNIFIED SD	3/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	510 KEYSTONE BLVD	None	PATTERSON	CA	95363	8861	50	06099	37.4737497	-121.160976	Stanislaus County
214635	Fee-for-Service	1376876912	1376876912	1	4	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	10431 LEMON ST	UNIT N	RANCHO CUCAMONGA	CA	91737	3700	36	06071	34.13966252	-117.5775255	San Bernardino County
214656	Fee-for-Service	1225100860	1225100860	1	1	PRINCE, SHERIAN L	4/5/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PACIFIC MEDICAL SUPPLY	620 PETALUMA BLVD N	STE A	PETALUMA	CA	94952	2870	49	06097	38.2414914	-122.643718	Sonoma County
214675	Fee-for-Service	1326153354	1326153354	2	1	PSM HEALTHCARE INC	12/3/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	631 W DUARTE RD	None	ARCADIA	CA	91007	7332	19	06037	34.12643788	-118.0526434	Los Angeles County
214679	Fee-for-Service	1194875526	1194875526	1	1	PRIDE, DAVID T MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91401	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
214688	Fee-for-Service	1104434216	1104434216	1	1	PLANNED PARENTHOOD LOS	9/16/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	2550 E SLAUSON AVE	SUITE B	HUNTINGTON PARK	CA	90255	2889	19	06037	33.98915101	-118.2261679	Los Angeles County
214702	Fee-for-Service	1366510356	1366510356	1	1	PECCI, PIETRO G MD	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80350	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
214744	Fee-for-Service	1669405684	1669405684	1	1	PACIFICOAST AMBULATORY	2/2/2016	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGICENTER LLC	665 CAMINO DE LOS MARES	100C	SAN CLEMENTE	CA	92673	2840	30	06059	33.45730192	-117.6483252	Orange County
214845	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2015	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
214857	Fee-for-Service	1164616736	1164616736	1	1	PHAM, AI P MD	4/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101006	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
214862	Fee-for-Service	1669544581	1669544581	1	1	PAPADAKIS, KONSTANTINOS	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61776	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
214876	Fee-for-Service	1033283353	1033283353	1	1	PATRICK, ERIC S MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63909	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
214877	Fee-for-Service	1467542928	1467542928	1	1	POLSON, CRAIG A MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46113	None	None	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
214902	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	8/11/2017	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
214909	Fee-for-Service	1447596291	1447596291	1	1	PLATINUM HOSPICE CARE, INC	4/20/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4533 VAN NUYS BLVD	SUITE 302	SHERMAN OAKS	CA	91403	2950	19	06037	34.154037	-118.4487285	Los Angeles County
214914	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	11/30/2018	163WG0000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
214930	Fee-for-Service	1033282637	1033282637	1	1	PELTON, KEVIN MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80695	20	Orthopedic Surgery	0	In state provider	None	1700 CESAR CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
214941	Fee-for-Service	1619942968	1619942968	1	1	PEARSON, WILLIAM F MD	2/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101065	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
214951	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
214955	Fee-for-Service	1598191512	1598191512	1	1	PATHOLOGY ASSOCIATES	6/2/2014	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY OF SOUTHERN	9355 CHAPMAN AVE	SUITE 102 & 104	GARDEN GROVE	CA	92841	2536	30	06059	33.78855341	-117.9687409	Orange County
214970	Fee-for-Service	1386664084	1386664084	1	1	PLOTKIN, ELLIOT L DPM	9/17/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1285	19	06037	34.27904453	-118.459944	Los Angeles County
215002	Fee-for-Service	1053959189	1053959189	1	1	PHARMMED INC	6/12/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	360 EAST LAS TUNAS DRIVE	UNIT 101 A & 101 B	SAN GABRIEL	CA	91776	5513	19	06037	34.10323665	-118.0955292	Los Angeles County
215051	Fee-for-Service	1174707707	1174707707	1	1	PINNACLE OPTOMETRY, INC.	6/11/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12762 LIMONITE AVENUE	SUITE 104	CORONA	CA	92880	4201	33	06065	33.97527353	-117.561978	Riverside County
215055	Fee-for-Service	1619244688	1619244688	1	1	PINNACLE PRIMARY CARE INC	5/7/2012	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	7400 DISTRICT BLVD	SUITE C	BAKERSFIELD	CA	93313	4818	15	06029	35.31317675	-119.0831837	Kern County
215077	Fee-for-Service	1336301019	1336301019	1	1	PATEL, EKTA T MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139064	01	General Practice	0	In state provider	None	1820 41ST AVE	SUITE C	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
215104	Fee-for-Service	1245383165	1245383165	1	1	PROVIDENCE TRINITYCARE	1/1/1988	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	5315 TORRANCE BLVD	SUITE B1	TORRANCE	CA	90503	4011	19	06037	33.83759847	-118.370277	Los Angeles County
215134	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	9/25/2018	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
215189	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	9/11/2012	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
215196	Fee-for-Service	1447596291	1447596291	1	1	PLATINUM HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4533 VAN NUYS BLVD	SUITE 302	SHERMAN OAKS	CA	91403	2950	19	06037	34.154037	-118.4487285	Los Angeles County
215198	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	9/11/2012	163WG0000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
215204	Fee-for-Service	1053301945	1053301945	1	1	PORZIO, RICHARD M MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60117	None	None	0	In state provider	None	1530 BESSIE AVE	STE 108	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
215205	Fee-for-Service	1417904574	1417904574	1	1	PREMIER INFUSION AND	4/22/2004	251F00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARE SERVICES, INC.	19500 NORMANDIE AVE	None	TORRANCE	CA	90502	1108	19	06037	33.85398111	-118.2992036	Los Angeles County
215243	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
215258	Fee-for-Service	1053430181	1053430181	1	1	PREASMYER, SANDRA J NP	6/13/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
215264	Fee-for-Service	1396729810	1396729810	1	1	PRESTON, MARK P MD	11/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87041	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
215330	Fee-for-Service	1003980608	1003980608	1	1	PERRY, RENEE L MD	12/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8802	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
215353	Fee-for-Service	1629017801	1629017801	1	1	PARSA, KOOROS MD	5/6/1993	207RH0003X	NA	Oncology	026	PHYSICIANS	21697	68	Hematology	0	In state provider	None	500 E ESPLANADE DR	STE 740	OXNARD	CA	93036	0514	56	06111	34.22877446	-119.1713365	Ventura County
215391	Fee-for-Service	1245383165	1245383165	1	1	PROVIDENCE TRINITYCARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	5315 TORRANCE BLVD	SUITE B1	TORRANCE	CA	90503	4011	19	06037	33.83759847	-118.370277	Los Angeles County
215404	Fee-for-Service	1932124351	1932124351	1	1	PATTERSON, STEPHEN C MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75189	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
215424	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	11/30/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
215448	Fee-for-Service	1881615847	1881615847	1	1	PIC WOOD CORPORATION	12/7/1987	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2370 WESTWOOD BLVD	None	LOS ANGELES	CA	90064	2120	19	06037	34.0408993	-118.4291065	Los Angeles County
215473	Fee-for-Service	1164927406	1164927406	1	1	PRIESTLEY, ERIKA MD	11/13/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163606	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
215478	Fee-for-Service	1235226531	1235226531	1	38	PERMANENTE MEDICAL GROUP INC	1/6/2017	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
215484	Fee-for-Service	1871036798	1871036798	1	1	PETERSON, CHARLES C DO	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15085	01	General Practice	0	In state provider	None	801 S CHEVY CHASE DR	STE 230	GLENDALE	CA	91205	4436	19	06037	34.136757	-118.2396195	Los Angeles County
215489	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	9/12/2018	163WG0000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
215501	Fee-for-Service	1205896024	1205896024	1	1	PALMER, DAPHNE MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	55391	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
215512	Fee-for-Service	1447263140	1447263140	1	1	PONG, CHIU WING PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
215529	Fee-for-Service	1265963508	1265963508	1	1	PATTY, CHRISTINA MD	12/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165104	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
215531	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
215532	Fee-for-Service	1295858652	1295858652	1	1	POSITIVE DIRECTIONS INC	12/19/2000	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	838 20TH AVE	None	DELANO	CA	93215	1019	15	06029	35.78311947	-119.2466025	Kern County
215590	Fee-for-Service	1699157701	1699157701	1	1	PROVIDENCE HEALTHCARE PARTNE	12/22/2015	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RS INC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
215605	Fee-for-Service	1447447248	1447447248	1	4	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	5767 MISSION ST	None	SAN FRANCISCO	CA	94112	4208	38	06075	37.70983514	-122.4496184	San Francisco County
215637	Fee-for-Service	1366588626	1366588626	1	1	PANOMITROS, DEMETRA MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74740	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
215645	Fee-for-Service	1306839923	1306839923	2	1	PEARCE, STEPHEN F MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45135	None	None	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
215649	Fee-for-Service	1134405905	1134405905	1	1	PRIMAVERA, JENNIFER N LMFT	1/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1620 N CARPENTER RD	STE D 47B	MODESTO	CA	95351	1153	50	06099	37.65976262	-121.0310604	Stanislaus County
215664	Fee-for-Service	1891031670	1891031670	1	1	PAL, AMIT MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152254	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
215691	Fee-for-Service	1144277633	1144277633	1	10	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	6125 FRESNO ST	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
215711	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	9/25/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
215763	Fee-for-Service	1194341230	1194341230	1	1	PRIETO, JULIAN R MD	12/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189213	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
215770	Fee-for-Service	1750479655	1750479655	1	1	PUTNAM, DEBORAH A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 S KING ST	None	HONOLULU	HI	96813	3009	00	None	21.30218603	-157.8505732	Honolulu County
215773	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	4/2/2009	163WG0000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
215774	Fee-for-Service	1053460188	1053460188	1	1	PITTSBURG OPEN MRI	4/15/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1441 E LELAND ROAD	STE E	PITTSBURG	CA	94565	5100	07	06013	38.00834053	-121.8664397	Contra Costa County
215785	Fee-for-Service	1861627242	1861627242	1	1	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
215786	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
215814	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	6/19/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
215835	Fee-for-Service	1558623397	1558623397	1	2	PHARNICHYAKUL, SAHACHAT LMF	2/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
215854	Fee-for-Service	1013075290	1013075290	1	1	PHILLIPS, JUDY	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8899 UNIVERSITY CENTER L	STE 310	SAN DIEGO	CA	92122	1021	37	06073	32.8702653	-117.2280462	San Diego County
215879	Fee-for-Service	1699157701	1699157701	1	1	PROVIDENCE HEALTHCARE PARTNE	12/22/2015	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	RS INC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
215893	Fee-for-Service	1649293176	1649293176	1	1	PAUL, RIA MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80263	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
215895	Fee-for-Service	1447447248	1447447248	1	4	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	5767 MISSION ST	None	SAN FRANCISCO	CA	94112	4208	38	06075	37.70983514	-122.4496184	San Francisco County
215979	Fee-for-Service	1144277633	1144277633	1	10	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	6125 FRESNO ST	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
215992	Fee-for-Service	1598834608	1598834608	1	1	PAYNE,MICHAEL D	9/20/2007	174400000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	PAYNE COMMUNICATIONS INC	923 DANA DR	STE 2	REDDING	CA	96003	4051	45	06089	40.58575147	-122.354559	Shasta County
215999	Fee-for-Service	1770351561	1770351561	1	1	PIERCY, ROBERT BCO	12/18/2023	332B00000X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	321 NORTH LARCHMONT BOUL	SUITE 711	LOS ANGELES	CA	90004	3049	19	06037	34.0769016	-118.323663	Los Angeles County
216000	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	2/5/2019	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
216061	Fee-for-Service	1295378040	1295378040	1	1	PARNOW, SARAH PSYD	3/25/2020	103TH0004X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
216066	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	9/25/2018	163WG0000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
216070	Fee-for-Service	1861627242	1861627242	1	1	PLATINUM HOSPITALISTS LLP	1/24/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
216075	Fee-for-Service	1326134032	1326134032	1	1	PATEL, MONA S MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89377	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	MS #76	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
216076	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	11/21/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
216104	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
216148	Fee-for-Service	1598075665	1598075665	1	1	PRICE, CAROLINE J CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
216170	Fee-for-Service	1699157701	1699157701	1	1	PROVIDENCE HEALTHCARE PARTNE	12/22/2015	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	RS INC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
216196	Fee-for-Service	1669551578	1669551578	1	1	PEREZ, HUGO R DPM	1/22/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	307 S CHESTER AVE	None	BAKERSFIELD	CA	93304	3650	15	06029	35.351406	-119.0189475	Kern County
216218	Fee-for-Service	1497944805	1497944805	1	1	PRESENTE, ASAF MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99158	None	None	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
216228	Fee-for-Service	1437122991	1437122991	1	1	POWAR, JAGBIR S MD	4/30/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44150	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4731 ENGLE RD	# 16	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3546634	Sacramento County
216231	Fee-for-Service	1902257207	1902257207	1	1	PEATTIE, MICHELLE J	6/19/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
216248	Fee-for-Service	1508311630	1508311630	1	1	PRODIGY HEALTHCARE INC	9/15/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2888 S IVY AVENUE	None	FRESNO	CA	93706	5513	10	06019	36.697689	-119.7930585	Fresno County
216251	Fee-for-Service	1922019389	1922019389	1	1	PAZORNIK, ARTHUR S OD	2/28/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4476 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6359	19	06037	33.94280053	-118.1931037	Los Angeles County
216287	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	12/8/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
216325	Fee-for-Service	1326750951	1326750951	1	1	PHAN, JANE LCSW	8/27/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
216346	Fee-for-Service	1760858872	1760858872	1	1	PUREVISION OPTOMETRY	2/11/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1099 E HOSPITALITY LN	None	SAN BERNARDINO	CA	92408	2813	36	06071	34.06887134	-117.2625206	San Bernardino County
216352	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	11/24/2019	163WG0000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
216358	Fee-for-Service	1861627242	1861627242	1	1	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
216363	Fee-for-Service	1386665511	1386665511	1	1	PEDIATRIC CARDIOLOGY MED	6/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	ASSOCS OF CALIFORNIA	5400 BALBOA BLVD	STE 202	ENCINO	CA	91316	1529	19	06037	34.169283	-118.501072	Los Angeles County
216365	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
216374	Fee-for-Service	1730120700	1730120700	1	1	PRAKASH, AMITABH MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37785	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
216389	Fee-for-Service	1972021251	1972021251	1	1	PILLE, ANDRES LMFT	3/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
216393	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
216415	Fee-for-Service	1528178852	1528178852	1	1	PACIFIC CLINICS	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	790 E BONITA AVE	None	POMONA	CA	91767	1906	19	06037	34.09621447	-117.737406	Los Angeles County
216431	Fee-for-Service	1447447248	1447447248	1	11	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	4650 HOEN AVE	None	SANTA ROSA	CA	95405	9407	49	06097	38.441034	-122.665257	Sonoma County
216457	Fee-for-Service	1134251192	1134251192	1	1	PROHEALTH PARTNERS, A MEDICA	7/1/1995	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC	1760 TERMINO	SUITE 214	LONG BEACH	CA	90804	2169	19	06037	33.78889871	-118.1458784	Los Angeles County
216471	Fee-for-Service	1730113671	1730113671	1	1	PARRINO,SUZANNE S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	0000	00	None	44.94428014	-93.10733608	Ramsey County
216564	Fee-for-Service	1538588868	1538588868	1	1	PHAM, ANDREW D MD	5/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140080	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINTAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
216576	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	9/12/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
216598	Fee-for-Service	1124030507	1124030507	1	1	PAYAWAL, JONATHAN H MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103732	05	Anesthesiology	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	99140	2542	19	06037	34.21980849	-118.4301135	Los Angeles County
216610	Fee-for-Service	1144471715	1144471715	1	1	PROVIDENCE HEALTH & SERVICES	7/29/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WA	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
216624	Fee-for-Service	1740493717	1740493717	1	1	PRZEKOP, ALLISON A DO	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8670	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216640	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	2/5/2019	163WG0000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
216652	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
216661	Fee-for-Service	1730120700	1730120700	1	1	PRAKASH, AMITABH MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37785	22	Pathology (M.D. only)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
216677	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
216696	Fee-for-Service	1629590401	1629590401	1	1	PARFENOVA, ANNA OD	5/17/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	22809 HAWTHORNE BLVD	None	TORRANCE	CA	90505	3615	19	06037	33.819993	-118.3512385	Los Angeles County
216717	Fee-for-Service	1447447248	1447447248	1	11	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	4650 HOEN AVE	None	SANTA ROSA	CA	95405	9407	49	06097	38.441034	-122.665257	Sonoma County
216734	Fee-for-Service	1336290691	1336290691	1	1	PEREZ, JOSE L MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74744	08	Family Practice	0	In state provider	None	2237 W BALL ROAD	None	ANAHEIM	CA	92804	5314	30	06059	33.817798	-117.9610599	Orange County
216772	Fee-for-Service	1447719745	1447719745	1	1	PERDOMO, RYAN M MD	7/15/2022	207P00000X	NA	Other	026	PHYSICIANS	177021	None	None	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
216846	Fee-for-Service	1124588058	1124588058	1	1	PATEL, PARTH MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	177949	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
216862	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	11/30/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
216892	Fee-for-Service	1043215379	1043215379	1	1	PIH HEALTH HOSPITAL WHITTIER	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
216901	Fee-for-Service	1144471715	1144471715	1	1	PROVIDENCE HEALTH & SERVICES	7/29/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WA	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
216910	Fee-for-Service	1174921167	1174921167	1	1	PATHANIA, PRATIMA PSYD	12/9/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
216929	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
216938	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
216954	Fee-for-Service	1184681470	1184681470	1	1	PACE, ROBERT C MD INC	1/1/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	21246	20	Orthopedic Surgery	0	In state provider	None	521 E ELDER ST	STE 105	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
216967	Fee-for-Service	1194104521	1194104521	1	1	POHL, CHARLES E MD	10/6/2021	2080P0203X	NA	Other	026	PHYSICIANS	147454	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
216970	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
217056	Fee-for-Service	1770088213	1770088213	1	1	PATEL, MONIQUE MD	9/24/2021	207R00000X	NA	Other	026	PHYSICIANS	165306	None	None	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
217063	Fee-for-Service	1841646981	1841646981	1	1	PIMENTEL, NORIANNE MD	7/16/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	140310	13	Neurology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
217100	Fee-for-Service	1023107505	1023107505	1	2	PARK, HERAN A MD	1/6/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67916	40	Pediatrics	0	In state provider	None	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	30	06059	33.7877325	-117.8109675	Orange County
217134	Fee-for-Service	1831299783	1831299783	1	1	PADMA SHUKLA	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1860 TOWN CENTER DR	STE 210	RESTON	VA	20190	5905	00	None	38.961819	-77.366034	City of Fairfax
217138	Fee-for-Service	1336295138	1336295138	1	1	PLEASANTON PHYSICAL THERAPY	3/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PY	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
217150	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	1/11/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
217160	Fee-for-Service	1851484323	1851484323	1	1	PERUMALSAMY, KUMARAVEL S	8/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103387	41	Internal Medicine	0	In state provider	None	1753-B W AVENUE J	None	LANCASTER	CA	93535	2703	19	06037	34.6896573	-118.0973883	Los Angeles County
217166	Fee-for-Service	1558387373	1558387373	1	1	PAPP, ALEXANDER S MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51343	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
217191	Fee-for-Service	1912134917	1912134917	1	1	PATEL, TUSHAR R MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120109	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE ROAD	None	MODESTO	CA	95355	2869	50	06099	37.668645	-120.9756715	Stanislaus County
217213	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	12/8/2018	163WG0000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
217226	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
217228	Fee-for-Service	1609398759	1609398759	1	1	PIERCE, SHERRI L LCSW	11/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
217254	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
217263	Fee-for-Service	1043613821	1043613821	1	1	PEDIATRIC O&P SERVICES-	8/1/2016	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	WEST INC	909 S FAIR OAKS AVE	None	PASADENA	CA	91105	2625	19	06037	34.13056002	-118.1503751	Los Angeles County
217265	Fee-for-Service	1003860446	1003860446	1	1	PLANNED PRNTHD MAR MONTE	7/1/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	500 E ALMOND AVE	STE 3	MADERA	CA	93637	5600	20	06039	36.94548547	-120.0518941	Madera County
217281	Fee-for-Service	1679542245	1679542245	1	1	PACIFIC IMAGING SERVICES	10/14/2008	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	INC	24551 SILVER CLOUD CT	STE 100	MONTEREY	CA	93940	6532	27	06053	36.57307876	-121.8042628	Monterey County
217327	Fee-for-Service	1972703114	1972703114	1	1	PAPPOE, AKHENATON A MD	2/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95638	45	Nephrology (Renal-Kidney)	0	In state provider	None	1900 ROYALTY DRIVE	SUITE 130	POMONA	CA	91767	3032	19	06037	34.07754346	-117.7463466	Los Angeles County
217334	Fee-for-Service	1306808720	1306808720	1	1	PARDY, MATHEW T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1417 S MINNESOTA AVE	None	SIOUX FALLS	SD	57105	1715	00	None	43.532343	-96.731658	Minnehaha County
217353	Fee-for-Service	1669201901	1669201901	1	1	PIETTE, ALISA LMFT	9/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1264 HIGUERA ST	STE 211	SAN LUIS OBISPO	CA	93401	3175	40	06079	35.28353986	-120.6568095	San Luis Obispo County
217367	Fee-for-Service	1679697411	1679697411	1	1	POTTHARST, ELLEN R MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149052	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
217371	Fee-for-Service	1427317031	1427317031	1	1	PHAM, RHODA D DO	3/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13722	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
217430	Fee-for-Service	1952841363	1952841363	1	1	PREMIER HEALTHCARE OF CALIFO	3/1/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RNIA	405 SOUTH ST	STE F	REDDING	CA	96001	2101	45	06089	40.5787858	-122.3740386	Shasta County
217439	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	12/27/2016	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
217475	Fee-for-Service	1821076100	1821076100	1	1	PRATT, RANDALL N JR	12/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	33734	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
217486	Fee-for-Service	1013473883	1013473883	2	1	PRIORITY HOME HEALTH CARE	7/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10117 SEPULVEDA BLVD	STE 203C	MISSION HILLS	CA	91345	2600	19	06037	34.254252	-118.467507	Los Angeles County
217489	Fee-for-Service	1548609241	1548609241	1	1	PARK, BRIAN Y MD	2/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137213	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
217491	Fee-for-Service	1891160503	1891160503	1	1	PATEL, CHIRAG NP	7/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
217506	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	9/20/2017	163WG0000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
217513	Fee-for-Service	1063943033	1063943033	1	1	PAGANO, EVAN E MD	11/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	181744	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
217514	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
217519	Fee-for-Service	1508930124	1508930124	1	1	PHUNG, CHI H MD INC	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64118	01	General Practice	0	In state provider	None	13155 BROOKHURST ST	None	GARDEN GROVE	CA	92843	1080	30	06059	33.77167222	-117.9551894	Orange County
217537	Fee-for-Service	1841497278	1841497278	1	1	PRINCE, SUSANNE J MD	12/19/2007	207P00000X	NA	Other	026	PHYSICIANS	101068	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PRKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
217543	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
217555	Fee-for-Service	1942768445	1942768445	1	1	PEACE HOSPICE AND PALLIATIVE	3/18/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	13743 VICTORY BLVD	STE F	VAN NUYS	CA	91401	2316	19	06037	34.18669945	-118.432755	Los Angeles County
217559	Fee-for-Service	1568679843	1568679843	1	1	PANCHAL, AMIESHA S MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108601	01	General Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
217576	Fee-for-Service	1356669790	1356669790	1	1	PACIFIC HOSPITALIST ASSOCIAT	8/1/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ES A MEDICAL CORPORATION	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
217593	Fee-for-Service	1184014565	1184014565	1	1	PACIFIC CENTRAL COAST HEALTH	7/22/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1250 PEACH STREET	SUITE A	SAN LUIS OBISPO	CA	93401	2837	40	06079	35.28647825	-120.6599674	San Luis Obispo County
217655	Fee-for-Service	1194183038	1194183038	1	1	PINKERTON, KATRINA L NP	8/31/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
217659	Fee-for-Service	1528077740	1528077740	1	1	POLITOSKE, DOUGLAS A MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	52965	10	Gastroenterology (M.D. only)	0	In state provider	None	625 E GRAND AVE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12475309	-117.0733326	San Diego County
217686	Fee-for-Service	1891514261	1891514261	1	1	PAQUIN, ALYSSA V PT	10/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	210 W PINE ST	None	LODI	CA	95240	2020	39	06077	38.13427214	-121.2755342	San Joaquin County
217726	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	6/25/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
217746	Fee-for-Service	1760407555	1760407555	1	1	PILLING, SOHEYLA H MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74639	05	Anesthesiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
217753	Fee-for-Service	1346353182	1346353182	1	1	PANOSSIAN, SEDA G MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45117	08	Family Practice	0	In state provider	None	5000 W SUNSET BLVD	STE 650	LOS ANGELES	CA	90027	5866	19	06037	34.0981066	-118.2986382	Los Angeles County
217773	Fee-for-Service	1407871015	1407871015	1	1	PHAM, TIMOTHY DPM	10/31/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1879 LUNDY AVE	# 122	SAN JOSE	CA	95131	1834	43	06085	37.39301965	-121.8906676	Santa Clara County
217788	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	2/5/2019	163WG0000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
217798	Fee-for-Service	1902814643	1902814643	1	1	PITRODA, ARPITA P MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55233	41	Internal Medicine	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
217803	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
217834	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
217843	Fee-for-Service	1942768445	1942768445	1	1	PEACE HOSPICE AND PALLIATIVE	3/18/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	13743 VICTORY BLVD	STE F	VAN NUYS	CA	91401	2316	19	06037	34.18669945	-118.432755	Los Angeles County
217847	Fee-for-Service	1487965547	1487965547	1	1	PATHAK, SANUP D MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137481	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
217897	Fee-for-Service	1417442682	1417442682	1	1	POLAKOF, LANDON S MD	6/30/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	162737	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217898	Fee-for-Service	1851658710	1851658710	1	1	PAPAGEORGE, CHRISTINA M MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
217904	Fee-for-Service	1730641010	1730641010	1	1	PARK, GREIGORY W MD	10/10/2022	2086S0120X	NA	General Surgery	026	PHYSICIANS	182158	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
217909	Fee-for-Service	1831418045	1831418045	1	2	POWELL, AARON J MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	25	Physical Medicine and Rehabilitation	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
217947	Fee-for-Service	1336126721	1336126721	1	1	PETERSON, AARON T MD	8/30/2024	2085R0204X	NA	Other	026	PHYSICIANS	82742	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
217956	Fee-for-Service	1124749403	1124749403	1	1	PIROOZ, NEDA D OD	2/18/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	52565 CESAR CHAVEZ ST	#105	COACHELLA	CA	92236	1534	33	06065	33.66690605	-116.1817556	Riverside County
217977	Fee-for-Service	1740761196	1740761196	1	1	PHU, AILEEN LAC	7/21/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
218002	Fee-for-Service	1801802095	1801802095	1	1	PEABODY, ROBERT R JR.	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	63473	18	Ophthalmology	0	In state provider	None	1700 ALHAMBRA BLVD	STE 202	SACRAMENTO	CA	95816	7050	34	06067	38.564847	-121.469121	Sacramento County
218005	Fee-for-Service	1285086843	1285086843	1	1	PROHEALTH PARTNERS, A MEDICA	8/22/2019	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC.	10861 CHERRY ST	104	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
218008	Fee-for-Service	1487610499	1487610499	1	1	PERALTA, FRANCISCO JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19829 N 27TH AVE	None	PHOENIX	AZ	85027	4001	00	None	33.665616	-112.116267	Maricopa County
218014	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	5/3/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
218015	Fee-for-Service	1942589866	1942589866	1	1	PEDIATRIC OPTHALMOLOGY AND	9/27/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	STRABISMUS SPECIALISTS	516 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	4616	19	06037	34.06814714	-118.3742894	Los Angeles County
218042	Fee-for-Service	1902023336	1902023336	1	1	PHAN, VU D MD	3/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55621	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
218050	Fee-for-Service	1700998937	1700998937	1	1	PEREZ, FRANCISCO J LCSW	6/5/2008	104100000X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	505 N TUSTIN AVE	STE 140	SANTA ANA	CA	92705	3778	30	06059	33.74962094	-117.8341227	Orange County
218067	Fee-for-Service	1851692610	1851692610	1	1	PRITCHARD, ELAINE S LMFT	10/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4444 BLACK AVE	None	PLEASANTON	CA	94566	6105	01	06001	37.67215847	-121.876551	Alameda County
218080	Fee-for-Service	1235226531	1235226531	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	163WG0000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
218085	Fee-for-Service	1619210523	1619210523	1	1	PONTARELLI, ELIZABETH M MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	106622	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
218089	Fee-for-Service	1902814643	1902814643	1	1	PITRODA, ARPITA P MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55233	67	Endocrinology	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
218091	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
218096	Fee-for-Service	1194177816	1194177816	1	1	PATEL, PREET MD	2/3/2025	207LP2900X	NA	Other	026	PHYSICIANS	174605	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
218097	Fee-for-Service	1205369006	1205369006	1	1	PASADENA INFECTIOUS DISEASES	4/10/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	AND TROPICAL MEDICINE I	50 ALESSANDRO PL	SUITE 360	PASADENA	CA	91105	3149	19	06037	34.13101049	-118.151532	Los Angeles County
218113	Fee-for-Service	1609254879	1609254879	1	1	PHAM, ANNA L DO	9/6/2018	207R00000X	NA	Other	026	PHYSICIANS	15059	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
218118	Fee-for-Service	1700164282	1700164282	1	1	PERSAUD, KHAMRANIE N MD	10/21/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
218119	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
218231	Fee-for-Service	1952842627	1952842627	1	1	PIAZZISI-MOYES, MEGAN	5/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
218257	Fee-for-Service	1831122480	1831122480	1	1	PACIFIC UROLOGY MEDICAL	1/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	CORPORATION	2222 EAST ST	STE 250	CONCORD	CA	94520	2096	07	06013	37.98125538	-122.0329375	Contra Costa County
218269	Fee-for-Service	1982231411	1982231411	1	1	PAWLOSKI, MEGAN E MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	183082	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
218295	Fee-for-Service	1386645893	1386645893	1	1	PRICKETT, DAVID C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 GLENN HENDREN DR	None	LIBERTY	MO	64068	0000	00	None	39.278767	-94.42102759	Clay County
218302	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	6/25/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
218304	Fee-for-Service	1679518203	1679518203	1	1	PAJE, VIRNA C MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54409	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
218377	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
218389	Fee-for-Service	1538626999	1538626999	1	1	PATEL, JAY K DO	8/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19492	None	None	0	In state provider	None	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
218409	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
218426	Fee-for-Service	1699906842	1699906842	1	1	PHAM, TINA T OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
218435	Fee-for-Service	1619900859	1619900859	1	1	PASADENA CYTO-PATHOLOGY	11/3/1985	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY INC	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
218439	Fee-for-Service	1134198930	1134198930	1	1	PAUL T WOO OPTOMETRIC CORP	6/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	1234 EYE CARE CLN & OPT	1234 S GARFIELD AVE	STE 105	ALHAMBRA	CA	91801	5068	19	06037	34.0796013	-118.1229688	Los Angeles County
218448	Fee-for-Service	1063525947	1063525947	1	1	PARVEEN, SHAISTA MD	1/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72979	40	Pediatrics	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
218500	Fee-for-Service	1376876912	1376876912	1	2	PINNACLE MEDICAL GROUP INC	2/1/1998	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2150 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
218501	Fee-for-Service	1558392159	1558392159	1	1	PHAM, CO D L MD INC	9/30/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34091	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10362 BOLSA AVE	STE 110	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
218539	Fee-for-Service	1417391657	1417391657	1	1	PLOTZKER, ROSALYN E MD	1/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	150578	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218546	Fee-for-Service	1487112371	1487112371	1	1	PAK, REBECCA A NP	5/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
218589	Fee-for-Service	1851305098	1851305098	1	1	PATEL, SHANTU MD	8/31/1995	207R00000X	NA	Other	026	PHYSICIANS	42784	41	Internal Medicine	0	In state provider	None	105 DURIAN ST	None	VISTA	CA	92083	6205	37	06073	33.192558	-117.272973	San Diego County
218594	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
218623	Fee-for-Service	1942846498	1942846498	1	1	PRONTO TRANSPORTATION	8/6/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3610 CENTRAL AVE	STE 400	RIVERSIDE	CA	92506	5907	33	06065	33.95352247	-117.3917745	Riverside County
218631	Fee-for-Service	1811526619	1811526619	1	1	PAMACHECHE, CHRISTOPHER A MD	11/22/2024	207L00000X	NA	Other	026	PHYSICIANS	188641	05	Anesthesiology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
218656	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
218665	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
218695	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
218724	Fee-for-Service	1255408076	1255408076	1	1	PATEL, NILESH J MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75188	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
218739	Fee-for-Service	1831306968	1831306968	1	1	PRYOR, LANDON S MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99159	24	Plastic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
218761	Fee-for-Service	1972600237	1972600237	1	1	PHAM, PETER H MD	4/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101941	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
218818	Fee-for-Service	1063496651	1063496651	1	24	PACIFIC CENTRAL COAST HEALTH	7/18/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1941 JOHNSON AVE	SUITE 105B	SAN LUIS OBISPO	CA	93401	4140	40	06079	35.27804785	-120.649711	San Luis Obispo County
218819	Fee-for-Service	1457468233	1457468233	1	1	PATES, HUGH D PHD	12/1/1994	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7855 IVANHOE AVE	STE 212	LA JOLLA	CA	92037	4508	37	06073	32.84719024	-117.2720299	San Diego County
218850	Fee-for-Service	1063496651	1063496651	1	53	PACIFIC CENTRAL COAST HEALTH	10/15/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	850 FAIR OAKS AVE	STE 200	ARROYO GRANDE	CA	93420	3929	40	06079	35.11274104	-120.588873	San Luis Obispo County
218854	Fee-for-Service	1245378074	1245378074	1	1	PROSTHETICS ETC.,INC	7/1/2007	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	PROSTHETICS ETC., INC.	1700 E LINCOLN AVE	STE 101	ANAHEIM	CA	92805	4346	30	06059	33.84008418	-117.8937053	Orange County
218862	Fee-for-Service	1336368984	1336368984	1	2	PROMISING FUTURES, INC-	11/30/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	AGAPE	1350 TETON DR	None	EL CAJON	CA	92021	1042	37	06073	32.826726	-116.9597855	San Diego County
218879	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	11/24/2019	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
218912	Fee-for-Service	1043368855	1043368855	1	1	PHAM, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73754	08	Family Practice	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
218923	Fee-for-Service	1447345707	1447345707	1	1	PFEIFFER, WILLIAM F MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88419	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
218940	Fee-for-Service	1295239879	1295239879	1	1	PASQUA, JESSICA N MD	7/27/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	167629	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218944	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
218953	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
218969	Fee-for-Service	1851834071	1851834071	1	1	PAVLAK, KATE W LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
218983	Fee-for-Service	1235226531	1235226531	1	50	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
219001	Fee-for-Service	1184243651	1184243651	1	1	POON, JESSICA MD	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	176078	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
219017	Fee-for-Service	1528011335	1528011335	1	1	PATEL, CORI A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 EAST SOUTH TEMPLE	None	SALT LAKE CITY	UT	84102	1507	00	None	40.76933651	-111.8610765	Salt Lake County
219018	Fee-for-Service	1033344817	1033344817	1	1	PATEL, KATEN M MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132442	24	Plastic Surgery	0	In state provider	None	1510 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
219033	Fee-for-Service	1982698957	1982698957	2	1	PHAN, QUANG Q MD	7/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44365	10	Gastroenterology (M.D. only)	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 304	GARDEN GROVE	CA	92843	1917	30	06059	33.77450141	-117.9123364	Orange County
219063	Fee-for-Service	1104082718	1104082718	1	1	PANDEY, TANU S MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131626	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
219066	Fee-for-Service	1275598765	1275598765	1	1	PATEL, JYOTIN K MD	10/29/2009	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	43752	40	Pediatrics	0	In state provider	None	30271 GOLDEN LANTERN	STE C	LAGUNA NIGUEL	CA	92677	5983	30	06059	33.52255101	-117.6859055	Orange County
219072	Fee-for-Service	1669568606	1669568606	1	1	PHAM, ELIZABETH W MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88287	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
219076	Fee-for-Service	1609591676	1609591676	1	1	PHAM, LISA NP	12/21/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
219083	Fee-for-Service	1063496651	1063496651	1	26	PACIFIC CENTRAL COAST HEALTH	6/6/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5825 ENTRADA AVENUE	None	ATASCADERO	CA	93422	4220	40	06079	35.490435	-120.6684704	San Luis Obispo County
219163	Fee-for-Service	1386756427	1386756427	1	1	PAREEK, GAUTAM MD	6/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50776	41	Internal Medicine	0	In state provider	None	1900 MOWRY AVE	STE 104	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
219166	Fee-for-Service	1235226531	1235226531	1	27	PERMANENTE MEDICAL GROUP INC	2/5/2019	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
219170	Fee-for-Service	1134309891	1134309891	1	1	PARK, CHANG WON CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	975 S VERMONT AVE	STE 201	LOS ANGELES	CA	90006	5907	19	06037	34.0534412	-118.2916415	Los Angeles County
219201	Fee-for-Service	1043368855	1043368855	1	1	PHAM, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73754	25	Physical Medicine and Rehabilitation	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
219225	Fee-for-Service	1376168112	1376168112	1	1	PERUMAL, DHIVYA MD	11/27/2024	207L00000X	NA	Other	026	PHYSICIANS	188559	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
219233	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	6/25/2009	171100000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
219241	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219242	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219319	Fee-for-Service	1982698957	1982698957	2	1	PHAN, QUANG Q MD	7/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44365	41	Internal Medicine	0	In state provider	None	12665 GARDEN GROVE BLVD	SUITE 304	GARDEN GROVE	CA	92843	1917	30	06059	33.77450141	-117.9123364	Orange County
219361	Fee-for-Service	1013948256	1013948256	1	2	PRECIADO, JOSEPHINE P MD	12/4/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	75900	-	NOT APPLICABLE	0	In state provider	None	245 E INGER	STE 103 B	SANTA MARIA	CA	93454	8669	42	06083	34.92661232	-120.4330162	Santa Barbara County
219364	Fee-for-Service	1558999300	1558999300	1	1	PADARIYA, PALNA MD	8/21/2023	207R00000X	NA	Other	026	PHYSICIANS	186125	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
219373	Fee-for-Service	1780063461	1780063461	1	1	POORZAND, PARDIS MD	10/11/2019	208M00000X	NA	Other	026	PHYSICIANS	148420	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
219381	Fee-for-Service	1952513871	1952513871	1	1	PEZESHPOUR, MAHNAZ MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99581	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
219412	Fee-for-Service	1447879648	1447879648	1	1	PARK, DAVID J MD	12/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219430	Fee-for-Service	1346504305	1346504305	1	1	POLK, JULIA P MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153207	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
219441	Fee-for-Service	1811287337	1811287337	1	1	PACIFIC MEDICAL, INC	8/24/2012	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	264 SAN JOSE ST.	A	SALINAS	CA	93901	3936	27	06053	36.65804664	-121.6454853	Monterey County
219485	Fee-for-Service	1811332075	1811332075	1	1	PAGE, SARAH J DO	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14135	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
219503	Fee-for-Service	1265515431	1265515431	1	1	PETER APICELLA, MD	10/8/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1995 E STATE ST	None	SALEM	OH	44460	2423	00	None	40.90091162	-80.83276427	Columbiana County
219518	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	6/23/2016	171100000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
219527	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219529	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
219531	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219562	Fee-for-Service	1871607762	1871607762	1	68	PROVIDENCE MEDICAL FOUNDATIO	1/29/2015	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	30131 TOWN CENTER DR	SUITE 215	LAGUNA NIGUEL	CA	92677	2033	30	06059	33.52530096	-117.7148334	Orange County
219626	Fee-for-Service	1487950903	1487950903	1	1	PRIMARY CARE AND GERIATRICS	4/26/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54283	08	Family Practice	0	In state provider	INC	700 WEST PARR AVE	STE B	LOS GATOS	CA	95032	1416	43	06085	37.26403	-121.9683443	Santa Clara County
219628	Fee-for-Service	1073636940	1073636940	1	1	PEVZNER, LEO MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98610	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
219650	Fee-for-Service	1396758363	1396758363	1	1	PATERSON, MARTHA H	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2031 W ALAMEDA AVE	STE 300	BURBANK	CA	91506	2960	19	06037	34.15972797	-118.3237055	Los Angeles County
219708	Fee-for-Service	1649786807	1649786807	1	1	PATLA, IRFANA LMFT	6/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12555 CENTRAL AVE	STE C	CHINO	CA	91710	3569	36	06071	34.025247	-117.6892645	San Bernardino County
219720	Fee-for-Service	1699799593	1699799593	1	1	PARK, RO J MD	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51913	08	Family Practice	0	In state provider	None	7825 ENGINEER RD	STE 101	SAN DIEGO	CA	92111	1929	37	06073	32.82639677	-117.1533615	San Diego County
219742	Fee-for-Service	1154791705	1154791705	1	1	PAYDAR, KIARASH MD INC	11/7/2016	207L00000X	NA	Other	026	PHYSICIANS	119688	05	Anesthesiology	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
219748	Fee-for-Service	1154436178	1154436178	1	1	PRAVIN DARJI	3/6/1995	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MORENA VALLEY PHARMACY	12980 FREDERICK ST	STE B	MORENO VALLEY	CA	92553	5263	33	06065	33.931872	-117.2613835	Riverside County
219760	Fee-for-Service	1467895714	1467895714	1	1	PACI, GABRIELLE M MD	8/30/2020	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	131764	46	Hand Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
219767	Fee-for-Service	1275981136	1275981136	1	1	PHAM, WILLIAM P DO	10/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18360	08	Family Practice	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
219793	Fee-for-Service	1730166349	1730166349	1	1	PEATROSS, TRACEY K MD	2/4/2024	208M00000X	NA	Other	026	PHYSICIANS	185575	None	None	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
219800	Fee-for-Service	1083073407	1083073407	1	1	PRUNES, ANTHONY W MD	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152377	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
219807	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	12/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
219808	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	11/24/2019	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
219816	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219817	Fee-for-Service	1235226531	1235226531	1	49	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
219823	Fee-for-Service	1184041949	1184041949	1	1	PARADIGM LABS, LLC	3/8/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1302 FOUNTAIN PARK CIR	None	BRUNSWICK	GA	31520	4860	00	None	31.1721957	-81.4753543	Glynn County
219863	Fee-for-Service	1801453030	1801453030	1	1	PETERSON, PRESTON L CNP	2/18/2020	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
219866	Fee-for-Service	1679580005	1679580005	1	1	PATEL, MEENAKSHI R MD	3/18/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	91828	40	Pediatrics	0	In state provider	None	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
219872	Fee-for-Service	1760570600	1760570600	1	18	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1580 CREEKSIDE DR	200	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
219915	Fee-for-Service	1487950903	1487950903	1	1	PRIMARY CARE AND GERIATRICS	4/26/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54283	38	Geriatrics	0	In state provider	INC	700 WEST PARR AVE	STE B	LOS GATOS	CA	95032	1416	43	06085	37.26403	-121.9683443	Santa Clara County
219924	Fee-for-Service	1659435626	1659435626	1	1	PETAL V PARUL MD	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
219930	Fee-for-Service	1902282718	1902282718	1	1	PATTON, GAMALIA LMFT	4/21/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	251 WEST MAIN ST	M	BRAWLEY	CA	92227	2201	13	06025	32.97866046	-115.545663	Imperial County
219931	Fee-for-Service	1790103562	1790103562	1	1	PARTHASARATHY, SUDHARSHAN M	5/31/2019	207R00000X	NA	Other	026	PHYSICIANS	153411	41	Internal Medicine	0	In state provider	D	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
219952	Fee-for-Service	1255528170	1255528170	1	1	PARADISE HOME HLTH CARE	6/9/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12509 OXNARD STREET	STE 212P	NORTH HOLLYWOOD	CA	91606	4443	19	06037	34.17943548	-118.405683	Los Angeles County
219975	Fee-for-Service	1760570600	1760570600	1	8	PEDIATRIC MEDICAL ASSOCIATES	3/13/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	S	1561 CREEKSIDE DR	140	FOLSOM	CA	95630	3492	34	06067	38.668032	-121.150188	Sacramento County
220006	Fee-for-Service	1699799593	1699799593	1	1	PARK, RO J MD	2/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51913	02	General Surgery	0	In state provider	None	7825 ENGINEER RD	STE 101	SAN DIEGO	CA	92111	1929	37	06073	32.82639677	-117.1533615	San Diego County
220061	Fee-for-Service	1871074633	1871074633	1	1	PHILBRICK, MEGAN M NP	7/20/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
220094	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	6/23/2016	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
220095	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
220101	Fee-for-Service	1720061914	1720061914	1	1	PARK OPTOMETRY INC	4/1/2002	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1939 GRAND AVE	None	SAN DIEGO	CA	92109	4508	37	06073	32.79919484	-117.233892	San Diego County
220104	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
220126	Fee-for-Service	1518300151	1518300151	1	1	PHILLPOTTS, MARC E MD	8/11/2020	207RR0500X	NA	Other	026	PHYSICIANS	168762	83	Rheumatology	0	In state provider	None	2215 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
220129	Fee-for-Service	1366608879	1366608879	1	1	PATEL, SONAL G MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122390	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
220159	Fee-for-Service	1760570600	1760570600	1	18	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1580 CREEKSIDE DR	200	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
220166	Fee-for-Service	1699007591	1699007591	1	1	PASEK, ADRIENNE E PHD	4/6/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
220167	Fee-for-Service	1962456558	1962456558	1	1	PLANNED PRNTHD MAR MONTE	10/29/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PLANNED PARENTHOOD	2633 16TH STREET	None	BAKERSFIELD	CA	93301	3348	15	06029	35.37232854	-119.0327985	Kern County
220192	Fee-for-Service	1952355364	1952355364	1	1	PITTET, JEAN-FRANCOIS MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54382	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
220229	Fee-for-Service	1144876756	1144876756	1	1	PIERSON, DOUGLAS LMFT	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	222 FASHION LN	212	TUSTIN	CA	92780	3339	30	06059	33.74712935	-117.8174161	Orange County
220276	Fee-for-Service	1558070383	1558070383	1	1	PACIA, KENNETH PAUL PT	2/24/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
220283	Fee-for-Service	1578331153	1578331153	1	1	PREMIUM ALLERGY	4/22/2024	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	ORY CENTER	1069 E CHAMPLAIN DR	A	FRESNO	CA	93720	4223	10	06019	36.87198602	-119.7645172	Fresno County
220308	Fee-for-Service	1063496651	1063496651	1	54	PACIFIC CENTRAL COAST HEALTH	6/1/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2323 DE LA VINA STREET	STE 205	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
220309	Fee-for-Service	1447447248	1447447248	1	9	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	234 SAN PEDRO RD	None	SAN RAFAEL	CA	94903	2858	21	06041	38.00293213	-122.5214702	Marin County
220319	Fee-for-Service	1629537451	1629537451	1	1	PLEASANT, INDIA	11/9/2022	207R00000X	NA	Other	026	PHYSICIANS	19932	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
220326	Fee-for-Service	1487814109	1487814109	1	1	PATEL, ZARA M MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112083	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220334	Fee-for-Service	1811280084	1811280084	1	1	PETERS, OLUSANMI A CRNA	8/22/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
220349	Fee-for-Service	1376876912	1376876912	1	7	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
220381	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	9/12/2018	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
220384	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	9/12/2018	171100000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
220389	Fee-for-Service	1811646987	1811646987	1	1	PEAHI BAY LLC	4/18/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1611 SCENIC DRIVE	None	MODESTO	CA	95355	4907	50	06099	37.65076798	-120.9693766	Stanislaus County
220391	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
220400	Fee-for-Service	1619369527	1619369527	1	1	PHARMACIST HOLDING GROUP	11/26/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9528 TOPANGA CYN BLVD	None	CHATSWORTH	CA	91311	4011	19	06037	34.24482736	-118.6057573	Los Angeles County
220409	Fee-for-Service	1073519559	1073519559	1	1	POLLOCK, KATHLEEN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68341	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MARGARITA	22032 EL PASEO	STE 200	RANCHO SANTA MARG	CA	92688	3947	30	06059	33.64249979	-117.5948976	Orange County
220443	Fee-for-Service	1316170749	1316170749	1	1	PALANISWAMY, CHANDRASEKAR MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141618	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2335 E KASHIAN LANE	STE 240	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
220473	Fee-for-Service	1639413297	1639413297	1	1	PAYNE, LEMLEM W NP	7/15/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
220481	Fee-for-Service	1366765752	1366765752	1	1	POWER THERAPEUTICS, LLC	5/24/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	260	VALENCIA	CA	91355	4793	19	06037	34.43847322	-118.5729968	Los Angeles County
220573	Fee-for-Service	1902982432	1902982432	1	1	PEARL, ROBERT M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25490	02	General Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
220591	Fee-for-Service	1447447248	1447447248	1	9	PACIFIC INPATIENT MEDICAL GR	3/28/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	234 SAN PEDRO RD	None	SAN RAFAEL	CA	94903	2858	21	06041	38.00293213	-122.5214702	Marin County
220636	Fee-for-Service	1376876912	1376876912	1	7	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
220637	Fee-for-Service	1609282771	1609282771	1	1	PARK, SARAH CNP	6/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
220653	Fee-for-Service	1215018403	1215018403	1	1	PECK, KIMBERLY A MD	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99324	89	Surgery-Traumatic	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
220668	Fee-for-Service	1548374200	1548374200	1	1	PHAM, TAN N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67089	08	Family Practice	0	In state provider	None	2967 DAVISON CT	STE A	COLUSA	CA	95932	3248	06	06011	39.18822138	-121.9974157	Colusa County
220670	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	10/23/2017	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
220671	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	9/25/2018	171100000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
220678	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
220728	Fee-for-Service	1114452810	1114452810	1	1	PATEL, MANDIRA DO	9/7/2023	1835C0206X	NA	None	026	PHYSICIANS	16797	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
220734	Fee-for-Service	1851515894	1851515894	1	2	PARK, HYUN S MD	12/1/2013	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	43 BELLEVUE	None	IRVINE	CA	92602	0112	30	06059	33.74404956	-117.7687024	Orange County
220737	Fee-for-Service	1528037041	1528037041	1	1	PLANNED PARENTHOOD	5/1/1989	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	918 W FOOTHILL BLVD	STE A	UPLAND	CA	91786	3772	36	06071	34.10676594	-117.6636152	San Bernardino County
220740	Fee-for-Service	1851384911	1851384911	1	1	PEDIATRIC ASSOCIATES	3/11/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF STOCKTON	89 W MARCH LN	STE 1	STOCKTON	CA	95207	5723	39	06077	37.9950695	-121.307499	San Joaquin County
220741	Fee-for-Service	1295758498	1295758498	2	1	PATEL, KANU K MD	10/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32124	20	Orthopedic Surgery	0	In state provider	None	7851 WALKER ST	103	LA PALMA	CA	90623	1734	30	06059	33.848253	-118.037309	Orange County
220754	Fee-for-Service	1992929616	1992929616	1	1	PARK, MI RAN MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103558	08	Family Practice	0	In state provider	None	329 W 8TH STREET	STE 101	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
220755	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
220760	Fee-for-Service	1144722653	1144722653	1	1	PRANA DIABETES INC	10/28/2020	251S00000X	NA	Other	102	DIABETES PREVENTION PROGRAM SUPPLIER	-	-	NOT APPLICABLE	0	In state provider	None	10 RAGSDALE DR	SUITE 102	MONTEREY	CA	93940	5793	27	06053	36.57825348	-121.823766	Monterey County
220761	Fee-for-Service	1699046508	1699046508	1	1	PATEL, KOMAL A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
220775	Fee-for-Service	1073534103	1073534103	1	1	PACIFIC SLEEP DISORDERS	9/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CENTER	1801 E MARCH LN	STE C310	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
220789	Fee-for-Service	1609986702	1609986702	2	1	PLUMAS MEDICAL SERVICES	7/29/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PLUMAS MEDICAL SERVICES	4352 MAIN STREET	None	TAYLORSVILLE	CA	95983	0185	32	06063	40.07526816	-120.8405421	Plumas County
220827	Fee-for-Service	1225131857	1225131857	1	1	PONRARTANA, SAOWAREE MD	6/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35227	40	Pediatrics	0	In state provider	None	3526 W 1ST ST	None	SANTA ANA	CA	92703	3302	30	06059	33.7451367	-117.9165177	Orange County
220844	Fee-for-Service	1912991597	1912991597	1	1	PATHOLOGY ASSOCIATES OF	5/25/1995	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOUTHERN CALIFORNIA	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
220845	Fee-for-Service	1083183107	1083183107	1	1	PRETZER, GINA M CCC-SLP	5/6/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
220869	Fee-for-Service	1649400128	1649400128	1	1	PHARMAGRACE INC	9/8/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	GRANDVIEW PHARMACY	13768 ROSWELL AVE	#111	CHINO	CA	91710	1402	36	06071	34.0038	-117.7218555	San Bernardino County
220893	Fee-for-Service	1598289704	1598289704	1	1	PETRAITIS HATFIELD, ANNA M L	12/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	D LMFT	735 STATE ST	STE 421	SANTA BARBARA	CA	93101	5584	42	06083	34.41942344	-119.6991527	Santa Barbara County
220925	Fee-for-Service	1912393505	1912393505	1	1	PAIK, PETER	9/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
220926	Fee-for-Service	1376876912	1376876912	1	7	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
220941	Fee-for-Service	1215018403	1215018403	1	1	PECK, KIMBERLY A MD	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99324	02	General Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
220953	Fee-for-Service	1265597967	1265597967	1	1	PINON, ALEXANDRA L MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102834	40	Pediatrics	0	In state provider	None	27555 YNEZ ROAD	SUITE 370	TEMECULA	CA	92591	4678	33	06065	33.50370608	-117.1492569	Riverside County
220960	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	11/24/2019	171100000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
220961	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
220963	Fee-for-Service	1902368947	1902368947	1	1	PELLETIER, PAUL MD	7/24/2023	207P00000X	NA	Other	026	PHYSICIANS	187250	None	None	0	In state provider	None	2050 VIBORG RD	None	SOLVANG	CA	93463	2220	42	06083	34.60246267	-120.1261332	Santa Barbara County
220968	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
220978	Fee-for-Service	1285921155	1285921155	1	1	PRABHU, DIVYA MD	7/29/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	137902	None	None	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
220991	Fee-for-Service	1841241585	1841241585	1	9	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	7850 VISTA HILL RD.	STE. 604	SAN DIEGO	CA	92123	2717	37	06073	32.79493052	-117.155268	San Diego County
221044	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
221051	Fee-for-Service	1760425862	1760425862	1	5	PROVIDENCE MEDICAL INSTITUTE	6/11/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	405 N MACLAY AVE	STE 104	SAN FERNANDO	CA	91340	2445	19	06037	34.28673788	-118.4367207	Los Angeles County
221084	Fee-for-Service	1306545090	1306545090	1	1	PIH HEALTH COMMUNITY PHARMAC	4/18/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11480 BROOKSHIRE AVE	102	DOWNEY	CA	90241	5091	19	06037	33.93622932	-118.1311752	Los Angeles County
221113	Fee-for-Service	1114942596	1114942596	1	1	PECK, DENNIS W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5702 N 26TH ST	None	TACOMA	WA	98407	0000	00	None	47.2710522	-122.5134367	Pierce County
221117	Fee-for-Service	1225131857	1225131857	1	1	PONRARTANA, SAOWAREE MD	6/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	35227	08	Family Practice	0	In state provider	None	3526 W 1ST ST	None	SANTA ANA	CA	92703	3302	30	06059	33.7451367	-117.9165177	Orange County
221143	Fee-for-Service	1144277633	1144277633	1	7	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
221158	Fee-for-Service	1306905047	1306905047	1	1	PAK, ESTHER MD	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89584	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
221188	Fee-for-Service	1205882883	1205882883	1	1	PELAYO, ARTURO MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72916	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
221190	Fee-for-Service	1942352315	1942352315	1	1	PAKDAMAN, MEHRDAD MD	2/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88797	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
221199	Fee-for-Service	1881907871	1881907871	1	1	PATHAK, ASHA K MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156811	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
221242	Fee-for-Service	1124016589	1124016589	1	1	PESCE, MICHAEL B MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37414	66	Emergency Medicine (Urgent Care)	0	In state provider	FRESNO COMMUNITY HOSP	PO BOX 1232	None	FRESNO	CA	93715	1232	10	06019	0	0	None
221247	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	8/11/2017	171100000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
221248	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	1/3/2014	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
221254	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
221260	Fee-for-Service	1063816882	1063816882	1	1	PARK, SEUNA NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
221266	Fee-for-Service	1386844694	1386844694	1	1	PLOTKIN, BENJAMIN E MD	11/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101721	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
221290	Fee-for-Service	1487702452	1487702452	1	1	PUGH, ANNE M MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60592	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
221293	Fee-for-Service	1821163221	1821163221	1	1	PREMIER MEDICAL SUPPLY	2/1/1993	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2800 MITCHELL RD	STE F	CERES	CA	95307	9463	50	06099	37.59177745	-120.9387542	Stanislaus County
221298	Fee-for-Service	1871607762	1871607762	1	56	PROVIDENCE MEDICAL FOUNDATIO	7/10/2019	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	N	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
221307	Fee-for-Service	1215047451	1215047451	1	1	PLEASURE, SAMUEL J MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	81074	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
221330	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
221341	Fee-for-Service	1104474261	1104474261	1	1	PATEL, KRISHNA OD	2/22/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 E WEBER AVE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
221362	Fee-for-Service	1093152324	1093152324	1	2	PALLIATIVE CARE CONSULTANTS	11/13/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	OF SANTA BARBARA	400 W PUEBLO AT BATH	None	SANTA BARBARA	CA	93105	4390	42	06083	34.430526	-119.72196	Santa Barbara County
221433	Fee-for-Service	1144277633	1144277633	1	7	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
221442	Fee-for-Service	1356495857	1356495857	1	1	PURVI JAI SANGHVI, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12505 LEBANON RD	None	FRISCO	TX	75035	8298	00	None	33.11585211	-96.77068374	Collin County
221489	Fee-for-Service	1881907871	1881907871	1	1	PATHAK, ASHA K MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156811	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
221531	Fee-for-Service	1124016589	1124016589	1	1	PESCE, MICHAEL B MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37414	05	Anesthesiology	0	In state provider	FRESNO COMMUNITY HOSP	PO BOX 1232	None	FRESNO	CA	93715	1232	10	06019	0	0	None
221535	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	5/3/2019	171100000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
221536	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	12/27/2016	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
221543	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
221572	Fee-for-Service	1588174395	1588174395	1	1	PHAN, TIFFANY H OD	6/12/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
221585	Fee-for-Service	1871607762	1871607762	1	56	PROVIDENCE MEDICAL FOUNDATIO	10/1/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
221586	Fee-for-Service	1194113977	1194113977	1	1	PITTS, JANA R LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3403	33	06065	33.904782	-117.469323	Riverside County
221595	Fee-for-Service	1285870717	1285870717	1	1	PRADHAN, SRUTI MD	10/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134997	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
221618	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
221630	Fee-for-Service	1700380110	1700380110	1	1	PRATT, MALERIE S MD	7/20/2021	208600000X	NA	General Surgery	026	PHYSICIANS	163838	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
221641	Fee-for-Service	1346224557	1346224557	1	2	PRESTERA, TORY MD	5/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	62321	18	Ophthalmology	0	In state provider	None	100 N RANCHO SANTA FE RD	STE 126	SAN MARCOS	CA	92069	1294	37	06073	33.15125491	-117.197854	San Diego County
221664	Fee-for-Service	1568783470	1568783470	1	1	PETERSEN, DANA K MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128697	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
221675	Fee-for-Service	1770150385	1770150385	1	1	PHAM, BRYAN MD	4/30/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	186871	41	Internal Medicine	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
221695	Fee-for-Service	1326173949	1326173949	1	1	PARVIN, ALIYAR A MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125127	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
221743	Fee-for-Service	1891926275	1891926275	1	1	PIYA, ANJULI MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121870	41	Internal Medicine	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
221752	Fee-for-Service	1790718625	1790718625	1	1	PATEL, SHAILESH C MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63416	36	Psychiatry	0	In state provider	None	801 SENECA ST	None	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
221771	Fee-for-Service	1518055409	1518055409	1	1	POLO-JACOBSSON, ESTELA M	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
221799	Fee-for-Service	1629062021	1629062021	1	1	POLUSSA, ARTHUR A MD	8/30/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36877	08	Family Practice	0	In state provider	None	812 POLLARD RD	SUITE 5	LOS GATOS	CA	95032	1420	43	06085	37.26225259	-121.9703692	Santa Clara County
221823	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2018	171100000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
221824	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	11/21/2016	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
221834	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
221836	Fee-for-Service	1437289147	1437289147	1	1	PATEL, JIGISHBHAI S MD	10/24/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172360	None	None	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2302	19	06037	34.02980528	-118.4786605	Los Angeles County
221847	Fee-for-Service	1194969956	1194969956	1	1	PADILLA, WILLIAM J A	5/25/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43091	08	Family Practice	0	In state provider	MEDICAL CORPORATION	263 CHURCH AVE	None	CHULA VISTA	CA	91910	2728	37	06073	32.64292218	-117.0793772	San Diego County
221870	Fee-for-Service	1386813947	1386813947	1	1	PAUL A SIMON MD	1/1/2013	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2268 MORENO DRIVE	None	LOS ANGELES	CA	90039	3044	19	06037	34.10116913	-118.2682016	Los Angeles County
221873	Fee-for-Service	1952406613	1952406613	1	1	PLOTNER, DAVID R MD FACS	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	25905	18	Ophthalmology	0	In state provider	None	201 W VALLEY PKWY	None	ESCONDIDO	CA	92025	2608	37	06073	33.12178205	-117.0836663	San Diego County
221905	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
221910	Fee-for-Service	1154591121	1154591121	1	1	PROMESA BEHAVIORAL HEALTH	12/13/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	7120 N MARKS AVE	SUIITE 110	FRESNO	CA	93711	0268	10	06019	36.83911219	-119.8473805	Fresno County
221913	Fee-for-Service	1528385200	1528385200	1	1	PARKWAY ENDOSCOPY CENTER	9/30/2004	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	488 E VALLEY PKWY	STE 110	ESCONDIDO	CA	92025	3366	37	06073	33.12523814	-117.0769715	San Diego County
221928	Fee-for-Service	1033607940	1033607940	1	1	PET, DOUGLAS B MD	6/22/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	167249	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
221940	Fee-for-Service	1932204070	1932204070	1	1	PHAM, DAN A MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36272	08	Family Practice	0	In state provider	None	4697 STILLWELL RD	None	SANTA MARIA	CA	93455	4566	42	06083	34.86881372	-120.4039184	Santa Barbara County
221952	Fee-for-Service	1447672290	1447672290	1	1	PAPA, CRISTINA CRNA	10/6/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
221953	Fee-for-Service	1568783470	1568783470	1	1	PETERSEN, DANA K MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128697	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
221955	Fee-for-Service	1447275938	1447275938	1	1	PIKEN, EDWARD P MD	7/1/1978	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	31877	41	Internal Medicine	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
221973	Fee-for-Service	1386807725	1386807725	1	1	PERALTA, RAPHAEL U MD	8/9/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186150	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
221993	Fee-for-Service	1700842556	1700842556	1	1	PATEL, MANESH R MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68394	30	Radiology	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1932	43	06085	37.34275712	-121.8768207	Santa Clara County
221994	Fee-for-Service	1891892774	1891892774	1	1	PANDOL, STEPHEN J MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33954	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
222029	Fee-for-Service	1043254220	1043254220	1	1	PAYNE, MICHAEL M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSOCI	0401 CASTLE CREEK RD	None	ASPEN	CO	81611	1159	00	None	39.190482	-106.839324	Pitkin County
222055	Fee-for-Service	1700270642	1700270642	1	1	PACIFIC INPATIENT PHYSICIANS	7/10/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
222102	Fee-for-Service	1679130132	1679130132	1	1	PATEL, SHIVANI DO	4/4/2024	390200000X	NA	Other	026	PHYSICIANS	19549	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
222113	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	12/27/2016	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
222114	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	1/11/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
222122	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
222141	Fee-for-Service	1447215256	1447215256	1	1	PETERSON, GAIL E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
222158	Fee-for-Service	1972913762	1972913762	1	1	PANNELL, WILLIAM C III MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132633	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
222195	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
222241	Fee-for-Service	1073063996	1073063996	1	1	PLACENTIA LINDA PHARMACY INC	1/17/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1233 E YORBA LINDA BLVD	None	PLACENTIA	CA	92870	3830	30	06059	33.8884683	-117.8406527	Orange County
222243	Fee-for-Service	1447275938	1447275938	1	1	PIKEN, EDWARD P MD	7/1/1978	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	31877	10	Gastroenterology (M.D. only)	0	In state provider	None	23560 MADISON ST	STE 211	TORRANCE	CA	90505	4710	19	06037	33.81145007	-118.3479265	Los Angeles County
222280	Fee-for-Service	1760570600	1760570600	1	25	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	650 HOWE AVE	BUILDING 100	SACRAMENTO	CA	95825	4732	34	06067	38.577294	-121.4146395	Sacramento County
222283	Fee-for-Service	1891892774	1891892774	1	1	PANDOL, STEPHEN J MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33954	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
222284	Fee-for-Service	1356648976	1356648976	1	1	PEREZ, ROSANA TRIVINO I LCSW	2/28/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
222297	Fee-for-Service	1982022737	1982022737	1	1	PARK, JOON S MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137694	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
222342	Fee-for-Service	1700270642	1700270642	1	1	PACIFIC INPATIENT PHYSICIANS	7/10/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
222375	Fee-for-Service	1407304439	1407304439	1	1	PREMIER ORTHOPAEDIC TRAUMA	10/31/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
222389	Fee-for-Service	1811351562	1811351562	1	1	PETURSSON, FREYR MD	8/26/2020	207P00000X	NA	Other	026	PHYSICIANS	153519	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
222399	Fee-for-Service	1235226531	1235226531	1	28	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
222400	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	9/25/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
222402	Fee-for-Service	1518586163	1518586163	1	1	PEREZ, BRITTANY M CNP	7/1/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	726 MEDICAL CENTER DR E	STE 205	CLOVIS	CA	93611	6809	10	06019	36.84186593	-119.6624867	Fresno County
222407	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
222410	Fee-for-Service	1407932619	1407932619	1	1	PACIFIC EYE INSTITUTE	11/2/1993	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
222412	Fee-for-Service	1336687797	1336687797	1	1	PAFENBERG, TROY E LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
222416	Fee-for-Service	1366509499	1366509499	1	1	PAUL, LESLIE D MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61506	41	Internal Medicine	0	In state provider	None	3831 HUGHES AVE	STE 705	CULVER CITY	CA	90232	6838	19	06037	34.02243278	-118.3981492	Los Angeles County
222443	Fee-for-Service	1255029054	1255029054	1	1	PATLA, CAITLIN LCSW	10/16/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
222483	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	2/27/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
222527	Fee-for-Service	1972625184	1972625184	1	1	PETRE, MAREN A LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6765 GREEN VALLEY RD	None	PLACERVILLE	CA	95667	0543	09	06017	38.72039732	-120.8664353	El Dorado County
222531	Fee-for-Service	1699295139	1699295139	1	2	PURCELL, NICOLE M LMFT	3/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
222567	Fee-for-Service	1760570600	1760570600	1	25	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	650 HOWE AVE	BUILDING 100	SACRAMENTO	CA	95825	4732	34	06067	38.577294	-121.4146395	Sacramento County
222593	Fee-for-Service	1871918870	1871918870	1	1	PROSPECT CHARTERCARE SJHSRI	7/13/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	200 HIGH SERVICE AVE	None	N PROVIDENCE	RI	02904	5114	00	None	41.85587499	-71.4585939	Providence County
222631	Fee-for-Service	1356927537	1356927537	1	1	PARSA, NAZLI	10/30/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
222650	Fee-for-Service	1093779613	1093779613	1	1	POCETA, J STEVEN MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59976	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
222667	Fee-for-Service	1386126829	1386126829	1	1	PETRIE, CAITLIN M CCC-SLP	6/12/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
222672	Fee-for-Service	1316079106	1316079106	1	1	PREMIER NEPHROLOGY	5/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1400 S GRAND AVE	STE 800	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
222680	Fee-for-Service	1780191882	1780191882	1	1	POSEY, NATASHA L LCSW	10/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
222687	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	12/9/2016	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
222698	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
222726	Fee-for-Service	1427117027	1427117027	1	1	PANCHAL, RASHMIN M MD	12/9/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45648	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
222734	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
222772	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
222848	Fee-for-Service	1871650135	1871650135	1	1	PAPPAS, WILLIAM F OD	6/30/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
222880	Fee-for-Service	1801671334	1801671334	1	1	PRATIVA RAJBHANDARI MD	10/13/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4201 TORRANCE BLVD	STE. 750	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
222881	Fee-for-Service	1871918870	1871918870	1	1	PROSPECT CHARTERCARE SJHSRI	7/13/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	200 HIGH SERVICE AVE	None	N PROVIDENCE	RI	02904	5114	00	None	41.85587499	-71.4585939	Providence County
222903	Fee-for-Service	1699773432	1699773432	1	1	PUNATAR, HARENDRA MD	7/2/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40868	06	Cardiovascular Disease (M.D. only)	0	In state provider	P O BOX 1619	5144 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10419823	-122.9089591	Lake County
222922	Fee-for-Service	1588002521	1588002521	1	1	PESTANA, LAURA DO	6/19/2019	207R00000X	NA	Other	026	PHYSICIANS	14732	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
222930	Fee-for-Service	1982720959	1982720959	1	1	POLLY, LAUREN E CCC-SLP	10/4/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
222931	Fee-for-Service	1619584497	1619584497	1	1	PROHEALTH PARTNERS A MEDICAL	6/22/2022	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP	3325 PALO VERDE AVENUE,	SUITE 201	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
222959	Fee-for-Service	1568776300	1568776300	1	1	PENNER, JANIS A MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103386	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
222975	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	12/8/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
222988	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	11/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
223014	Fee-for-Service	1427117027	1427117027	1	1	PANCHAL, RASHMIN M MD	12/9/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45648	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
223023	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
223055	Fee-for-Service	1710929963	1710929963	1	1	PHILLIPS, THEODORE L MD	9/1/2002	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19551	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223059	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
223068	Fee-for-Service	1679664361	1679664361	1	1	PATEL, KAVERI S DO	8/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7847	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
223125	Fee-for-Service	1609835198	1609835198	1	1	PARK, THOMAS MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54622	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
223183	Fee-for-Service	1548247042	1548247042	1	1	PROVIDENTI L JULIE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT P.C	2550 S PARKER RD	STE 206	AURORA	CO	80014	1679	00	None	39.670515	-104.8642785	Arapahoe County
223190	Fee-for-Service	1659830776	1659830776	2	1	PIH HEALTH GOOD SAMARITAN HO	3/27/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARMACY	1245 WILSHIRE BLVD	201	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
223196	Fee-for-Service	1114974797	1114974797	2	1	PHARMACY ALTERNATIVES CALIFO	12/16/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20635 GAS POINT RD	None	COTTONWOOD	CA	96022	9458	45	06089	40.38929336	-122.2881745	Shasta County
223205	Fee-for-Service	1982834347	1982834347	1	1	PENERA, KEITH E DPM	6/20/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1236 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2607	30	06059	33.8508897	-117.9761562	Orange County
223207	Fee-for-Service	1851850721	1851850721	1	1	PATEL, KEVIN MD	4/26/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	184958	07	Dermatology	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
223220	Fee-for-Service	1619584497	1619584497	1	1	PROHEALTH PARTNERS A MEDICAL	6/22/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP	3325 PALO VERDE AVENUE,	SUITE 201	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
223233	Fee-for-Service	1487810834	1487810834	1	1	PALOOLIAN, GREG W DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	932 RYLAND ST	None	RENO	NV	89502	1605	00	None	39.52380293	-119.7998835	Washoe County
223244	Fee-for-Service	1932135654	1932135654	1	1	PHIPATANAKUL, WESLEY MD	6/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81135	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
223261	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
223272	Fee-for-Service	1235226531	1235226531	1	48	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
223297	Fee-for-Service	1801406772	1801406772	1	1	PINE FOREST HEALTHCARE INC	1/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13922 CERISE AVE	None	HAWTHORNE	CA	90258	8118	19	06037	33.904692	-118.3330135	Los Angeles County
223303	Fee-for-Service	1417211426	1417211426	1	2	POMONA COMMUNITY HEALTH	1/28/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1448 E HOLT AVE	None	POMONA	CA	91767	5822	19	06037	34.06298538	-117.7221747	Los Angeles County
223309	Fee-for-Service	1770569642	1770569642	1	1	PHILLIPS, CHRISTOPHER J MD	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
223312	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
223342	Fee-for-Service	1710929963	1710929963	1	1	PHILLIPS, THEODORE L MD	9/1/2002	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19551	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223347	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
223380	Fee-for-Service	1114284163	1114284163	1	1	PENMAN, ADAM W A MD	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129234	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
223398	Fee-for-Service	1538701925	1538701925	1	1	PATEL, BINITA	5/7/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
223406	Fee-for-Service	1992809412	1992809412	2	4	POKROY MEDICAL GROUP OF NEVA	2/9/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	EVADA	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
223407	Fee-for-Service	1407477003	1407477003	1	1	PLEMAN, BRANDON M MD	9/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190238	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223418	Fee-for-Service	1528022712	1528022712	1	1	PERSONIUS, MATTHEW L MD	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62512	08	Family Practice	0	In state provider	None	20044 CEDAR RD N	None	SONORA	CA	95370	5900	55	06109	37.9872161	-120.3662945	Tuolumne County
223420	Fee-for-Service	1790924033	1790924033	1	1	PONCE, ROBERT A LCSW	2/2/2021	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
223428	Fee-for-Service	1386175867	1386175867	1	1	PRASAD, POOJA MD	7/31/2024	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	157711	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223456	Fee-for-Service	1548435811	1548435811	1	1	PARASHAR, KALIND MD	9/12/2023	390200000X	NA	Other	026	PHYSICIANS	189918	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
223510	Fee-for-Service	1619584497	1619584497	1	1	PROHEALTH PARTNERS A MEDICAL	6/22/2022	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP	3325 PALO VERDE AVENUE,	SUITE 201	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
223541	Fee-for-Service	1134312812	1134312812	1	1	PARTOVI, SUSAN M MD	12/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55312	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
223552	Fee-for-Service	1235226531	1235226531	1	45	PERMANENTE MEDICAL GROUP INC	1/3/2014	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
223555	Fee-for-Service	1013150176	1013150176	1	1	PANG, EVA K PT	7/15/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
223592	Fee-for-Service	1417211426	1417211426	1	2	POMONA COMMUNITY HEALTH	1/28/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1448 E HOLT AVE	None	POMONA	CA	91767	5822	19	06037	34.06298538	-117.7221747	Los Angeles County
223599	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
223603	Fee-for-Service	1477798759	1477798759	1	1	PEASE, ABIGAIL R MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97305	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
223605	Fee-for-Service	1922282862	1922282862	1	1	PASCUAL, EVELYN P	4/6/2000	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	304 CALLE ALCAZAR	None	WALNUT	CA	91789	1614	19	06037	34.01475678	-117.8751246	Los Angeles County
223635	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
223647	Fee-for-Service	1043599020	1043599020	1	1	PEREZ, MARIA LCSW	5/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
223664	Fee-for-Service	1396865234	1396865234	1	2	PACIFIC RIM HOME HEALTH INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2225 W COMMONWEALTH AVE	SUITE 202	ALHAMBRA	CA	91803	1334	19	06037	34.08783653	-118.1505384	Los Angeles County
223693	Fee-for-Service	1992809412	1992809412	2	4	POKROY MEDICAL GROUP OF NEVA	2/9/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	1	Border provider	EVADA	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
223701	Fee-for-Service	1144277633	1144277633	1	17	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2755 HERNDON AVENUE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
223709	Fee-for-Service	1629456520	1629456520	1	1	PORCIUNCULA, KEVIN T MD	3/4/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156667	01	General Practice	0	In state provider	None	1251 W TENNYSON RD	STE 4	HAYWARD	CA	94544	4400	01	06001	37.63146808	-122.0783775	Alameda County
223727	Fee-for-Service	1366824708	1366824708	1	1	PEREZ, EDITH J LCSW	7/19/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
223741	Fee-for-Service	1104922848	1104922848	1	2	PRN AMBULANCE, LLC	3/18/2024	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8928 SEPULVEDA BLVD	None	NORTH HILLS	CA	91343	4306	19	06037	34.23320214	-118.4674524	Los Angeles County
223787	Fee-for-Service	1285406397	1285406397	1	1	PATRICK-MUDD, LAUREN B LCSW	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
223799	Fee-for-Service	1912526179	1912526179	1	1	PHAN, ANN H DO	8/23/2023	207R00000X	NA	Other	026	PHYSICIANS	20914	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
223818	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
223872	Fee-for-Service	1689665317	1689665317	1	1	PHOENIX EMERGENCY	6/12/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MED GRP, INC.	13855 E 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
223876	Fee-for-Service	1205601747	1205601747	1	1	PRINCE & PRINCESS NEMT AND C	4/9/2024	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ONSULTING LLC	180 PROMENADE CIR	3RD FLOOR STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
223890	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
223895	Fee-for-Service	1205299187	1205299187	1	1	PARKER, ALICE R NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
223904	Fee-for-Service	1891862660	1891862660	1	1	PHAM, TAM T MD	12/5/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	78242	41	Internal Medicine	0	In state provider	None	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.8531521	-117.8160824	Orange County
223924	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
223927	Fee-for-Service	1497142251	1497142251	2	1	PHARMEDQUEST PHARMACY SERVIC	10/22/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	0000	19	06037	34.06750236	-117.925203	Los Angeles County
223930	Fee-for-Service	1275986697	1275986697	1	1	PACE, A PSYCHOLOGY CORPORATI	2/14/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ON	28310 ROADSIDE DR	STE 222	AGOURA HILLS	CA	91301	4923	19	06037	34.14271418	-118.7432847	Los Angeles County
223954	Fee-for-Service	1851595003	1851595003	1	1	PETERS, MICHAEL C MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112281	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUSS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223978	Fee-for-Service	1962972067	1962972067	1	1	PALMIERE, ADRIANA PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
223989	Fee-for-Service	1144277633	1144277633	1	17	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	2755 HERNDON AVENUE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
224055	Fee-for-Service	1104998400	1104998400	1	1	POLLACK, LARRY H MD	3/23/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	41696	24	Plastic Surgery	0	In state provider	None	7930 FROST ST	STE 101	SAN DIEGO	CA	92123	2756	37	06073	32.80027001	-117.1532893	San Diego County
224063	Fee-for-Service	1760845473	1760845473	1	1	PAYNE, NATHAN B DPM	5/1/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	123 MARGARET LN	STE A-1	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
224068	Fee-for-Service	1447447248	1447447248	1	5	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1355 ELLIS ST	None	SAN FRANCISCO	CA	94115	4215	38	06075	37.78281575	-122.4286471	San Francisco County
224071	Fee-for-Service	1841241585	1841241585	1	11	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	221 W CREST ST	SUITE 102	ESCONDIDO	CA	92025	1739	37	06073	33.13080316	-117.0884254	San Diego County
224080	Fee-for-Service	1265929129	1265929129	1	1	POSADAS, KRISTINE T MD	11/17/2022	208M00000X	NA	Other	026	PHYSICIANS	179505	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
224088	Fee-for-Service	1932555000	1932555000	1	1	PEREZ, MELISSA J MD	10/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153380	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
224103	Fee-for-Service	1790255990	1790255990	1	1	PIERRE, AYA NP	2/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
224108	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
224114	Fee-for-Service	1316319023	1316319023	1	1	PASALO, JAMES DO	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22366	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
224129	Fee-for-Service	1033378591	1033378591	1	1	PITOTTI, CHRISTOPHER J MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
224147	Fee-for-Service	1538209119	1538209119	1	1	PARAG, TORAL CHUNI MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88841	40	Pediatrics	0	In state provider	None	657 CAMINO DE LOS MARES	STE 243	SAN CLEMENTE	CA	92673	2811	30	06059	33.4575611	-117.6492697	Orange County
224152	Fee-for-Service	1447447248	1447447248	1	1	PACIFIC INPATIENT MEDICAL GR	1/16/2008	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
224161	Fee-for-Service	1619640059	1619640059	1	1	PIERNAS MARRIAGE & FAMILY TH	8/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERAPY INC.	27576 COMMERCE CENTER DR	SUITE 204	TEMECULA	CA	92590	2537	33	06065	33.51281416	-117.1616529	Riverside County
224178	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
224182	Fee-for-Service	1952457293	1952457293	1	1	PULMONARY CRITICAL CARE AND	3/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96384	29	Pulmonary Diseases (M.D. only)	0	In state provider	SLEEP	4046 S DEMAREE ST	None	VISALIA	CA	93277	9476	54	06107	36.293913	-119.3298255	Tulare County
224194	Fee-for-Service	1811324825	1811324825	1	1	PURE PEDIATRIC THERAPY INC	1/15/2021	225XF0002X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	92 ARGONAUT	SUITE 170	ALISO VIEJO	CA	92656	0000	30	06059	33.59217762	-117.7242901	Orange County
224196	Fee-for-Service	1669863114	1669863114	1	1	PROSTHETIC ARTISTS INC	5/23/2016	335E00000X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	1736 PROFESSIONAL DRIVE	None	SACRAMENTO	CA	95825	2105	34	06067	38.59707634	-121.3869587	Sacramento County
224203	Fee-for-Service	1972370807	1972370807	1	1	PANXPRESS HEALTH INC	3/13/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3055 MCKEE RD	None	SAN JOSE	CA	95127	1835	43	06085	37.37435097	-121.836765	Santa Clara County
224209	Fee-for-Service	1407044175	1407044175	1	1	PLANNED PARENTHOOD	6/27/2007	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHASTA-DIABLO	2935 BECHELLI LANE	STE C	REDDING	CA	96002	1905	45	06089	40.56452304	-122.3626362	Shasta County
224212	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
224216	Fee-for-Service	1003839002	1003839002	1	1	PARK, JOONG Y MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39059	41	Internal Medicine	0	In state provider	None	3511 W OLYMPIC BLVD	STE 101	LOS ANGELES	CA	90019	3563	19	06037	34.0525695	-118.3152015	Los Angeles County
224236	Fee-for-Service	1366413064	1366413064	1	1	PAULO, JERROD D OT	12/4/2018	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13690 E 14TH ST STE 200	None	SAN LEANDRO	CA	94578	2584	01	06001	37.71615361	-122.1438999	Alameda County
224268	Fee-for-Service	1619939691	1619939691	1	1	PE, IRENE O MD PC	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49301	01	General Practice	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 606	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
224285	Fee-for-Service	1578548806	1578548806	1	1	PATRICK, SHERI R NP	2/6/2010	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
224307	Fee-for-Service	1053573519	1053573519	1	1	PATEL, HITESH K MD	6/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111753	13	Neurology (M.D. only)	0	In state provider	None	665 CAMINO DE LOS MARES	STE 200	SAN CLEMENTE	CA	92673	2828	30	06059	33.45730192	-117.6483252	Orange County
224314	Fee-for-Service	1891158200	1891158200	1	1	PUNDI, KRISHNA N MD	3/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	150907	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
224318	Fee-for-Service	1558535476	1558535476	1	1	PRESTIGE ADULT DAY HEALTH	10/29/2008	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1765 S MAIN ST	STE 101	MILPITAS	CA	95035	6764	43	06085	37.40594287	-121.9029593	Santa Clara County
224346	Fee-for-Service	1578614087	1578614087	1	1	PRECAUTIONARY HOME HEALTH	4/17/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	11011 CRENSHAW BLVD	SUITE 203	INGLEWOOD	CA	90303	6334	19	06037	33.9354	-118.3265875	Los Angeles County
224357	Fee-for-Service	1447447248	1447447248	1	5	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1355 ELLIS ST	None	SAN FRANCISCO	CA	94115	4215	38	06075	37.78281575	-122.4286471	San Francisco County
224359	Fee-for-Service	1841241585	1841241585	1	11	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	221 W CREST ST	SUITE 102	ESCONDIDO	CA	92025	1739	37	06073	33.13080316	-117.0884254	San Diego County
224384	Fee-for-Service	1396249850	1396249850	1	1	PHAM, KATHLEEN P MD	8/26/2024	111NR0200X	NA	Other	026	PHYSICIANS	192501	30	Radiology	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
224392	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	4/2/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
224441	Fee-for-Service	1447447248	1447447248	1	1	PACIFIC INPATIENT MEDICAL GR	1/16/2008	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
224462	Fee-for-Service	1558516823	1558516823	1	1	PHAM, NGUYEN PHUONG D MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	105426	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
224465	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
224482	Fee-for-Service	1811324825	1811324825	1	1	PURE PEDIATRIC THERAPY INC	1/18/2021	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	92 ARGONAUT	SUITE 170	ALISO VIEJO	CA	92656	0000	30	06059	33.59217762	-117.7242901	Orange County
224495	Fee-for-Service	1528078532	1528078532	1	1	PARRISH-LUMKONG,	9/18/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83408	08	Family Practice	0	In state provider	KATHLEEN A MD	3230 WARING CT	STE P	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
224498	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
224502	Fee-for-Service	1003839002	1003839002	1	1	PARK, JOONG Y MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39059	08	Family Practice	0	In state provider	None	3511 W OLYMPIC BLVD	STE 101	LOS ANGELES	CA	90019	3563	19	06037	34.0525695	-118.3152015	Los Angeles County
224525	Fee-for-Service	1770537185	1770537185	1	1	PASCUAL, LISA U MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70055	25	Physical Medicine and Rehabilitation	0	In state provider	None	1001 POTRERO AVE	# 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
224538	Fee-for-Service	1144483678	1144483678	1	1	PAECH, NIKOLAS K MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116557	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
224557	Fee-for-Service	1619939691	1619939691	1	1	PE, IRENE O MD PC	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49301	40	Pediatrics	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 606	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
224566	Fee-for-Service	1346386257	1346386257	1	1	PENN VALLEY FIRE PRO DIS	7/28/1981	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10513 SPENCEVILLE RD	None	PENN VALLEY	CA	95946	9623	29	06057	39.19603841	-121.1776856	Nevada County
224570	Fee-for-Service	1013065960	1013065960	1	1	PATTERSON, DELIAH CRNA	4/17/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
224593	Fee-for-Service	1770576431	1770576431	1	1	PACIFIC RHEUMATOLOGY	3/31/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES MEDICAL GROUP	2100 WEBSTER ST	STE 112	SAN FRANCISCO	CA	94115	2374	38	06075	37.7904826	-122.4324477	San Francisco County
224597	Fee-for-Service	1053573519	1053573519	1	1	PATEL, HITESH K MD	6/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111753	41	Internal Medicine	0	In state provider	None	665 CAMINO DE LOS MARES	STE 200	SAN CLEMENTE	CA	92673	2828	30	06059	33.45730192	-117.6483252	Orange County
224598	Fee-for-Service	1710453709	1710453709	1	1	PORCHIA, TARINA LCSW	8/5/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
224666	Fee-for-Service	1548683568	1548683568	1	1	PEAKE, SAMANTHA LMFT	4/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
224667	Fee-for-Service	1962903856	1962903856	1	1	PEREZ, SILVANO E	8/13/2021	106S00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
224678	Fee-for-Service	1316247182	1316247182	1	1	PALMDALE REGIONAL WOMEN'S	11/8/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	520 W PALMDALE BLVD.	STE Q	PALMDALE	CA	93551	4231	19	06037	34.58407117	-118.1400842	Los Angeles County
224684	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
224700	Fee-for-Service	1558587519	1558587519	1	1	PANA, ANDREA L MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	74916	01	General Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
224751	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
224755	Fee-for-Service	1871641753	1871641753	1	1	PEREZ, MERCEDES P MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82028	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
224770	Fee-for-Service	1811324825	1811324825	1	1	PURE PEDIATRIC THERAPY INC	1/15/2021	225XF0002X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	92 ARGONAUT	SUITE 170	ALISO VIEJO	CA	92656	0000	30	06059	33.59217762	-117.7242901	Orange County
224787	Fee-for-Service	1235226531	1235226531	1	43	PERMANENTE MEDICAL GROUP INC	4/15/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3784 BROADWAY	None	OAKLAND	CA	94611	5614	01	06001	37.82564701	-122.2578268	Alameda County
224797	Fee-for-Service	1871957639	1871957639	1	1	PAULOS, JOSHUA LCSW	9/30/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
224799	Fee-for-Service	1831103779	1831103779	1	1	PEACE, DEVAUGHN K MD INC	1/1/1979	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	29868	40	Pediatrics	0	In state provider	None	4326 S WESTERN AVE	None	LOS ANGELES	CA	90062	1648	19	06037	34.004241	-118.308901	Los Angeles County
224806	Fee-for-Service	1164000840	1164000840	1	1	PHINNEY, LAUREN B MD	6/6/2024	207R00000X	NA	Other	026	PHYSICIANS	192275	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224867	Fee-for-Service	1710067632	1710067632	1	1	PROF ACTION MED TRAN,INC	10/14/2005	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ACTION MEDICAL TRANSPORT	4749 ELMWOOD AVE	None	LOS ANGELES	CA	90004	3110	19	06037	34.07831412	-118.3108794	Los Angeles County
224881	Fee-for-Service	1144277633	1144277633	1	8	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	FRESNO AND R STREETS	2823 FRESNO STREET	FRESNO	CA	93721	1324	10	06019	36.741663	-119.7841005	Fresno County
224895	Fee-for-Service	1528697307	1528697307	1	1	PERENNIAL HOME HEALTH	3/31/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	14664 VICTORY BLVD	STE 102	VAN NUYS	CA	91411	1621	19	06037	34.18663547	-118.4529105	Los Angeles County
224912	Fee-for-Service	1750495669	1750495669	1	1	PERITONEAL DIALYSIS CENTER	10/19/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF AMERICA LLC	3112 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02380316	-118.1371892	Los Angeles County
224934	Fee-for-Service	1770752545	1770752545	1	1	PREMIER EMERG PHYSICIANS	3/1/2008	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIF MEDICAL GRP APC	1310 HANNA AVE	None	CORCORAN	CA	93212	2314	16	06031	36.09975818	-119.5641426	Kings County
224970	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
224990	Fee-for-Service	1558587519	1558587519	1	1	PANA, ANDREA L MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	74916	25	Physical Medicine and Rehabilitation	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
225001	Fee-for-Service	1679024731	1679024731	1	1	POSADAS, JOSSETTE A NP	5/14/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
225015	Fee-for-Service	1508072307	1508072307	2	1	PENTA STAR INC	6/24/2013	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	204 E CHEVY CHASE DR	#5	GLENDALE	CA	91205	3178	19	06037	34.13349253	-118.253466	Los Angeles County
225020	Fee-for-Service	1306446976	1306446976	1	1	PASSAGES HOSPICE CARE, INC	12/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2345 ERRINGER ROAD	SUITE 211	SIMI VALLEY	CA	93065	2262	56	06111	34.2780309	-118.7614333	Ventura County
225041	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
225071	Fee-for-Service	1205846722	1205846722	1	1	PEKAREK, DAWN M MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132839	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
225080	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	4/5/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
225086	Fee-for-Service	1699354787	1699354787	1	1	PEACE & HARMONY HOME HEALTH	2/23/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	11350 VENTURA BLVD	SUITE 102	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
225087	Fee-for-Service	1407035512	1407035512	1	1	POPLAR HOLDINGS, LLC	4/16/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15632 POMERADO RD	None	POWAY	CA	92064	2406	37	06073	32.9980677	-117.0579223	San Diego County
225095	Fee-for-Service	1538195821	1538195821	1	1	PORTERVILLE COMMUNITY	6/9/2006	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PHYSICIANS INC	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
225109	Fee-for-Service	1144277633	1144277633	1	9	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	15 E AUDUBON DRIVE	None	FRESNO	CA	93720	1542	10	06019	36.86091856	-119.7886861	Fresno County
225143	Fee-for-Service	1285011445	1285011445	1	1	POTYAGOVA, NATALYA MFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 303	TARZANA	CA	91356	6022	19	06037	34.17264197	-118.5613482	Los Angeles County
225165	Fee-for-Service	1144277633	1144277633	1	8	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	FRESNO AND R STREETS	2823 FRESNO STREET	FRESNO	CA	93721	1324	10	06019	36.741663	-119.7841005	Fresno County
225199	Fee-for-Service	1780808592	1780808592	1	1	PAPPAS, LAURIE A	3/22/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1738 JEANNE CIR	None	MARTINEZ	CA	94553	6618	07	06013	37.97697838	-122.0926389	Contra Costa County
225201	Fee-for-Service	1427009364	1427009364	1	1	PISUPATI, DEEPTI MD	1/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82391	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
225225	Fee-for-Service	1861584294	1861584294	1	1	PODDUTURU, VIKRAM R MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108475	None	None	0	In state provider	None	340 W EAST AVENUE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
225257	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
225310	Fee-for-Service	1306446976	1306446976	1	1	PASSAGES HOSPICE CARE, INC	12/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2345 ERRINGER ROAD	SUITE 211	SIMI VALLEY	CA	93065	2262	56	06111	34.2780309	-118.7614333	Ventura County
225325	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
225368	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	5/25/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
225378	Fee-for-Service	1225008485	1225008485	1	1	PETROZZI, CAROLS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 S BALLENGER HWY	None	FLINT	MI	48532	3638	00	None	43.01432039	-83.73359605	Genesee County
225382	Fee-for-Service	1003888991	1003888991	1	1	PFISTERER, WILLIAM H MD	8/18/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	27764	30	Radiology	0	In state provider	None	400 N POMONA	None	FULLERTON	CA	92632	0000	30	06059	33.87368812	-117.9220861	Orange County
225396	Fee-for-Service	1013905660	1013905660	1	2	PROVIDENCE HEALTH & SERVICES	6/13/2018	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	1915 E REZANOF DR	None	KODIAK	AK	99615	6602	00	None	57.80140363	-152.3733142	Kodiak Island Borough
225397	Fee-for-Service	1144277633	1144277633	1	9	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	15 E AUDUBON DRIVE	None	FRESNO	CA	93720	1542	10	06019	36.86091856	-119.7886861	Fresno County
225429	Fee-for-Service	1285782102	1285782102	1	1	PEARL, IRWIN J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40002	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
225439	Fee-for-Service	1144277633	1144277633	1	15	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
225446	Fee-for-Service	1245331537	1245331537	1	1	PETROVICH, ANNA A	7/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8324	08	Family Practice	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
225511	Fee-for-Service	1467606368	1467606368	1	3	PERKINS, KRISTIN LCSW	7/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
225546	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
225549	Fee-for-Service	1144413998	1144413998	1	1	PEGG, JANELLE D MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126423	08	Family Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
225554	Fee-for-Service	1508849084	1508849084	1	1	PORTWOOD, MARGARET M	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38758	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 J ST	STE 105	SACRAMENTO	CA	95816	5542	34	06067	38.571237	-121.4566245	Sacramento County
225556	Fee-for-Service	1841796398	1841796398	1	1	PATTON, NADINE M MD	6/12/2024	2084E0001X	NA	Neurology	026	PHYSICIANS	187085	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
225558	Fee-for-Service	1396163713	1396163713	1	1	PRUITT, LOUIS	11/7/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
225579	Fee-for-Service	1144380536	1144380536	1	1	POTTER, MARIA P	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
225585	Fee-for-Service	1366567026	1366567026	1	1	PREGNANCY CONSULTATION	5/3/1993	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTER & MEDICAL GROUP	5301 F ST	STE 10	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
225617	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
225653	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	4/13/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
225682	Fee-for-Service	1013905660	1013905660	1	2	PROVIDENCE HEALTH & SERVICES	6/13/2018	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	WASHINGTON	1915 E REZANOF DR	None	KODIAK	AK	99615	6602	00	None	57.80140363	-152.3733142	Kodiak Island Borough
225718	Fee-for-Service	1285782102	1285782102	1	1	PEARL, IRWIN J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40002	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
225728	Fee-for-Service	1144277633	1144277633	1	15	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
225783	Fee-for-Service	1053513259	1053513259	1	1	PRYOR, DAVID P MD	10/1/2000	207R00000X	NA	Other	026	PHYSICIANS	68432	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
225837	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	3/5/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
225902	Fee-for-Service	1952784076	1952784076	1	1	PERFECT HEALTHNET LLC	3/28/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 TOWNSEND ST	SUITE 636	SAN FRANCISCO	CA	94107	1697	38	06075	37.7761061	-122.396307	San Francisco County
225906	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	6/19/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
225930	Fee-for-Service	1083068340	1083068340	1	1	PANDYARAJAN, VIJAY MD	7/1/2022	207R00000X	NA	Other	026	PHYSICIANS	153821	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
225931	Fee-for-Service	1528880432	1528880432	1	1	PEREIRA, SUGEIY OT	3/12/2025	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
225939	Fee-for-Service	1568897718	1568897718	1	1	PULKET, HOLLY L PT	5/7/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	770 MASON STREET	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
225944	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	5/18/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
225951	Fee-for-Service	1841241585	1841241585	1	5	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	1550 HOTEL CIR N	STE. 450	SAN DIEGO	CA	92108	2901	37	06073	32.75959113	-117.1772351	San Diego County
225974	Fee-for-Service	1134449929	1134449929	1	1	PALOMAKI, MARY B MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	121747	40	Pediatrics	0	In state provider	None	1186 LELAND STREET	None	TULARE	CA	93274	7811	54	06107	36.23014473	-119.3277192	Tulare County
225996	Fee-for-Service	1457321317	1457321317	1	2	PALOMAR HEALTH	4/24/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	120 CRAVEN ROAD	STE 109	SAN MARCOS	CA	92078	4236	37	06073	33.12748853	-117.1662795	San Diego County
225998	Fee-for-Service	1104299346	1104299346	1	1	PAPPAS, DUSTIN D LMFT	10/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
226071	Fee-for-Service	1780245563	1780245563	1	1	PATEL, ISHITA MD	8/19/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176001	None	None	0	In state provider	None	200 S WELLS RD STE 100	None	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
226110	Fee-for-Service	1316396906	1316396906	1	1	PARK, JOANN J MD	10/4/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	151063	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
226124	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
226153	Fee-for-Service	1760845846	1760845846	1	1	PALOMINO VARGAS, JORGE D MD	10/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159750	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
226160	Fee-for-Service	1699726984	1699726984	3	1	PULMONARY SOLUTIONS, LLC	11/29/2018	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2396 WALSH AVE	STE A	SANTA CLARA	CA	95051	1340	43	06085	37.36945147	-121.9679875	Santa Clara County
226168	Fee-for-Service	1043398811	1043398811	1	1	PHU, PHAN T MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84679	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
226180	Fee-for-Service	1669820163	1669820163	1	1	PATEL, SWATI MD	4/30/2021	207R00000X	NA	Other	026	PHYSICIANS	162372	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
226195	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
226199	Fee-for-Service	1669727210	1669727210	1	1	PULLEY, BENJAMIN R MD	8/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148168	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226209	Fee-for-Service	1568786465	1568786465	2	1	PATEL, KARTIK K MD	5/3/2023	207R00000X	NA	Other	026	PHYSICIANS	170538	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
226229	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
226263	Fee-for-Service	1063496651	1063496651	1	35	PACIFIC CENTRAL COAST HEALTH	4/30/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3418 LOMA VISTA RD	STE B	VENTURA	CA	93003	3065	56	06111	34.27643562	-119.2503132	Ventura County
226285	Fee-for-Service	1376720219	1376720219	1	1	PRICE, LESTINA C MD	1/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101168	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
226300	Fee-for-Service	1073872826	1073872826	1	1	PATEL, VISAL H MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147037	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
226315	Fee-for-Service	1972608214	1972608214	1	1	PHAN, JOHN C MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	75733	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
226329	Fee-for-Service	1154453108	1154453108	1	1	PROHEALTH PARTNERS	10/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1777 N BELLFLOWER BLVD	STE 101	LONG BEACH	CA	90815	4019	19	06037	33.78791149	-118.1240221	Los Angeles County
226414	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
226444	Fee-for-Service	1063944759	1063944759	1	1	POBLETE, JOBERT B MD	5/28/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161588	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
226480	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
226505	Fee-for-Service	1871287995	1871287995	1	1	PEREZ-FRANCO, MARTHA DOULA	8/21/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
226506	Fee-for-Service	1598812174	1598812174	1	1	PEREZ, LUIS A MD INC	4/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56266	08	Family Practice	0	In state provider	None	16297 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	5425	19	06037	33.8857437	-118.1602005	Los Angeles County
226520	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	5/18/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
226522	Fee-for-Service	1245262948	1245262948	1	1	PRADO, MICHAEL S DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5524 ASSEMBLY COURT	None	SACRAMENTO	CA	95823	2625	34	06067	38.493306	-121.4392995	Sacramento County
226523	Fee-for-Service	1851352371	1851352371	1	1	PETTIS, CHRISTOPHER R MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156627	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
226531	Fee-for-Service	1003958240	1003958240	1	1	PEARL, RONALD G MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	38269	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
226559	Fee-for-Service	1063496651	1063496651	1	46	PACIFIC CENTRAL COAST HEALTH	9/1/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4460 BROAD ST	STE 110	SAN LUIS OBISPO	CA	93401	7933	40	06079	35.24211197	-120.6389543	San Luis Obispo County
226591	Fee-for-Service	1659771541	1659771541	1	1	PIERCE, JASON LMFT	11/14/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
226617	Fee-for-Service	1831377829	1831377829	1	1	PERAFAN, JEANNE M	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	81709 DR CARREON BLVD	STE C3	INDIO	CA	92201	5577	33	06065	33.70733082	-116.2400326	Riverside County
226698	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
226710	Fee-for-Service	1063844496	1063844496	1	1	PETER BATES, APRN	7/16/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	302 N HOSPITAL DR	None	GIRARD	KS	66743	2000	00	None	37.51462395	-94.8583732	Crawford County
226712	Fee-for-Service	1023773306	1023773306	1	1	PIPES-JOYNER, STACY Y LCSW	1/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6809 INDIANA AVE	130 B-11	RIVERSIDE	CA	92506	4221	33	06065	33.94312844	-117.3918196	Riverside County
226734	Fee-for-Service	1376886606	1376886606	1	1	PARK, KATHERINE J MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134092	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
226750	Fee-for-Service	1831385624	1831385624	1	1	PRYOR, WANDEE PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
226760	Fee-for-Service	1447447248	1447447248	1	12	PACIFIC INPATIENT MEDICAL GR	6/23/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
226766	Fee-for-Service	1235226531	1235226531	1	52	PERMANENTE MEDICAL GROUP INC	6/19/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
226773	Fee-for-Service	1619948809	1619948809	1	1	PARREIRA, AMANDA M OD	5/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	894 MEINECKE AVE	STE A	SAN LUIS OBISPO	CA	93405	1790	40	06079	35.29244146	-120.6683145	San Luis Obispo County
226805	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	3/25/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
226818	Fee-for-Service	1003958240	1003958240	1	1	PEARL, RONALD G MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	38269	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
226822	Fee-for-Service	1598813461	1598813461	1	1	PORCH, JULIET V MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73757	24	Plastic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
226872	Fee-for-Service	1255508305	1255508305	1	1	PIQUE ALLISON L MD	10/26/2010	207P00000X	NA	Other	026	PHYSICIANS	105764	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
226882	Fee-for-Service	1225527054	1225527054	1	1	PUKHALSKAYA, TATSIANA MD	10/12/2023	207ND0900X	NA	Dermatology	026	PHYSICIANS	176396	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
226926	Fee-for-Service	1396239919	1396239919	1	1	PATEL, DEEP MD	9/20/2023	207LP2900X	NA	Other	026	PHYSICIANS	186679	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
226935	Fee-for-Service	1083055073	1083055073	1	1	PATEL, JIGNESH A MD	6/18/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171563	None	None	0	In state provider	None	415 E HARDING WAY	STE D	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
226953	Fee-for-Service	1033375910	1033375910	1	1	PICHETSHOTE, NIPAPORN MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	103806	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	4125	19	06037	34.07671715	-118.3799413	Los Angeles County
226955	Fee-for-Service	1881912566	1881912566	1	1	PACIFIC MEDICAL INC	11/23/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6011 N FRESNO	STE 115	FRESNO	CA	93710	5237	10	06019	36.823329	-119.7814395	Fresno County
226966	Fee-for-Service	1043581713	1043581713	1	1	PADHYA, DIPTI MD	11/24/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169667	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
226982	Fee-for-Service	1265842934	1265842934	1	1	PAN, DANA MD	8/25/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141881	10	Gastroenterology (M.D. only)	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
226988	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	7/24/2017	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
227046	Fee-for-Service	1447447248	1447447248	1	12	PACIFIC INPATIENT MEDICAL GR	6/23/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
227050	Fee-for-Service	1528590684	1528590684	1	1	PATHAK, KRITI	11/20/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	23334	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
227066	Fee-for-Service	1801115233	1801115233	1	1	PHU ACUNA, MAI J MD	3/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11217	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
227070	Fee-for-Service	1811968449	1811968449	1	1	PLOURD, DAVID M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50472	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
227087	Fee-for-Service	1689792327	1689792327	1	1	PORTERFIELD, CHRISTOPHER P	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128646	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	1941 JOHNSON AVE	SUITE 101	SAN LUIS OBISPO	CA	93401	4154	40	06079	35.27804785	-120.649711	San Luis Obispo County
227096	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
227097	Fee-for-Service	1063610178	1063610178	1	1	PARKER, KRISTINE J	12/10/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
227106	Fee-for-Service	1609873074	1609873074	1	1	PARMLEY, MICHAEL W MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	65290	41	Internal Medicine	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
227158	Fee-for-Service	1932416740	1932416740	1	1	PHADKE, MADHURA Y MD	12/28/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	168756	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
227164	Fee-for-Service	1063496651	1063496651	1	38	PACIFIC CENTRAL COAST HEALTH	2/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1255 LAS TABLAS RD	SUITE 201	TEMPLETON	CA	93456	9750	40	06079	35.55437053	-120.721806	San Luis Obispo County
227192	Fee-for-Service	1053586461	1053586461	1	1	PAREKH, HEMALATHA R MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50919	01	General Practice	0	In state provider	None	333 N SUNSET AVE	None	WEST COVINA	CA	91790	1651	19	06037	34.07709274	-117.9352522	Los Angeles County
227204	Fee-for-Service	1801148564	1801148564	1	1	PRIORITY HOSPICE CARE INC	12/19/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	410 W BADILLO ST	SUITE 200	COVINA	CA	91723	1832	19	06037	34.08628025	-117.8971241	Los Angeles County
227245	Fee-for-Service	1285688176	1285688176	1	1	PETER M SCHULMAN MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
227252	Fee-for-Service	1609358282	1609358282	1	1	PERENNIAL HOME HEALTH CARE	6/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC.	2321 WEST OLIVE AVE	SUITE L	BURBANK	CA	91506	2662	19	06037	34.16225637	-118.3284986	Los Angeles County
227276	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
227308	Fee-for-Service	1194782326	1194782326	1	1	PATALINO,DAVID J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1729 BURRSTONE ROAD	None	NEW HARTFORD	NY	13413	0000	00	None	43.093143	-75.279564	Oneida County
227338	Fee-for-Service	1528590684	1528590684	1	1	PATHAK, KRITI	11/20/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	23334	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
227385	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	7/4/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
227413	Fee-for-Service	1376829697	1376829697	1	2	PROVIDENCE HOME MEDICAL, L.P	6/5/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	.	451 VALLEY BROOK ROAD	STE 204	MCMURRAY	PA	15317	3375	00	None	40.28011335	-80.08602048	Washington County
227421	Fee-for-Service	1083927503	1083927503	1	1	PRAEGER, JONATHAN A MD	8/4/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	143138	33	Thoracic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
227482	Fee-for-Service	1720689755	1720689755	1	1	PASADENA VILLA INC	4/13/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1811 N RAYMOND AVE	None	PASADENA	CA	91103	1840	19	06037	34.17706177	-118.1491908	Los Angeles County
227492	Fee-for-Service	1073093472	1073093472	1	1	PIVOT ACUPUNCTURE & INTEGRAT	2/23/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1300 OLIVER RD	180	FAIRFIELD	CA	94534	3413	48	06095	38.25596102	-122.0674133	Solano County
227493	Fee-for-Service	1801148564	1801148564	1	1	PRIORITY HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	410 W BADILLO ST	SUITE 200	COVINA	CA	91723	1832	19	06037	34.08628025	-117.8971241	Los Angeles County
227506	Fee-for-Service	1396233185	1396233185	1	1	PETROSSIAN, CAROLINE MD	4/13/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	76448	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
227530	Fee-for-Service	1003857715	1003857715	1	1	PETZINGER, GISSELLE M MD	2/1/1997	2084N0400X	NA	Neurology	026	PHYSICIANS	81976	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
227541	Fee-for-Service	1942372271	1942372271	1	1	PHAN, ANH H MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65503	22	Pathology (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
227564	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
227567	Fee-for-Service	1942598479	1942598479	1	1	PETROSIAN, MELISSA LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY RD	201	VALENCIA	CA	91355	1804	19	06037	34.41741018	-118.5770409	Los Angeles County
227582	Fee-for-Service	1457437626	1457437626	1	1	PANG, SHIRLEY W MD	5/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80798	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
227599	Fee-for-Service	1922590074	1922590074	1	1	PIONEER ORTHOTICS AND PROSTH	1/28/2019	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ETICS	23672 BIRTCHER DR	A	LAKE FOREST	CA	92630	1711	30	06059	33.63359204	-117.7170667	Orange County
227663	Fee-for-Service	1902873342	1902873342	1	1	PATAWARAN, DOMINIC D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68859	08	Family Practice	0	In state provider	None	1711 W TEMPLE ST	FL 7	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
227673	Fee-for-Service	1649628884	1649628884	1	1	PAXTON, HEATHER LCSW	1/29/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
227674	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
227686	Fee-for-Service	1477390086	1477390086	1	1	PATTERSON, BRITTA BIRTH DOU	8/6/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
227687	Fee-for-Service	1558623397	1558623397	1	1	PHARNICHYAKUL, SAHACHAT LMF	1/11/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97180	-	NOT APPLICABLE	0	In state provider	LMFT	11777 SEBASTIAN WAY	SUITE 102	RANCHO CUCAMONGA	CA	91730	0707	36	06071	34.10414799	-117.548378	San Bernardino County
227705	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
227706	Fee-for-Service	1972683118	1972683118	1	1	PHAM, LINH T MD	6/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81562	40	Pediatrics	0	In state provider	None	600 WEST LA PALMA AVENUE	None	ANAHEIM	CA	92801	2361	30	06059	33.8471617	-117.9259968	Orange County
227707	Fee-for-Service	1679621510	1679621510	1	1	PANIAGUA, SANDRA MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60293	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
227737	Fee-for-Service	1184030843	1184030843	1	1	PINEDA, GABRIELA LMFT	7/12/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	19	06037	33.73875253	-118.2899475	Los Angeles County
227771	Fee-for-Service	1801985049	1801985049	1	1	PLANNED PARENTHOOD LA-	7/28/2005	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	DOROTHY HEALTH CENTER	8520 S BROADWAY	None	LOS ANGELES	CA	90003	3335	19	06037	33.96110579	-118.2782667	Los Angeles County
227776	Fee-for-Service	1144747122	1144747122	1	1	PERLMAN, JONATHAN D LCSW	12/4/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5855 TOPANGA CANYON BLVD	STE 510	WOODLAND HILLS	CA	91367	4627	19	06037	34.17696642	-118.605101	Los Angeles County
227832	Fee-for-Service	1720340805	1720340805	1	1	PAUL-COKER, DESMOND DO	5/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13835	41	Internal Medicine	0	In state provider	None	4770 W HERNDON AVE	STE 107	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
227851	Fee-for-Service	1235226531	1235226531	1	14	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
227853	Fee-for-Service	1417211426	1417211426	1	3	POMONA COMMUNITY HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	750 S PARK AVE	SUITE 101	POMONA	CA	91766	3129	19	06037	34.05272034	-117.7543163	Los Angeles County
227890	Fee-for-Service	1639367410	1639367410	1	1	PATTERSON, SHANE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101116	01	General Practice	0	In state provider	None	255 NEW YORK RANCH RD	STE C	JACKSON	CA	95646	2131	03	06005	38.35486618	-120.7676002	Amador County
227908	Fee-for-Service	1184331928	1184331928	1	1	PEREZ, KRISTIN A CNP	2/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
227910	Fee-for-Service	1366057499	1366057499	1	1	PELAEZ ESTRADA, JESSICA LCS	12/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
227957	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
227958	Fee-for-Service	1538210950	1538210950	1	1	PENA, JEANETTE DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	620 ALABAMA ST	None	REDLANDS	CA	92373	8059	36	06071	34.061841	-117.208804	San Bernardino County
227963	Fee-for-Service	1396125449	1396125449	1	1	PATEL, PRASHANT DO	10/14/2022	208M00000X	NA	Other	026	PHYSICIANS	19876	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
227971	Fee-for-Service	1013156967	1013156967	1	1	PUGH, SHAWNNELL LCSW	2/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7121 MAGNOLIA AVE	STE O	RIVERSIDE	CA	92504	3805	33	06065	33.9455319	-117.4027101	Riverside County
227974	Fee-for-Service	1679866057	1679866057	1	1	PNR PHARMA INC	8/26/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14541 BROOKHURST STREET	#C5	WESTMINSTER	CA	92683	5784	30	06059	33.75135	-117.954936	Orange County
227994	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	4/15/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
228012	Fee-for-Service	1982047163	1982047163	1	1	PIRROTTA, STEFANIA A DO	6/30/2020	207RC0200X	NA	Other	026	PHYSICIANS	15652	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
228034	Fee-for-Service	1780203943	1780203943	1	3	PILLAY, YEOSHINA MD	3/10/2025	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	188620	-	NOT APPLICABLE	0	In state provider	None	1914 22ND ST	None	SACRAMENTO	CA	95816	7109	34	06067	38.565666	-121.482	Sacramento County
228070	Fee-for-Service	1689661571	1689661571	1	1	PHUNG, RICHARD N OD	5/1/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9880 HIBERT ST	STE E1	SAN DIEGO	CA	92131	1068	37	06073	32.91546519	-117.1139382	San Diego County
228100	Fee-for-Service	1588760185	1588760185	1	1	PALMER, STEVEN L MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85814	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE STREET	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
228102	Fee-for-Service	1982185484	1982185484	1	1	PHAM, CASSIDY	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
228104	Fee-for-Service	1437598703	1437598703	1	1	PHILLIPS, ERIN J LMFT	7/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	310 8TH ST	SUITE 201	OAKLAND	CA	94607	4210	01	06001	37.79894269	-122.2704172	Alameda County
228130	Fee-for-Service	1881862845	1881862845	2	1	PANDY, LIZANDER C DO	1/6/2009	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	9809	None	None	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
228141	Fee-for-Service	1417211426	1417211426	1	3	POMONA COMMUNITY HEALTH	7/24/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	750 S PARK AVE	SUITE 101	POMONA	CA	91766	3129	19	06037	34.05272034	-117.7543163	Los Angeles County
228158	Fee-for-Service	1114388014	1114388014	1	1	PHILLIP, NIMEKA N MD	1/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163662	None	None	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
228199	Fee-for-Service	1942459607	1942459607	1	1	PARKS, PAT PA-C	9/9/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	56397	-	NOT APPLICABLE	0	In state provider	None	1116 ALICE ST	None	MODESTO	CA	95350	5905	50	06099	37.64725064	-121.007524	Stanislaus County
228224	Fee-for-Service	1134423387	1134423387	1	1	PETIT, THOMAS SEAN WILLIAM	8/20/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	MD	12923 INGLEWOOD AVE	STE. 1	HAWTHORNE	CA	90250	5573	19	06037	33.914961	-118.3613055	Los Angeles County
228249	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	4/26/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
228260	Fee-for-Service	1316970338	1316970338	1	1	PALCHAK, MICHAEL J MD	7/31/1988	207P00000X	NA	Other	026	PHYSICIANS	63751	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
228265	Fee-for-Service	1902881972	1902881972	1	1	PARK, SUSANNA S MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75691	18	Ophthalmology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
228280	Fee-for-Service	1710989223	1710989223	1	1	PANTIG ASTORGA, ROWENA D	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52675	08	Family Practice	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
228281	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
228287	Fee-for-Service	1023364593	1023364593	2	1	PATEL, SATYAM MD	9/14/2023	208M00000X	NA	Other	026	PHYSICIANS	165036	None	None	0	In state provider	None	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
228289	Fee-for-Service	1447447248	1447447248	1	13	PACIFIC INPATIENT MEDICAL GR	12/18/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	40 CAMINO ALTO	None	MILL VALLEY	CA	94941	2956	21	06041	37.89488678	-122.529946	Marin County
228316	Fee-for-Service	1750860771	1750860771	1	1	PARRELL, BOBBIE R LCSW	11/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
228317	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
228336	Fee-for-Service	1831574557	1831574557	1	1	PREMIUM PODIATRY HEALTHCARE	4/3/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	& SERVICES INC	21650 BURBANK BLVD	UNIT 210	WOODLAND HILLS	CA	91367	6472	19	06037	34.17324948	-118.601235	Los Angeles County
228359	Fee-for-Service	1205412244	1205412244	1	1	PRECISION HEALTH CENTER	10/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	709 N HILL ST	STE 18	LOS ANGELES	CA	90012	2361	19	06037	34.06103994	-118.2404034	Los Angeles County
228370	Fee-for-Service	1588998124	1588998124	1	1	PRAIRIE MEDICAL LLC	9/16/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1565 E LEIGH FIELD DR	#150	MERIDIAN	ID	83646	5371	00	None	43.640406	-116.375121	Ada County
228395	Fee-for-Service	1275755142	1275755142	1	1	PINCH, COLLEEN M NP	3/27/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
228407	Fee-for-Service	1164455820	1164455820	1	1	PELUCIO, MARIA MD	7/26/2019	207P00000X	NA	Other	026	PHYSICIANS	160734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
228414	Fee-for-Service	1659640183	1659640183	1	1	PARRA, JOSE D MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121908	08	Family Practice	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
228416	Fee-for-Service	1902194095	1902194095	1	1	PATHWAY SOCIETY, INC.	12/7/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	102 SOUTH 11TH STREET	None	SAN JOSE	CA	95112	2132	43	06085	37.33916461	-121.8784624	Santa Clara County
228432	Fee-for-Service	1649965344	1649965344	1	1	PARKER VILLA OPCO LLC	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	629 MICHAEL ST	None	OCEANSIDE	CA	92057	3505	37	06073	33.26068617	-117.299843	San Diego County
228438	Fee-for-Service	1831143379	1831143379	1	1	POLE, CAROLYN M LAC	3/1/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	337 S KALMIA ST	None	ESCONDIDO	CA	92025	4208	37	06073	33.1200291	-117.078484	San Diego County
228439	Fee-for-Service	1801852611	1801852611	2	1	PIERSON, RAYMOND S MD	6/3/2019	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2221 WANKEL WAY	None	OXNARD	CA	93030	0192	56	06111	34.21677352	-119.1475125	Ventura County
228467	Fee-for-Service	1437317773	1437317773	1	1	PASKO, JACLYN K MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108904	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
228481	Fee-for-Service	1215993704	1215993704	1	1	PROVIDENCE SPEECH AND	6/1/1992	225XP0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING CENTER	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
228519	Fee-for-Service	1619533478	1619533478	1	1	PORTERA, SAIGE PSYD	3/29/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
228550	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	7/22/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
228554	Fee-for-Service	1467828491	1467828491	1	1	PUGH, CAITLIN LCSW	12/17/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
228568	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2015	111N00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
228570	Fee-for-Service	1710178702	1710178702	1	1	PATEL, DIVYANSU D MD	1/18/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175434	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
228575	Fee-for-Service	1447447248	1447447248	1	13	PACIFIC INPATIENT MEDICAL GR	12/18/2023	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	40 CAMINO ALTO	None	MILL VALLEY	CA	94941	2956	21	06041	37.89488678	-122.529946	Marin County
228598	Fee-for-Service	1619192309	1619192309	1	1	PSYCHOTHERAPY ASSOCIATES OF	6/10/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE	1335 S EUCLID ST	None	ANAHEIM	CA	92802	2008	30	06059	33.814575	-117.9414565	Orange County
228602	Fee-for-Service	1144494626	1144494626	1	1	POGGETTI, LINDA LCSW	6/15/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET	STE 950	SAN JOSE	CA	95113	1112	43	06085	37.33791617	-121.8939388	Santa Clara County
228604	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
228637	Fee-for-Service	1205412244	1205412244	1	1	PRECISION HEALTH CENTER	10/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	709 N HILL ST	STE 18	LOS ANGELES	CA	90012	2361	19	06037	34.06103994	-118.2404034	Los Angeles County
228647	Fee-for-Service	1730341751	1730341751	1	1	PLOTZ, ZACHARY J MD	3/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152748	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
228653	Fee-for-Service	1972544765	1972544765	1	1	PASADENA DIALYSIS, LLC	10/22/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ARROYO DIALYSIS	1111 S ARROYO PKWY	STE 150	PASADENA	CA	91105	3217	19	06037	34.12800981	-118.1473729	Los Angeles County
228680	Fee-for-Service	1609172097	1609172097	1	1	POURNIK, HOMAYOUN MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146226	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
228685	Fee-for-Service	1255908216	1255908216	1	1	PIERRE, LUDINE LPCC	6/9/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
228691	Fee-for-Service	1588753701	1588753701	1	1	PLANNED PARENTHOOD WORLD	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHERMAN OAKS	7100 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
228702	Fee-for-Service	1922637966	1922637966	1	1	PENG, MAVIS S MD	6/29/2023	208M00000X	NA	Other	026	PHYSICIANS	185893	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
228726	Fee-for-Service	1801852611	1801852611	2	1	PIERSON, RAYMOND S MD	6/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2221 WANKEL WAY	None	OXNARD	CA	93030	0192	56	06111	34.21677352	-119.1475125	Ventura County
228769	Fee-for-Service	1215993704	1215993704	1	1	PROVIDENCE SPEECH AND	6/1/1992	225XP0200X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING CENTER	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
228779	Fee-for-Service	1003811134	1003811134	3	1	PALMDALE MEDICAL PHARMACY, I	12/18/2024	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	540 W PALMDALE BLVD	#A	PALMDALE	CA	93551	4232	19	06037	34.58428429	-118.1406423	Los Angeles County
228787	Fee-for-Service	1134652837	1134652837	1	1	PIVO, SARAH E MD	8/2/2022	208600000X	NA	General Surgery	026	PHYSICIANS	178288	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
228789	Fee-for-Service	1669218608	1669218608	1	1	PROMISES2KIDS FOUNDATION	8/29/2024	251V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	UNDATION	9400 RUFFIN CT	STE A	SAN DIEGO	CA	92123	5300	37	06073	32.830713	-117.1230525	San Diego County
228797	Fee-for-Service	1205017589	1205017589	1	1	PODDATOORI, VINEELA R MD	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97939	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12 CAMINO ENCINAS	None	ORINDA	CA	94563	0000	07	06013	37.87679015	-122.1800856	Contra Costa County
228801	Fee-for-Service	1255620787	1255620787	1	1	PATEL, PRANJAL R MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127994	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
228821	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	3/9/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
228843	Fee-for-Service	1033202635	1033202635	1	2	PRN MED TRANSPORT, INC.	5/13/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	150	TEMECULA	CA	92590	5660	33	06065	33.52030169	-117.1659061	Riverside County
228855	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2015	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
228874	Fee-for-Service	1659014082	1659014082	1	1	PEREZ, JESSICA LMFT	10/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
228878	Fee-for-Service	1629282074	1629282074	1	1	PARKER, STEPHEN R CRNA	11/1/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
228891	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
228914	Fee-for-Service	1639245988	1639245988	1	1	POWELL, REED M OD	1/31/1988	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	21660 BEAR VALLEY RD	STE F-2	APPLE VALLEY	CA	92308	7226	36	06071	34.47153045	-117.190701	San Bernardino County
228962	Fee-for-Service	1376581066	1376581066	1	1	PRZEBIEDA, DAREK R	8/10/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
228985	Fee-for-Service	1386636165	1386636165	1	2	P GILL OBSTETRICS & GYN	12/29/2009	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2509 W MARCH LANE	SUITE 250	STOCKTON	CA	95207	8222	39	06077	37.98503764	-121.3384384	San Joaquin County
228992	Fee-for-Service	1851347272	1851347272	1	1	PALMS IMAGING MEDICAL GROUP	10/11/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1901 OUTLET CENTER DR	STE 120	OXNARD	CA	93036	0664	56	06111	34.21965581	-119.1491337	Ventura County
229009	Fee-for-Service	1427069194	1427069194	1	1	PAPPAS, LYNNE G MD	4/18/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63576	36	Psychiatry	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
229034	Fee-for-Service	1992809412	1992809412	2	1	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	1	Border provider	EVADA	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
229041	Fee-for-Service	1477760247	1477760247	1	1	PARTIDA-RUESGA, JOSE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41951	08	Family Practice	0	In state provider	None	979 BROADWAY	STE A	CHULA VISTA	CA	91911	1792	37	06073	32.6145244	-117.0829116	San Diego County
229057	Fee-for-Service	1215993704	1215993704	1	1	PROVIDENCE SPEECH AND	11/19/2018	225XP0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HEARING CENTER	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
229098	Fee-for-Service	1154476174	1154476174	1	1	PEREYDA, MARGARITA MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	54750	01	General Practice	0	In state provider	None	795 WILLOW RD	BLDG 334	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
229107	Fee-for-Service	1982710539	1982710539	1	1	POTTMEYER, EDWARD W III MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51597	33	Thoracic Surgery	0	In state provider	None	2440 SAMARITAN DRIVE	STE 1	SAN JOSE	CA	95124	3911	43	06085	37.25105247	-121.9471875	Santa Clara County
229109	Fee-for-Service	1235226531	1235226531	1	57	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
229122	Fee-for-Service	1891173720	1891173720	1	1	PATEL, RISHI R DO	1/10/2020	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	15503	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
229123	Fee-for-Service	1841241585	1841241585	1	1	PSYCHIATRIC CENTERS AT SAN D	5/31/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	S D INC MEDICAL GRP	6153 FAIRMOUNT AVE	STE 140	SAN DIEGO	CA	92120	3422	37	06073	32.78594632	-117.101446	San Diego County
229144	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	4/15/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
229146	Fee-for-Service	1861503443	1861503443	1	1	PASCUA, ROELIZA E MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72733	41	Internal Medicine	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
229151	Fee-for-Service	1871607762	1871607762	1	153	PROVIDENCE MEDICAL FOUNDATIO	3/2/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	N	26800 CROWN VALLEY PKWY	525, 545	MISSION VIEJO	CA	92691	8030	30	06059	33.56286021	-117.6673449	Orange County
229163	Fee-for-Service	1205186210	1205186210	1	1	PINNACLE HOME HEALTH CARE	8/28/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2829 N GLENOAKS BLVD	STE 201	BURBANK	CA	91504	2660	19	06037	34.2035185	-118.3349635	Los Angeles County
229172	Fee-for-Service	1396163945	1396163945	1	1	POKKAMTHANAM, SUNEENA PA-C	11/30/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51531	-	NOT APPLICABLE	0	In state provider	None	1000 FAIRVIEW RD	None	HOLLISTER	CA	95023	9644	35	06069	36.83036035	-121.3636084	San Benito County
229181	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
229211	Fee-for-Service	1285987636	1285987636	1	1	PAO, SHARON A MD	11/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122177	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
229214	Fee-for-Service	1083762058	1083762058	1	1	PATEL, MINESH C MD	2/1/1999	2085B0100X	NA	MRI Provider	026	PHYSICIANS	81691	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
229270	Fee-for-Service	1184794588	1184794588	1	1	PINSKER, ROBERT H MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	42500	05	Anesthesiology	0	In state provider	None	13 ETON WAY	None	MILL VALLEY	CA	94941	1414	21	06041	37.90996138	-122.5266617	Marin County
229271	Fee-for-Service	1770564718	1770564718	1	1	PETERSON, BRETT M MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74745	20	Orthopedic Surgery	0	In state provider	None	441 NORTH LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
229280	Fee-for-Service	1053552745	1053552745	1	1	PETTEGREW, JONATHAN M DO	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13395	20	Orthopedic Surgery	0	In state provider	None	609 E ORANGEBURG AVENUE	None	MODESTO	CA	95350	5512	50	06099	37.66364947	-120.9857985	Stanislaus County
229287	Fee-for-Service	1699739482	1699739482	1	1	PARKER, HILDA M NP	1/26/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
229299	Fee-for-Service	1427069194	1427069194	1	1	PAPPAS, LYNNE G MD	4/18/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63576	08	Family Practice	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
229321	Fee-for-Service	1992809412	1992809412	2	1	POKROY MEDICAL GROUP OF NEVA	10/23/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	EVADA	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
229346	Fee-for-Service	1215993704	1215993704	1	1	PROVIDENCE SPEECH AND	12/7/2007	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING CENTER	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
229377	Fee-for-Service	1689164642	1689164642	1	1	PHAM, CHARLEEN DO	11/5/2024	208M00000X	NA	Other	026	PHYSICIANS	22234	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
229393	Fee-for-Service	1952896557	1952896557	1	1	PARTO, PARHAM MD INC	2/25/2019	193400000X	NA	Other	026	PHYSICIANS	118697	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	520 SUPERIOR AVE	STE 305	NEWPORT BEACH	CA	92663	3667	30	06059	33.628914	-117.9276525	Orange County
229428	Fee-for-Service	1144218488	1144218488	1	1	PATAK, RAM MD MRCP	11/19/1991	174400000X	NA	Other	026	PHYSICIANS	39711	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	18350 ROSCOE BLVD	STE 210	NORTHRIDGE	CA	91325	4151	19	06037	34.22071855	-118.5341175	Los Angeles County
229433	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
229437	Fee-for-Service	1558495986	1558495986	1	1	PAVLIK, ROSTISLAV MD	4/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96373	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
229462	Fee-for-Service	1033391735	1033391735	1	1	POPE, PATRICIA L PHD	7/12/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4627 MORRO DR	None	WOODLAND HILLS	CA	91364	4542	19	06037	34.15442103	-118.5907434	Los Angeles County
229466	Fee-for-Service	1740580190	1740580190	1	1	PUTT, JENNIFER J	2/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DR	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
229467	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
229475	Fee-for-Service	1649495490	1649495490	1	1	PETZOLD, ROBERT W MD	3/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	500 5TH STREET	None	BROOKINGS	OR	97415	9702	00	None	42.056721	-124.2879845	Curry County
229516	Fee-for-Service	1235248725	1235248725	1	1	PAYLESS DRUG STORE 5952	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	1991 MOUNTAIN BLVD	None	OAKLAND	CA	94611	2812	01	06001	37.82747012	-122.2101895	Alameda County
229517	Fee-for-Service	1396771549	1396771549	1	1	PARISKY, YURI MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41673	30	Radiology	0	In state provider	USC RADIOLOGY ASSOCIATES	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
229540	Fee-for-Service	1457319758	1457319758	1	1	PIERCE, AVA E MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	5347	00	None	32.812245	-96.841584	Dallas County
229568	Fee-for-Service	1689961302	1689961302	1	1	PEOPLES COMMUNITY CLINIC	5/24/2012	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4139 VERDUGO ROAD	STE A	LOS ANGELES	CA	90065	3820	19	06037	34.1261475	-118.2319835	Los Angeles County
229640	Fee-for-Service	1841458213	1841458213	1	1	PATEL, SIDDHARTHA MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117403	01	General Practice	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
229655	Fee-for-Service	1063546455	1063546455	1	1	PARIS, LAURA LAC	5/3/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	700 CASS ST.	SUITE 116	MONTEREY	CA	93940	2912	27	06053	36.59492903	-121.89503	Monterey County
229663	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
229664	Fee-for-Service	1629471974	1629471974	1	1	POWERS, JAMIE T LCSW	11/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
229702	Fee-for-Service	1992769616	1992769616	1	1	PARTOVI, SHAHRAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
229720	Fee-for-Service	1982024188	1982024188	1	1	PATEL, POORVI R MD	2/22/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140016	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
229727	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	12/8/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
229748	Fee-for-Service	1821359605	1821359605	1	1	PATEL, AMAR V MD	9/1/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	158295	45	Nephrology (Renal-Kidney)	0	In state provider	None	340 FOURTH AVE	STE 14	CHULA VISTA	CA	91910	4414	37	06073	32.63831293	-117.0833536	San Diego County
229749	Fee-for-Service	1144277633	1144277633	1	2	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
229752	Fee-for-Service	1073679338	1073679338	1	1	PREM K KAMBOJ MD PC	9/1/1982	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1062 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22322475	-119.3375086	Tulare County
229754	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
229802	Fee-for-Service	1396771549	1396771549	1	1	PARISKY, YURI MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41673	01	General Practice	0	In state provider	USC RADIOLOGY ASSOCIATES	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
229818	Fee-for-Service	1134596612	1134596612	1	1	PRINCE, BERNADETTE T	6/19/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	STE 137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
229821	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
229836	Fee-for-Service	1306837927	1306837927	1	2	PANNU, AMRITPAL S MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62711	41	Internal Medicine	0	In state provider	None	215 KINGS AVE	None	CHOWCHILLA	CA	93610	2927	20	06039	37.1231883	-120.2614629	Madera County
229837	Fee-for-Service	1104359546	1104359546	1	1	PESTEREV, BAILEY M MD	10/19/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158325	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
229861	Fee-for-Service	1942485883	1942485883	1	1	PREZIOSI, MICHAEL J MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99585	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
229889	Fee-for-Service	1659647386	1659647386	1	1	PORTER, STACY MD	7/20/2020	207R00000X	NA	Other	026	PHYSICIANS	126790	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
229927	Fee-for-Service	1952487472	1952487472	1	1	PADALKAR, PADMAJA MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55998	40	Pediatrics	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
229953	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
229963	Fee-for-Service	1245481381	1245481381	1	1	PATEL, SANDIP P MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110132	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
229972	Fee-for-Service	1306878392	1306878392	1	1	PRIMACK, TODD O DO	12/31/1986	207L00000X	NA	Other	026	PHYSICIANS	5007	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
230015	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230021	Fee-for-Service	1730447178	1730447178	1	1	PHAM, QUYNH H V MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149332	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
230032	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
230038	Fee-for-Service	1144277633	1144277633	1	2	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
230044	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
230087	Fee-for-Service	1841381688	1841381688	1	1	PARKS, DAVID J MD	6/22/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78517	18	Ophthalmology	0	In state provider	None	8920 WILSHIRE BLVD	STE 500	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
230092	Fee-for-Service	1366698367	1366698367	1	2	PAJAK, DARIAN M MD DO	6/23/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162878	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
230100	Fee-for-Service	1487855086	1487855086	1	1	PASADENA GASTROENTEROLGY	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP	2750 E WASHINGTON BLVD	STE 330	PASADENA	CA	91107	1451	19	06037	34.1680038	-118.0943955	Los Angeles County
230109	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	10/19/2007	103TC2200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
230136	Fee-for-Service	1497097950	1497097950	1	1	PHAN, TIEN PSYD	3/26/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
230142	Fee-for-Service	1184143455	1184143455	1	1	PIH HEALTH COMMUNITY PHARMAC	1/24/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12400 BLOOMFIELD AVE	None	SANTA FE SPRINGS	CA	90670	6551	19	06037	33.91872688	-118.0638495	Los Angeles County
230145	Fee-for-Service	1922327980	1922327980	1	1	PANCHAL, ADITI DPM	1/22/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
230152	Fee-for-Service	1376554964	1376554964	2	1	PRS PHARMACEUTICAL GROUP, IN	10/24/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4950 BARRANCA PKWY	STE 102	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
230177	Fee-for-Service	1558651075	1558651075	1	1	PUTNAM, LUKE R MD	8/19/2020	208600000X	NA	General Surgery	026	PHYSICIANS	149331	02	General Surgery	0	In state provider	None	1450 SAN PABLO STREET	SUITE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
230233	Fee-for-Service	1518619048	1518619048	1	1	PASSIONATE HEALTHCARE INC	7/16/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	STE 454	RESEDA	CA	91335	6308	19	06037	34.18659852	-118.552221	Los Angeles County
230240	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
230252	Fee-for-Service	1245481381	1245481381	1	1	PATEL, SANDIP P MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110132	68	Hematology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
230257	Fee-for-Service	1215963939	1215963939	1	1	PLATZER, MERIL S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47770	13	Neurology (M.D. only)	0	In state provider	SUITE 417	6325 TOPANGA CANYON BLVD	None	WOODLAND HILLS	CA	91367	2006	19	06037	34.184934	-118.6059175	Los Angeles County
230269	Fee-for-Service	1700319043	1700319043	1	1	PARK, CATHLEEN J MD	9/19/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	173521	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
230297	Fee-for-Service	1548588122	1548588122	1	1	PRESSER, DEBORA A LCS	8/9/2013	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	7120 HAYVENHURST AVENUE	SUITE 118	VAN NUYS	CA	91406	3813	19	06037	34.200018	-118.492384	Los Angeles County
230299	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	4/2/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230321	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
230322	Fee-for-Service	1285079087	1285079087	1	1	PALHA DE SOUSA, CHIQUITA MD	7/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156022	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
230331	Fee-for-Service	1710307640	1710307640	1	1	PIERCE, RYAN M MD	11/22/2024	207R00000X	NA	Other	026	PHYSICIANS	145246	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
230332	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
230338	Fee-for-Service	1609903822	1609903822	1	1	PALOMAR POMERADO	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	225 E 2ND AVE	STE 340	ESCONDIDO	CA	92025	4245	37	06073	33.12175817	-117.0787555	San Diego County
230342	Fee-for-Service	1760425862	1760425862	1	8	PROVIDENCE MEDICAL INSTITUTE	8/5/2021	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	21311 MADRONA AVE	STE 100B	TORRANCE	CA	90503	5970	19	06037	33.835599	-118.3450965	Los Angeles County
230350	Fee-for-Service	1528448909	1528448909	1	1	PACIFIC REHABILITATION & PAI	1/26/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	1010 CASS ST	D3	MONTEREY	CA	93940	4515	27	06053	36.59171985	-121.8968501	Monterey County
230371	Fee-for-Service	1285769562	1285769562	1	1	POWELL, CARL A DO	11/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	5426	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
230376	Fee-for-Service	1841381688	1841381688	1	1	PARKS, DAVID J MD	6/22/2014	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78517	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	8920 WILSHIRE BLVD	STE 500	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
230386	Fee-for-Service	1487855086	1487855086	1	1	PASADENA GASTROENTEROLGY	2/28/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP	2750 E WASHINGTON BLVD	STE 330	PASADENA	CA	91107	1451	19	06037	34.1680038	-118.0943955	Los Angeles County
230399	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	7/20/2019	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
230452	Fee-for-Service	1831529569	1831529569	1	1	PEACH, ANNE B NP	10/25/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230488	Fee-for-Service	1063496651	1063496651	1	28	PACIFIC CENTRAL COAST HEALTH	3/28/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	697 WEST TEFFT ST	None	NIPOMO	CA	93444	9190	40	06079	35.03397948	-120.4897062	San Luis Obispo County
230491	Fee-for-Service	1134429749	1134429749	1	1	PEREZ, JEANETTE P MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114303	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
230505	Fee-for-Service	1124608765	1124608765	1	1	PETROSYAN, ANAHIT MD	3/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192462	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
230530	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	4/15/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
230555	Fee-for-Service	1700319043	1700319043	1	1	PARK, CATHLEEN J MD	9/19/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	173521	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
230561	Fee-for-Service	1649229154	1649229154	1	1	PEARSON, EARL S MD	3/9/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	41796	07	Dermatology	0	In state provider	None	573 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3270	54	06107	36.06956792	-119.0296869	Tulare County
230573	Fee-for-Service	1770602971	1770602971	1	1	PALRECHA, SAPNA J MD	9/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93065	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
230579	Fee-for-Service	1205811536	1205811536	1	1	PITCHER, JANET E	10/1/1999	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
230586	Fee-for-Service	1639458201	1639458201	1	2	PADILLA, BENJAMIN E MD	9/27/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	95016	7710	00	None	33.478749	-112.0426515	Maricopa County
230589	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	11/28/2016	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230599	Fee-for-Service	1316564305	1316564305	1	1	PEREZ, SYLVIA LMFT	12/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4909 MURPHY CANYON RD	300	SAN DIEGO	CA	92123	4349	37	06073	32.8287682	-117.1197549	San Diego County
230609	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	9/11/2012	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
230618	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
230659	Fee-for-Service	1285769562	1285769562	1	1	POWELL, CARL A DO	11/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	5426	02	General Surgery	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
230669	Fee-for-Service	1447607148	1447607148	1	1	PRUDENCIO, SABRINA L NP	12/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
230687	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
230698	Fee-for-Service	1710121744	1710121744	1	1	PORTER, EVELYN M MD	4/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111665	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
230721	Fee-for-Service	1902337793	1902337793	1	1	PARK, KEON MIN MD	7/30/2024	208200000X	NA	General Surgery	026	PHYSICIANS	160755	24	Plastic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
230759	Fee-for-Service	1356852461	1356852461	1	1	PATEL, HITAXI A PT	10/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3400 CENTRAL AVE	145	RIVERSIDE	CA	92506	2161	33	06065	33.95355249	-117.385407	Riverside County
230777	Fee-for-Service	1063496651	1063496651	1	59	PACIFIC CENTRAL COAST HEALTH	11/1/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1941 JOHNSON AVENUE	STE 102	SAN LUIS OBISPO	CA	93401	4174	40	06079	35.27804785	-120.649711	San Luis Obispo County
230812	Fee-for-Service	1962251967	1962251967	1	1	PENARANDA, PRECIOUS	8/25/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230817	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
230857	Fee-for-Service	1477588127	1477588127	1	1	PIMIENTA, WILLIAM OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4850 S BRADLEY RD	STE A2	SANTA MARIA	CA	93455	5071	42	06083	34.86657777	-120.4187092	Santa Barbara County
230867	Fee-for-Service	1639458201	1639458201	1	2	PADILLA, BENJAMIN E MD	9/27/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	95016	7710	00	None	33.478749	-112.0426515	Maricopa County
230876	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
230878	Fee-for-Service	1821187188	1821187188	1	1	PERIYASAMY, BASKER MD	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	1750 E DESERT INN RD	SUITE 200	LAS VEGAS	NV	89169	3202	00	None	36.12989452	-115.1278065	Clark County
230885	Fee-for-Service	1427394410	1427394410	1	2	PALLAPATI, ARUNA MD INC	6/1/2013	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98165	40	Pediatrics	0	In state provider	None	8990 GARFIELD STREET	SUITE 11	RIVERSIDE	CA	92503	3922	33	06065	33.92882844	-117.4396777	Riverside County
230896	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
230912	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
230916	Fee-for-Service	1841241585	1841241585	1	7	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IEGO INC MEDICAL GROUP	1061 TIERRA DEL REY	SUITE 200	CHULA VISTA	CA	91910	7880	37	06073	32.63799018	-117.017426	San Diego County
230940	Fee-for-Service	1114501970	1114501970	1	1	PETERS, GAIL D CNM	10/28/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
230953	Fee-for-Service	1487226502	1487226502	1	1	PUREX HOME HEALTH SERVICES	5/22/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	11755 VICTORY BLVD	STE 104	NORTH HOLLYWOOD	CA	91606	3462	19	06037	34.18670448	-118.389699	Los Angeles County
230959	Fee-for-Service	1417357872	1417357872	1	1	PETERSON, ASHLEY PSYD	3/24/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
230968	Fee-for-Service	1760059364	1760059364	1	1	PARTNERSHIP ADULT HOME CARE	7/13/2021	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	INC	15424 HAWTHORNE BLVD	STE 203C	LAWNDALE	CA	90260	0000	19	06037	33.890328	-118.3523315	Los Angeles County
230974	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
230986	Fee-for-Service	1437599867	1437599867	1	1	PATIL, SHAKUNTALA S MD	11/1/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	187566	None	None	0	In state provider	None	22555 ALESSANDRO BLVD	STE B	MORENO VALLEY	CA	92553	8533	33	06065	33.9169235	-117.2693745	Riverside County
230988	Fee-for-Service	1760570600	1760570600	1	22	PEDIATRIC MEDICAL ASSOCIATES	5/12/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	202 MAIN STREET	None	SAINT HELENA	CA	94574	0000	28	06055	38.49547619	-122.4576663	Napa County
231006	Fee-for-Service	1013960806	1013960806	1	1	POGGIO, ANTHONY DPM	11/30/1986	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2059 CLINTON AVE	None	ALAMEDA	CA	94501	4379	01	06001	37.76321262	-122.2534547	Alameda County
231007	Fee-for-Service	1891004305	1891004305	1	1	PATEL, NIRALI P MD	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114139	41	Internal Medicine	0	In state provider	None	655 EUCLID AVE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
231016	Fee-for-Service	1851459788	1851459788	1	1	PAO, SUSANNA T	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
231026	Fee-for-Service	1548774623	1548774623	1	1	PONZO, JENNIFER C NP	2/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
231063	Fee-for-Service	1083076947	1083076947	1	1	PHAN, ETHAN MD	11/8/2020	207R00000X	NA	Other	026	PHYSICIANS	170167	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
231076	Fee-for-Service	1760570600	1760570600	1	24	PEDIATRIC MEDICAL ASSOCIATES	6/4/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1062 CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22322475	-119.3375086	Tulare County
231105	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	11/20/2018	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
231126	Fee-for-Service	1891791299	1891791299	1	1	PHILLIPS, C VINCENT MD	9/1/1994	208600000X	NA	General Surgery	026	PHYSICIANS	37044	02	General Surgery	0	In state provider	None	500 OLD RIVER RD	STE 200	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
231160	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	4/15/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
231164	Fee-for-Service	1013211135	1013211135	1	1	POON, CHRISTINA L MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117643	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
231168	Fee-for-Service	1821187188	1821187188	1	1	PERIYASAMY, BASKER MD	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1750 E DESERT INN RD	SUITE 200	LAS VEGAS	NV	89169	3202	00	None	36.12989452	-115.1278065	Clark County
231176	Fee-for-Service	1124135959	1124135959	1	1	PIRMANN, JOEL R DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	PIRMANN CHIROPRACTIC	17885 SKY PARK CIR	STE J	IRVINE	CA	92614	6307	30	06059	33.6920037	-117.8584314	Orange County
231184	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
231196	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
231206	Fee-for-Service	1841241585	1841241585	1	7	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	1061 TIERRA DEL REY	SUITE 200	CHULA VISTA	CA	91910	7880	37	06073	32.63799018	-117.017426	San Diego County
231210	Fee-for-Service	1033644273	1033644273	1	1	PATRICK, RITA MD	9/28/2020	207R00000X	NA	Other	026	PHYSICIANS	166768	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	# 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
231211	Fee-for-Service	1760110530	1760110530	1	1	PARRA COUNSELING AND WELLNES	4/11/2023	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	S SERVICES, A LICENSED C	3160 W RAMSEY ST	None	BANNING	CA	92220	3724	33	06065	33.92559942	-116.9104797	Riverside County
231263	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
231307	Fee-for-Service	1780664326	1780664326	1	1	PHILLIPS, BARRATT L MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62443	18	Ophthalmology	0	In state provider	None	361 N SAN JACINTO ST	None	HEMET	CA	92543	3118	33	06065	33.752259	-116.958686	Riverside County
231332	Fee-for-Service	1649385311	1649385311	1	1	PLUCHE LYNN S OD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6094	08	Family Practice	0	In state provider	None	400 MOBIL AVE	STE C2	CAMARILLO	CA	93010	6388	56	06111	34.22111093	-119.0429505	Ventura County
231367	Fee-for-Service	1659363554	1659363554	1	1	PASABOC, LIVIU GEORGIAN	3/29/1999	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3857 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2187	15	06029	35.35409649	-119.0481637	Kern County
231393	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	2/19/2019	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
231411	Fee-for-Service	1891791299	1891791299	1	2	PHILLIPS, C VINCENT MD	9/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	9300 STOCKDALE HWY	STE 300	BAKERSFIELD	CA	93311	3611	15	06029	35.3545315	-119.1053925	Kern County
231413	Fee-for-Service	1891791299	1891791299	1	1	PHILLIPS, C VINCENT MD	9/1/1994	208600000X	NA	General Surgery	026	PHYSICIANS	37044	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 OLD RIVER RD	STE 200	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
231452	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
231459	Fee-for-Service	1811102171	1811102171	1	1	POTERACK, CATHERINE D MD	10/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	89300	40	Pediatrics	0	In state provider	None	3798 JANES RD	STE 3	ARCATA	CA	95521	4742	12	06023	40.89649119	-124.0930501	Humboldt County
231464	Fee-for-Service	1821135799	1821135799	1	1	PIRES, DAVID C DO	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9727	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
231471	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
231482	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
231493	Fee-for-Service	1841241585	1841241585	1	7	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IEGO INC MEDICAL GROUP	1061 TIERRA DEL REY	SUITE 200	CHULA VISTA	CA	91910	7880	37	06073	32.63799018	-117.017426	San Diego County
231521	Fee-for-Service	1811902430	1811902430	2	1	PHARMAHERBIA INC	4/6/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	22330 SHERMAN WAY	STE C3	CANOGA PARK	CA	91303	1056	19	06037	34.2009955	-118.613556	Los Angeles County
231545	Fee-for-Service	1053488940	1053488940	1	1	PHAM, ALFONSO N MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69597	30	Radiology	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
231551	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	2/2/2017	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
231564	Fee-for-Service	1760467864	1760467864	1	1	PATEL,SHARMILA R MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55281	10	Gastroenterology (M.D. only)	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
231567	Fee-for-Service	1639234446	1639234446	1	1	PODIATRY ASSOC OF SD CTY	4/24/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	655 EUCLID AVE	STE 401	NATIONAL CITY	CA	91950	2978	37	06073	32.68353398	-117.082625	San Diego County
231572	Fee-for-Service	1619519105	1619519105	1	1	PERONI, AGUSTINA LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
231597	Fee-for-Service	1518461789	1518461789	1	1	PATEL, NEAL D MD	12/5/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178584	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
231623	Fee-for-Service	1245312958	1245312958	1	1	PARK, YOUNG W MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32182	08	Family Practice	0	In state provider	None	2323 16TH ST	STE 200	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
231627	Fee-for-Service	1811054604	1811054604	1	1	PRICE, ERIN M MD	12/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56016	02	General Surgery	0	In state provider	None	4060 FOURTH AVE	SUITE 440	SAN DIEGO	CA	92103	2183	37	06073	32.75053673	-117.1616539	San Diego County
231659	Fee-for-Service	1720101330	1720101330	1	1	PRICE, BENJAMIN R PSYD	9/2/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
231668	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	12/26/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
231673	Fee-for-Service	1689738189	1689738189	1	1	PENA, JUAN C MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79366	08	Family Practice	0	In state provider	None	17500 FOOTHILL BLVD	STE A-2	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
231680	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	10/28/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
231685	Fee-for-Service	1326107954	1326107954	1	1	PRADO, LILIA DO	3/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
231687	Fee-for-Service	1689645756	1689645756	1	1	PATAY, BRADLEY A MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75805	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
231734	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	8/20/2021	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
231738	Fee-for-Service	1568957256	1568957256	1	1	PATEL, SHRUTI PT	4/14/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30428 HAUN RD.	STE. 810	MENIFEE	CA	92584	6824	33	06065	33.67819649	-117.1755448	Riverside County
231751	Fee-for-Service	1154348464	1154348464	1	1	PALMA, CLAUDIO A MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79161	05	Anesthesiology	0	In state provider	None	1580 VALENCIA ST	STE 703	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
231760	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	12/11/2015	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
231763	Fee-for-Service	1568509727	1568509727	1	1	PALO ALTO PATHOLOGY INC	7/9/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	HADLER, KENNETH MD	2325 EL CAMINO REAL	None	PALO ALTO	CA	94306	1620	43	06085	37.42549644	-122.1464806	Santa Clara County
231774	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
231780	Fee-for-Service	1962511436	1962511436	2	1	PROCARE PHARMACY, LLC	4/1/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 UNIVERSITY AVENUE	None	SAN DIEGO	CA	92103	3398	37	06073	32.74851092	-117.1549991	San Diego County
231790	Fee-for-Service	1720152473	1720152473	1	1	PEREZ, MARK A MD	11/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67514	-	NOT APPLICABLE	0	In state provider	None	15519 CRENSHAW BLVD	None	GARDENA	CA	90249	4525	19	06037	33.8896575	-118.3266105	Los Angeles County
231794	Fee-for-Service	1477015972	1477015972	1	1	PERNENKIL, VIKASH MD	1/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177339	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
231801	Fee-for-Service	1932360302	1932360302	1	1	PALMISANO, LUKE J MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112046	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
231837	Fee-for-Service	1760570600	1760570600	1	5	PEDIATRIC MEDICAL ASSOCIATES	4/26/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1580 CREEKSIDE DR	200	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
231839	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	7/3/2015	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
231849	Fee-for-Service	1760467864	1760467864	1	1	PATEL,SHARMILA R MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55281	41	Internal Medicine	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
231867	Fee-for-Service	1609510395	1609510395	1	1	PLANNED PARENTHOOD LOS	7/15/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	905 N LA BREA AVE	None	INGLEWOOD	CA	90302	2207	19	06037	33.9749861	-118.3577191	Los Angeles County
231887	Fee-for-Service	1578583597	1578583597	1	1	PHANUCHARAS, JIM P MD	1/1/2018	207R00000X	NA	Other	026	PHYSICIANS	82493	41	Internal Medicine	0	In state provider	None	1715 SOUTH CEDAR AVENUE	None	FRESNO	CA	93702	4331	10	06019	36.725625	-119.7546225	Fresno County
231891	Fee-for-Service	1083788095	1083788095	1	1	PYFROM, RICARDO O MD	10/16/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	190655	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
231899	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	9/25/2018	171100000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
231906	Fee-for-Service	1184654972	1184654972	1	1	PACK, JOHN JOSEPH MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78330	69	Unknown	0	In state provider	None	4560 ADMIRALTY WAY	STE 356	MARINA DEL REY	CA	90292	5449	19	06037	33.98364904	-118.4449069	Los Angeles County
231931	Fee-for-Service	1447447248	1447447248	1	18	PACIFIC INPATIENT MEDICAL GR	4/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	3751 MONTGOMERY DR	None	SANTA ROSA	CA	95405	5214	49	06097	38.453472	-122.6758185	Sonoma County
231935	Fee-for-Service	1821044629	1821044629	1	1	PAPE, FRANK G DO	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
231937	Fee-for-Service	1386097889	1386097889	1	1	PATEL, DHERAIN MD	10/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158029	08	Family Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
231953	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	2/5/2019	193400000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
231965	Fee-for-Service	1245913581	1245913581	1	1	PALACIOS GONZALEZ, WILMER N	10/5/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	1187 E HERNDON AVE	SUITE 101	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
231969	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	7/12/2019	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
231980	Fee-for-Service	1689645756	1689645756	1	1	PATAY, BRADLEY A MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75805	40	Pediatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
232012	Fee-for-Service	1962984013	1962984013	1	1	POINTER PSYCHOTHERAPY INC	1/14/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17662 IRVINE BLVD	STE 7	TUSTIN	CA	92780	3132	30	06059	33.74823851	-117.8240535	Orange County
232022	Fee-for-Service	1730645979	1730645979	1	1	PABUSTAN, LOUVELLA N CNP	11/21/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1275 CRANE ST	None	MENLO PARK	CA	94025	4212	41	06081	37.45251362	-122.1877503	San Mateo County
232023	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	6/23/2016	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232033	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	12/7/2017	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
232035	Fee-for-Service	1265604870	1265604870	1	1	PAO, VIVIAN Y MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85813	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
232039	Fee-for-Service	1720104078	1720104078	2	1	PHYSICAL THERAPY ASSOCIATES	2/3/2016	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	OF OROVILLE INC	2220-2 5TH AVE	None	OROVILLE	CA	95965	5816	04	06007	39.50224076	-121.5649012	Butte County
232047	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
232059	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
232090	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
232106	Fee-for-Service	1760702989	1760702989	1	1	PETO, JUDITH E PA	6/6/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	19689	-	NOT APPLICABLE	0	In state provider	None	7225 E SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2620	34	06067	38.49489	-121.435704	Sacramento County
232127	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	1/19/2017	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
232134	Fee-for-Service	1710001763	1710001763	1	1	PHAM, KRYSTAL H MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114075	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
232175	Fee-for-Service	1164462164	1164462164	1	1	PATEL, ANILKUMAR S MD	3/31/1991	2084P0800X	NA	Psychiatry	026	PHYSICIANS	46378	26	Psychiatry (child)	0	In state provider	None	910 SYCAMORE AVE	STE 220	VISTA	CA	92081	7834	37	06073	33.15991913	-117.2205623	San Diego County
232177	Fee-for-Service	1215291760	1215291760	1	1	PHAN, NATALIE D	1/5/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
232187	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232196	Fee-for-Service	1184654972	1184654972	1	1	PACK, JOHN JOSEPH MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78330	41	Internal Medicine	0	In state provider	None	4560 ADMIRALTY WAY	STE 356	MARINA DEL REY	CA	90292	5449	19	06037	33.98364904	-118.4449069	Los Angeles County
232219	Fee-for-Service	1447447248	1447447248	1	18	PACIFIC INPATIENT MEDICAL GR	4/16/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	3751 MONTGOMERY DR	None	SANTA ROSA	CA	95405	5214	49	06097	38.453472	-122.6758185	Sonoma County
232242	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	6/17/2008	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
232245	Fee-for-Service	1639148729	1639148729	1	1	PATEL, PRAKASH N MD	10/21/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170456	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
232257	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	5/3/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
232282	Fee-for-Service	1215952957	1215952957	1	1	PERKINS, ERIK F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4033 3RD AVE	STE 206	SAN DIEGO	CA	92103	2137	37	06073	32.75053781	-117.1627168	San Diego County
232303	Fee-for-Service	1053021915	1053021915	1	1	PATHWAY ASSISTED LIVING LLC	1/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2228 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3603	15	06029	35.37346129	-119.0279036	Kern County
232305	Fee-for-Service	1417214693	1417214693	1	1	PANCHAL, DHRUV	1/29/2024	208M00000X	NA	Other	026	PHYSICIANS	186780	None	None	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
232311	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	11/24/2019	103TC0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232312	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
232323	Fee-for-Service	1265604870	1265604870	1	1	PAO, VIVIAN Y MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85813	67	Endocrinology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
232337	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
232350	Fee-for-Service	1548343510	1548343510	1	22	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
232354	Fee-for-Service	1922186022	1922186022	1	1	PROBST, KIMBERLY H MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73025	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
232362	Fee-for-Service	1780889873	1780889873	1	1	PIETZSCH, ERIKA S MD	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102725	13	Neurology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
232378	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
232384	Fee-for-Service	1821108978	1821108978	1	1	PAREDES, KATHERINE	2/27/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S 1ST ST	STE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
232393	Fee-for-Service	1053517789	1053517789	1	1	PAREKH, ANJALI S MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105571	18	Ophthalmology	0	In state provider	None	5525 GROSSMONT CENTER DR	None	SAN DIEGO	CA	91942	3014	37	06073	32.781195	-117.0070695	San Diego
232407	Fee-for-Service	1265831853	1265831853	1	1	POHLE, VALERIE ANN	9/1/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1279 TEAL HOLLOW DR N	None	LINCOLN	CA	95648	2476	31	06061	38.90224064	-121.3294057	Placer County
232408	Fee-for-Service	1154862241	1154862241	1	1	PROHEALTH PARTNERS A MEDICAL	10/5/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	GROUP INC	3742 KATELLA AVE	303	LOS ALAMITOS	CA	90720	3172	30	06059	33.80299152	-118.067481	Orange County
232415	Fee-for-Service	1396493417	1396493417	1	1	PREYER, AUDEA NP	3/12/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
232417	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
232426	Fee-for-Service	1144277633	1144277633	1	13	PATHOLOGY ASSOCIATES	9/6/2024	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
232461	Fee-for-Service	1164462164	1164462164	1	1	PATEL, ANILKUMAR S MD	3/31/1991	2084P0800X	NA	Psychiatry	026	PHYSICIANS	46378	36	Psychiatry	0	In state provider	None	910 SYCAMORE AVE	STE 220	VISTA	CA	92081	7834	37	06073	33.15991913	-117.2205623	San Diego County
232474	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	5/3/2019	171100000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232511	Fee-for-Service	1972140804	1972140804	1	1	PETERSON, MAELEY R NP	3/6/2020	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
232531	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	2/5/2019	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
232532	Fee-for-Service	1912944653	1912944653	1	1	PATEL, YOGESH M MD	5/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	49192	45	Nephrology (Renal-Kidney)	0	In state provider	None	4361 LATHAM ST	STE 150	RIVERSIDE	CA	92501	1768	33	06065	34.00212634	-117.3743133	Riverside County
232544	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	11/24/2019	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
232571	Fee-for-Service	1215952957	1215952957	1	1	PERKINS, ERIK F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69544	13	Neurology (M.D. only)	0	In state provider	None	4033 3RD AVE	STE 206	SAN DIEGO	CA	92103	2137	37	06073	32.75053781	-117.1627168	San Diego County
232593	Fee-for-Service	1528527181	1528527181	1	2	PARAGON CHICO MEDICAL GROUP,	9/23/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	None	923 DANA DRIVE	None	REDDING	CA	96003	4051	45	06089	40.58575147	-122.354559	Shasta County
232598	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232600	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	8/3/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
232624	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
232645	Fee-for-Service	1487705604	1487705604	1	1	PHARMACY CARE NETWORK INC	5/10/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5847 KANAN RD	None	AGOURA HILLS	CA	91301	1651	19	06037	34.15618532	-118.7563212	Los Angeles County
232666	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	11/24/2019	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
232692	Fee-for-Service	1366531667	1366531667	1	1	PLON, MARINA MD	8/14/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	4275 BURNHAM AVE	STE 220	LAS VEGAS	NV	89119	5400	00	None	36.111699	-115.1238165	Clark County
232695	Fee-for-Service	1265831853	1265831853	1	1	POHLE, VALERIE ANN	9/1/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1279 TEAL HOLLOW DR N	None	LINCOLN	CA	95648	2476	31	06061	38.90224064	-121.3294057	Placer County
232704	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	4/17/2017	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
232714	Fee-for-Service	1144277633	1144277633	1	13	PATHOLOGY ASSOCIATES	9/6/2024	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
232715	Fee-for-Service	1841241585	1841241585	1	6	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IEGO INC MEDICAL GROUP	11770 BERNARDO PLAZA CT	SUITE 370	SAN DIEGO	CA	92128	2422	37	06073	33.02003995	-117.0767619	San Diego County
232761	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	12/16/2016	171100000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232762	Fee-for-Service	1679526693	1679526693	1	1	PLANNED PARENTHOOD MAR MONTE	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	201 29TH ST	None	SACRAMENTO	CA	95816	3271	34	06067	38.581875	-121.463802	Sacramento County
232769	Fee-for-Service	1629511886	1629511886	1	2	PRIME PULMONARY & SLEEP	6/30/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICINE CENTER INC	1205 GARCES HWY	STE 203	DELANO	CA	93215	3658	15	06029	35.76144147	-119.2400687	Kern County
232793	Fee-for-Service	1285895987	1285895987	1	1	PERSONAL UNICARE MEDICAL	9/21/2010	193400000X	NA	Other	026	PHYSICIANS	37859	01	General Practice	0	In state provider	CLINIC AMC	1019 N FAIRFAX AVE	STE 101	LOS ANGELES	CA	90046	6160	19	06037	34.08929477	-118.3615856	Los Angeles County
232819	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	5/3/2019	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
232826	Fee-for-Service	1750793162	1750793162	1	1	PRASAD, SAHODRA	10/24/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	824 E. EL CAMINO REAL	#1	SAN BRUNO	CA	94066	3152	41	06081	37.62944954	-122.4168437	San Mateo County
232830	Fee-for-Service	1356847685	1356847685	1	1	PAN, ZHUN MD	3/19/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232831	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
232871	Fee-for-Service	1811072457	1811072457	1	1	PAKBAZ, RAMIN SEAN MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73947	30	Radiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
232881	Fee-for-Service	1992809412	1992809412	2	5	POKROY MEDICAL GROUP OF NEVA	8/24/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	1	Border provider	EVADA	1050 WEST GALLERIA DR	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
232887	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	12/8/2018	103TC0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
232890	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	11/18/2016	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
232891	Fee-for-Service	1063496651	1063496651	1	56	PACIFIC CENTRAL COAST HEALTH	2/27/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	206 STRATFORD AVENUE	None	SANTA MARIA	CA	93454	5901	42	06083	34.951851	-120.414681	Santa Barbara County
232912	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
232919	Fee-for-Service	1962583617	1962583617	1	1	PIERNOT, ELLEN E MD	4/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135085	None	None	0	In state provider	None	857 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.2882813	-120.497688	Merced County
232950	Fee-for-Service	1205229564	1205229564	1	1	PRAKASH, AANCHAL MD	9/27/2021	207L00000X	NA	Other	026	PHYSICIANS	159366	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
232953	Fee-for-Service	1427121318	1427121318	1	1	PALMA, JOSEPH R DO	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8401	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
232954	Fee-for-Service	1295967594	1295967594	1	1	PEREZ, RONALD NINO M MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132584	01	General Practice	0	In state provider	None	1300 AVENIDA VISTA	HERMOSA STE 250	SAN CLEMENTE	CA	92673	6340	30	06059	33.45766933	-117.5920941	Orange County
232958	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	11/30/2018	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
232966	Fee-for-Service	1497774160	1497774160	1	1	PEHLING, JAMES R MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91941	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
232982	Fee-for-Service	1366531667	1366531667	1	1	PLON, MARINA MD	8/14/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	4275 BURNHAM AVE	STE 220	LAS VEGAS	NV	89119	5400	00	None	36.111699	-115.1238165	Clark County
232992	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
232996	Fee-for-Service	1508966391	1508966391	1	1	PARTHASARATHY, PADMA MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130487	01	General Practice	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
233002	Fee-for-Service	1841241585	1841241585	1	6	PSYCHIATRIC CENTERS AT SAN D	8/15/2019	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IEGO INC MEDICAL GROUP	11770 BERNARDO PLAZA CT	SUITE 370	SAN DIEGO	CA	92128	2422	37	06073	33.02003995	-117.0767619	San Diego County
233018	Fee-for-Service	1972984839	1972984839	1	1	PAYNE, RENEE N NP	8/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
233020	Fee-for-Service	1821211475	1821211475	1	1	POSITIVE DIRECTIONS #2	12/19/2000	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2017 19TH AVE	None	DELANO	CA	93215	3737	15	06029	35.78119931	-119.2281364	Kern County
233045	Fee-for-Service	1114097847	1114097847	1	1	PAVELOFF, DANIEL MD	10/5/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	72593	None	None	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
233050	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	9/12/2018	171100000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233066	Fee-for-Service	1760415335	1760415335	2	1	PHARMERICA DRUG SYSTEMS LLC	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMERICA	5574 EVERGLADES	UNIT A	VENTURA	CA	93003	6542	56	06111	34.25891982	-119.2158578	Ventura County
233075	Fee-for-Service	1609817535	1609817535	1	1	PATISH, GRIGORIY DPM	9/6/2024	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
233082	Fee-for-Service	1457320673	1457320673	1	1	PORCIUNCULA, GENEROSO MD	4/30/1980	207R00000X	NA	Other	026	PHYSICIANS	36153	41	Internal Medicine	0	In state provider	None	1251 W TENNYSON RD	STE 4	HAYWARD	CA	94544	4400	01	06001	37.63146808	-122.0783775	Alameda County
233105	Fee-for-Service	1770836603	1770836603	1	1	PEARL, ROBYN PSYD	3/4/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
233108	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	11/17/2015	193400000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
233115	Fee-for-Service	1750793162	1750793162	1	1	PRASAD, SAHODRA	10/24/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	824 E. EL CAMINO REAL	#1	SAN BRUNO	CA	94066	3152	41	06081	37.62944954	-122.4168437	San Mateo County
233120	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	5/18/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
233126	Fee-for-Service	1851515894	1851515894	1	1	PARK, HYUN S MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74242	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233129	Fee-for-Service	1437122769	1437122769	1	1	PIONEERS MEMORIAL HEALTHCARE	7/27/2004	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	450 E BIRCH ST	None	CALEXICO	CA	92231	2375	13	06025	32.67912485	-115.4913398	Imperial County
233133	Fee-for-Service	1033459524	1033459524	1	1	PHI HEALTH, LLC	5/30/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1650 AVIATION DR	None	WEST LAFAYETTE	IN	47906	3374	00	None	40.41538954	-86.9367891	Tippecanoe County
233141	Fee-for-Service	1689609489	1689609489	1	1	POLANCO, JUAN M MD	11/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	63064	41	Internal Medicine	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
233147	Fee-for-Service	1336116565	1336116565	1	1	PRASADARAO KONDAPALLI,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14519 DETROIT AVE	None	LAKEWOOD	OH	44107	4316	00	None	41.48527894	-81.79643923	Cuyahoga County
233169	Fee-for-Service	1992809412	1992809412	2	5	POKROY MEDICAL GROUP OF NEVA	8/24/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	1	Border provider	EVADA	1050 WEST GALLERIA DR	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
233175	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233177	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/25/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
233179	Fee-for-Service	1922539683	1922539683	1	1	PU, HELEN MD	6/22/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157010	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
233200	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
233210	Fee-for-Service	1225492085	1225492085	1	1	PYARALI, FAHIM F MD	10/4/2021	207RC0200X	NA	Other	026	PHYSICIANS	168822	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
233233	Fee-for-Service	1861436909	1861436909	1	1	PONTRELLI, GARY N MD	6/30/1989	207ZP0102X	NA	Other	026	PHYSICIANS	45965	22	Pathology (M.D. only)	0	In state provider	None	333 N F ST	None	OXNARD	CA	93030	4506	56	06111	34.206363	-119.1850685	Ventura County
233242	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
233266	Fee-for-Service	1992243794	1992243794	1	1	PADILLA, CHRISTINA LMFT	9/25/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
233271	Fee-for-Service	1598916975	1598916975	1	1	PATEL, MONICA S MD	10/9/2008	2085P0229X	NA	Other	026	PHYSICIANS	99772	30	Radiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
233273	Fee-for-Service	1649420332	1649420332	1	1	PARLETTE, JENNIFER BENTON	10/31/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1703 5TH AVE	STE 101	SAN RAFAEL	CA	94901	1826	21	06041	37.9750662	-122.5375444	Marin County
233277	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	6/12/2017	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
233279	Fee-for-Service	1063496651	1063496651	1	57	PACIFIC CENTRAL COAST HEALTH	2/27/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	300 SOUTH STRATFORD AVE	None	SANTA MARIA	CA	93454	5903	42	06083	34.95093895	-120.4146959	Santa Barbara County
233292	Fee-for-Service	1184251852	1184251852	1	1	PLATTNER, GRIFFIN MD	11/2/2023	207R00000X	NA	Other	026	PHYSICIANS	187680	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
233297	Fee-for-Service	1578126025	1578126025	1	1	PHAM, KIMBERLY DO	10/17/2022	390200000X	NA	Other	026	PHYSICIANS	19901	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
233330	Fee-for-Service	1659991552	1659991552	1	1	PARRY, HANNAH E MD	10/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3555 KENYON ST	STE 200	SAN DIEGO	CA	92110	5341	37	06073	32.75016963	-117.2160064	San Diego County
233335	Fee-for-Service	1346423944	1346423944	1	1	PALACIOS, JANELLE F CNM	5/2/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
233339	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	12/30/2018	171100000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233354	Fee-for-Service	1811421043	1811421043	1	1	PEREIRA, BENEDICT R MD	7/11/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	173037	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
233371	Fee-for-Service	1457320673	1457320673	1	1	PORCIUNCULA, GENEROSO MD	4/30/1980	207R00000X	NA	Other	026	PHYSICIANS	36153	01	General Practice	0	In state provider	None	1251 W TENNYSON RD	STE 4	HAYWARD	CA	94544	4400	01	06001	37.63146808	-122.0783775	Alameda County
233382	Fee-for-Service	1831372184	1831372184	1	1	PARHAM, VELINDA	5/16/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8706 BEAU MAISON WAY	None	BAKERSFIELD	CA	93311	1594	15	06029	35.33914678	-119.0991825	Kern County
233394	Fee-for-Service	1346744844	1346744844	1	1	PATIL, ACHYUT R MD	5/25/2021	207R00000X	NA	Other	026	PHYSICIANS	163492	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
233398	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	12/8/2018	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
233408	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	11/20/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
233417	Fee-for-Service	1437122769	1437122769	1	1	PIONEERS MEMORIAL HEALTHCARE	3/21/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	450 E BIRCH ST	None	CALEXICO	CA	92231	2375	13	06025	32.67912485	-115.4913398	Imperial County
233418	Fee-for-Service	1063496651	1063496651	1	48	PACIFIC CENTRAL COAST HEALTH	11/8/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	500 OLD RIVER RD	STE 200	BAKERSFIELD	CA	93311	9505	15	06029	35.35127492	-119.1142991	Kern County
233436	Fee-for-Service	1730240052	1730240052	1	1	POUSTI, SHEIVA L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3560 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	3420	37	06073	32.74323873	-117.1010132	San Diego County
233448	Fee-for-Service	1750154126	1750154126	1	1	POWERS, VINCENT PT	11/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
233461	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233465	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
233485	Fee-for-Service	1689057572	1689057572	1	1	PAXTON, DAVID DPM	5/9/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
233488	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
233498	Fee-for-Service	1528080462	1528080462	1	1	PICO, ELAINE L MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83371	25	Physical Medicine and Rehabilitation	0	In state provider	None	3031 TELEGRAPH AVE	STE 241	BERKELEY	CA	94705	2053	01	06001	37.85506766	-122.259871	Alameda County
233520	Fee-for-Service	1841671757	1841671757	1	1	PRABHU, SACHIDANAND MD	5/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139532	08	Family Practice	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
233529	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	4/15/2019	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
233554	Fee-for-Service	1760570600	1760570600	1	16	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2170 BIDWELL ST	100	FOLSOM	CA	95630	6465	34	06067	38.667321	-121.1435865	Sacramento County
233564	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	2/11/2013	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
233592	Fee-for-Service	1700832110	1700832110	1	1	POWELL, LEDFORD L MD	3/13/2009	208G00000X	NA	General Surgery	026	PHYSICIANS	66650	33	Thoracic Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 630	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
233608	Fee-for-Service	1861831836	1861831836	1	1	PENFIELD, CHRISTINA A MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233614	Fee-for-Service	1770100448	1770100448	1	1	PROFFITT, JAMIE PT	10/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
233615	Fee-for-Service	1609233543	1609233543	1	1	PROMED INC	8/27/2018	332B00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	42210 ROICK DRIVE	STE 4	TEMECULA	CA	92590	5523	33	06065	33.51019003	-117.1838092	Riverside County
233627	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233640	Fee-for-Service	1205856762	1205856762	1	1	PARNASSUS HEIGHTS PHARMA	5/26/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 PARNASSUS AVE	STE 100	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
233681	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	11/21/2017	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
233696	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
233703	Fee-for-Service	1184983728	1184983728	1	1	PANSARA, MEGHA L MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143429	18	Ophthalmology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
233704	Fee-for-Service	1437122769	1437122769	1	1	PIONEERS MEMORIAL HEALTHCARE	7/27/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	450 E BIRCH ST	None	CALEXICO	CA	92231	2375	13	06025	32.67912485	-115.4913398	Imperial County
233749	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
233750	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233758	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	6/19/2017	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
233770	Fee-for-Service	1235104761	1235104761	1	1	PHRAMPUS, ERIN D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 9055	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
233775	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	3/16/2009	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
233780	Fee-for-Service	1710513684	1710513684	1	1	PAN, VINCENT DO	11/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19710	None	None	0	In state provider	None	845 LA VETA	STE 108	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
233787	Fee-for-Service	1528080462	1528080462	1	1	PICO, ELAINE L MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83371	01	General Practice	0	In state provider	None	3031 TELEGRAPH AVE	STE 241	BERKELEY	CA	94705	2053	01	06001	37.85506766	-122.259871	Alameda County
233819	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
233851	Fee-for-Service	1801374723	1801374723	1	1	PEREZ, CRYSTAL M RCP	9/24/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
233852	Fee-for-Service	1548343510	1548343510	1	1	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
233889	Fee-for-Service	1902399231	1902399231	1	1	PATEL, NISHANT U MD	9/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173856	None	None	0	In state provider	None	3125 CONANT AVE	None	MODESTO	CA	95350	6527	50	06099	37.68548472	-121.0406676	Stanislaus County
233915	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
233969	Fee-for-Service	1881042471	1881042471	1	1	PRITCHARD, BRIAN DO	4/5/2024	207P00000X	NA	Other	026	PHYSICIANS	22104	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
233971	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	12/1/2016	193400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
233984	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
234010	Fee-for-Service	1083040463	1083040463	1	2	PORTEOUS, BRENT L MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12969	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
234038	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234039	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
234041	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
234063	Fee-for-Service	1548343510	1548343510	1	34	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
234076	Fee-for-Service	1528080462	1528080462	1	1	PICO, ELAINE L MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83371	40	Pediatrics	0	In state provider	None	3031 TELEGRAPH AVE	STE 241	BERKELEY	CA	94705	2053	01	06001	37.85506766	-122.259871	Alameda County
234092	Fee-for-Service	1386956308	1386956308	1	1	PAO, ELSA OD INC	4/24/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	405 9TH ST	None	OAKLAND	CA	94607	4001	01	06001	37.80062329	-122.2727632	Alameda County
234107	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	11/12/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
234143	Fee-for-Service	1760828420	1760828420	1	1	PATEL, NATALIE J MD	1/20/2020	207ZP0102X	NA	Other	026	PHYSICIANS	147231	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
234158	Fee-for-Service	1578666806	1578666806	1	1	PHAM, RYAN H MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75828	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234189	Fee-for-Service	1528238938	1528238938	1	1	PARK, YOUNGHEE	1/1/2001	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4132 KATELLA AVE	STE 204	LOS ALAMITOS	CA	90720	6601	30	06059	33.80297152	-118.060866	Orange County
234197	Fee-for-Service	1841208352	1841208352	1	1	PHAN, GREGORY H MD	7/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77619	18	Ophthalmology	0	In state provider	None	4585 STEVENS CREEK BLVD	STE 200	SANTA CLARA	CA	95051	6762	43	06085	37.32314549	-121.9832712	Santa Clara County
234202	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	12/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234206	Fee-for-Service	1932354206	1932354206	1	1	PREMIER EMERGENCY PHYSIC	12/1/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
234209	Fee-for-Service	1760508774	1760508774	1	1	PONCE, MOISES LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
234214	Fee-for-Service	1730509480	1730509480	1	1	PATEL, NEHA D MD	4/1/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146589	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
234242	Fee-for-Service	1962443184	1962443184	1	1	POLLACK, BARRY H MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36633	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
234245	Fee-for-Service	1568803583	1568803583	1	1	PERFORMANCE MEDICAL INC	8/10/2015	207LP2900X	NA	Other	026	PHYSICIANS	66891	05	Anesthesiology	0	In state provider	None	14148 FRANCISQUITO AVE	None	BALDWIN PARK	CA	92667	1010	19	06037	34.06339562	-117.9671298	Los Angeles County
234257	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	11/24/2019	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
234272	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	10/28/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
234284	Fee-for-Service	1386090074	1386090074	1	1	POLE, CAMERON C MD	7/9/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	151860	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
234324	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	5/25/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
234328	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	5/3/2019	103TC0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234329	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	8/3/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
234334	Fee-for-Service	1447316492	1447316492	1	1	PINERO, ONEIDA LCSW	3/14/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 NORTH TUSTIN AVENUE	SUITE 265	SANTA ANA	CA	78611	3112	30	06059	33.74962094	-117.8341227	Orange County
234336	Fee-for-Service	1104058122	1104058122	1	1	PREMIER HEALTHCARE SERVICES	6/28/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1730 WEST CAMERON AVENUE	SUITE 120	WEST COVINA	CA	91790	2722	19	06037	34.07013365	-117.9443203	Los Angeles County
234393	Fee-for-Service	1528005055	1528005055	1	1	PACIFIC GYN & OB MED GRP	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2100 WEBSTER ST	STE 319	SAN FRANCISCO	CA	94115	2377	38	06075	37.7904826	-122.4324477	San Francisco County
234396	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	9/12/2018	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
234437	Fee-for-Service	1063496651	1063496651	1	41	PACIFIC CENTRAL COAST HEALTH	7/13/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1560 MESA RD	STE 100	NIPOMO	CA	93444	0000	40	06079	35.02977199	-120.5498922	San Luis Obispo County
234438	Fee-for-Service	1356689483	1356689483	1	1	PARAMO, JULIO LCSW	10/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
234443	Fee-for-Service	1548606668	1548606668	1	1	PATEL, JANKI R MD	10/26/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	133101	10	Gastroenterology (M.D. only)	0	In state provider	None	700 GARDEN VIEW CT	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
234444	Fee-for-Service	1578666806	1578666806	1	1	PHAM, RYAN H MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75828	42	Nuclear Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234463	Fee-for-Service	1588735336	1588735336	1	1	PHILLIPS, SUSAN A MD	2/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	85921	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234468	Fee-for-Service	1790272599	1790272599	1	1	PARENTEAU, TIMOTHY R MD	4/21/2022	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	167098	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
234490	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	4/15/2019	171100000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234499	Fee-for-Service	1457326266	1457326266	1	1	PETROVIC, LIDIJA M MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52273	22	Pathology (M.D. only)	0	In state provider	None	2011 ZONAL AVE	None	LOS ANGELES	CA	90033	1054	19	06037	34.05979479	-118.2053794	Los Angeles County
234506	Fee-for-Service	1316991714	1316991714	1	1	PLANNED PARENTHOOD MAR MONTE	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	1125 10TH ST	None	SACRAMENTO	CA	95814	3503	34	06067	38.57890563	-121.4939739	Sacramento County
234511	Fee-for-Service	1447447248	1447447248	1	6	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
234548	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	9/11/2012	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
234561	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
234577	Fee-for-Service	1164887089	1164887089	1	1	POSITIVE DIRECTIONS INC	11/12/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1371 GRIFFITH AVE	None	WASCO	CA	93280	2265	15	06029	35.5860417	-119.340552	Kern County
234581	Fee-for-Service	1790041556	1790041556	1	1	POLLOCK, DEANNA M MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140726	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
234597	Fee-for-Service	1962609073	1962609073	1	1	PATEL, SALONI D DO	10/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10725	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
234607	Fee-for-Service	1659717965	1659717965	1	1	PRABHU, NAMRATHA MD	3/10/2021	208VP0014X	NA	Other	026	PHYSICIANS	153978	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	BLGD 3, SUITE 540	LA MESA	CA	91942	3024	37	06073	32.77978322	-117.0094766	San Diego County
234613	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	6/25/2009	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234614	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	7/4/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
234616	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
234624	Fee-for-Service	1720332307	1720332307	1	1	PRYOR, VERNA NP	8/28/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
234642	Fee-for-Service	1871549899	1871549899	1	19	PUEBLO RAD MED GRP INC	4/27/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	523 BARCELLUS	None	SANTA MARIA	CA	93454	6919	42	06083	34.93663547	-120.429171	Santa Barbara County
234685	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	12/8/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
234734	Fee-for-Service	1548606668	1548606668	1	1	PATEL, JANKI R MD	10/26/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	133101	41	Internal Medicine	0	In state provider	None	700 GARDEN VIEW CT	STE 102	ENCINITAS	CA	92024	2478	37	06073	33.05922419	-117.260629	San Diego County
234749	Fee-for-Service	1215946496	1215946496	1	1	PAN, AUDREY Y DO	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8667	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
234755	Fee-for-Service	1588735336	1588735336	1	1	PHILLIPS, SUSAN A MD	2/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	85921	67	Endocrinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234762	Fee-for-Service	1962894758	1962894758	1	1	PREMIER CARE PHARMACY	9/7/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	863 N 980 W	None	OREM	UT	84057	7710	00	None	40.31317118	-111.7197166	Utah County
234779	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234786	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	12/8/2015	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
234796	Fee-for-Service	1447447248	1447447248	1	6	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
234818	Fee-for-Service	1477626513	1477626513	1	1	PARKER, SHERINE B MD	6/28/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	81658	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 100	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
234825	Fee-for-Service	1215162607	1215162607	1	1	PIERCE, JAMES R MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88011	02	General Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
234829	Fee-for-Service	1114075397	1114075397	1	1	PETERSON, JEANNE M PHD	10/20/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4545 PARK BLVD	STE 105	SAN DIEGO	CA	92116	2668	37	06073	32.75996149	-117.1462424	San Diego County
234834	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	2/5/2019	193400000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
234841	Fee-for-Service	1578939880	1578939880	1	1	POPE, MADALYN LMFT	12/5/2024	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
234850	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	5/3/2019	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
234856	Fee-for-Service	1760425862	1760425862	1	12	PROVIDENCE MEDICAL INSTITUTE	10/28/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	20911 EARL ST	SUITE 220	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
234857	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
234859	Fee-for-Service	1649511106	1649511106	1	1	PHAM, TIN T	6/5/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
234873	Fee-for-Service	1740321884	1740321884	1	1	PATEL, ATUL K MD	3/17/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	80626	14	Neurological Surgery	0	In state provider	None	1200 B GALE WILSON	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
234900	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
234903	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
234909	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	6/15/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
234917	Fee-for-Service	1962584904	1962584904	1	1	PASADENA NEPHROLOGY CORP	7/31/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL GROUP	808 S FAIR OAKS AVE	None	PASADENA	CA	91105	2601	19	06037	34.131942	-118.1503315	Los Angeles County
234926	Fee-for-Service	1548596828	1548596828	1	1	PAN, RUTH L MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116139	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
234936	Fee-for-Service	1144277633	1144277633	1	5	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	6125 N FRESNO STREET	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
234958	Fee-for-Service	1093037582	1093037582	1	1	PATEL, AMAR B MD	5/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125607	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365 A	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
234961	Fee-for-Service	1609976547	1609976547	1	1	PARK, THOMAS C MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68104	02	General Surgery	0	In state provider	None	1201 ALHAMBRA BLVD	STE 680	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
234970	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	5/3/2019	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
234975	Fee-for-Service	1447204110	1447204110	1	1	PAIN INSTITUTE OF CALIFORNIA	10/29/2012	208VP0014X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LIFORNIA	9802 STOCKDALE HWY	SUITE 105	BAKERSFIELD	CA	93311	3653	15	06029	35.3544067	-119.1113372	Kern County
235016	Fee-for-Service	1053378000	1053378000	1	1	PLANCEY, ROBERT M MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	45522	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
235019	Fee-for-Service	1093153215	1093153215	1	1	PATEL, MITESH B MD	10/7/2019	208600000X	NA	General Surgery	026	PHYSICIANS	164467	02	General Surgery	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
235027	Fee-for-Service	1134440795	1134440795	1	1	PULIDO, ELIZABETH M DPM	9/28/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
235068	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	11/24/2019	171100000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235075	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
235102	Fee-for-Service	1831692730	1831692730	1	1	PRICE, SAYESTE M LMFT	3/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
235117	Fee-for-Service	1013991918	1013991918	1	1	PATRA, WOODY MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	33431	08	Family Practice	0	In state provider	None	1158 N COURT ST	None	REDDING	CA	96001	0436	45	06089	40.58710715	-122.3977283	Shasta County
235123	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	9/11/2012	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
235125	Fee-for-Service	1013090810	1013090810	1	1	PACHYNSKI, ALISON L MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87899	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
235135	Fee-for-Service	1922027986	1922027986	1	1	PALMER, GAYLON LCSW	4/1/2000	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	9718 FAIR OAKS	D	FAIR OAKS	CA	95628	7037	34	06067	38.638566	-121.277106	Sacramento County
235137	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	3/1/2019	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
235149	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
235150	Fee-for-Service	1235823550	1235823550	1	1	PITAYA HEALTHCARE, LLC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	101 S. ORCHARD AVE.	None	VACAVILLE	CA	95688	3635	48	06095	38.35699428	-122.0045191	Solano County
235189	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	4/26/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
235192	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235194	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
235195	Fee-for-Service	1568522035	1568522035	1	1	PETER SHIN, M.D.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
235223	Fee-for-Service	1144277633	1144277633	1	5	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	6125 N FRESNO STREET	None	FRESNO	CA	93710	5207	10	06019	36.825057	-119.7814395	Fresno County
235235	Fee-for-Service	1144600263	1144600263	1	1	PATEL, HEENA P MD	11/1/2020	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
235244	Fee-for-Service	1558387373	1558387373	1	2	PAPP, ALEXANDER S MD	12/4/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51343	-	NOT APPLICABLE	0	In state provider	None	140 ARBOR DR	None	SAN DIEGO	CA	92103	2007	37	06073	32.75382424	-117.1635451	San Diego County
235257	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
235292	Fee-for-Service	1720105943	1720105943	1	1	PUVVULA, JYOTI MD	7/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55283	08	Family Practice	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
235307	Fee-for-Service	1508982554	1508982554	1	1	PONEC, CHRISTINE LMFT	9/1/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40337	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
235316	Fee-for-Service	1912957259	1912957259	1	1	PONT, JON EDWARD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41799	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
235356	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	9/12/2018	171100000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235361	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	10/16/2012	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
235376	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
235399	Fee-for-Service	1821727819	1821727819	2	1	PRELUDE TRANSPORTATION LLC	11/30/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3468 CITRUS ST	SUITE G	LEMON GROVE	CA	91945	1532	37	06073	32.743359	-117.0407265	San Diego County
235403	Fee-for-Service	1225542665	1225542665	1	1	PEAK DIAGNOSTIC	11/5/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8901 ACTIVITY RD	STE 103	SAN DIEGO	CA	92126	4436	37	06073	32.8960193	-117.1345934	San Diego County
235411	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	6/23/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
235424	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
235426	Fee-for-Service	1770909830	1770909830	1	2	PHONG H BUI INC	6/29/2021	207RE0101X	NA	Endocrinology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16055 BROOKHURST ST	SUITE C	FOUNTAIN VALLEY	CA	92708	1544	30	06059	33.72960657	-117.9548029	Orange County
235433	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
235434	Fee-for-Service	1336883834	1336883834	1	1	PALM SPRINGS SOBER LIVING	7/11/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	707 E. TAHQUITZ CANYON W	14	PALM SPRINGS	CA	92262	6761	33	06065	33.8230137	-116.54049	Riverside County
235458	Fee-for-Service	1194013623	1194013623	1	1	PATEL, KEVIN R MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157342	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	SUITE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
235464	Fee-for-Service	1992753214	1992753214	1	1	PETERLIN, BORIS M MD	1/1/1982	207RR0500X	NA	Other	026	PHYSICIANS	28113	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
235478	Fee-for-Service	1235226531	1235226531	1	26	PERMANENTE MEDICAL GROUP INC	9/12/2018	103TC0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235479	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	10/7/2019	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
235487	Fee-for-Service	1235226531	1235226531	1	12	PERMANENTE MEDICAL GROUP INC	8/20/2013	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
235491	Fee-for-Service	1972888139	1972888139	1	1	PEACHSTATE HEALTH MANAGEMENT	12/12/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LLC	2225 CENTENNIAL DR	None	GAINESVILLE	GA	30504	5760	00	None	34.26281037	-83.86455056	Hall County
235507	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
235509	Fee-for-Service	1386119881	1386119881	1	1	PAVLOVA, POLINA NP	6/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
235514	Fee-for-Service	1285712877	1285712877	1	1	PONG, THOMAS M MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39714	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
235524	Fee-for-Service	1063533412	1063533412	1	1	POTSIC, BRADLEY J MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LN	SUITE #100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
235537	Fee-for-Service	1639106198	1639106198	1	1	PATEL, MUKESHCMANDRA M	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43158	41	Internal Medicine	0	In state provider	SHANTI MOHAN MED CTR INC	16077 KAMANA RD	None	APPLE VALLEY	CA	92307	1331	36	06071	34.54331235	-117.2708109	San Bernardino County
235547	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	11/30/2018	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
235548	Fee-for-Service	1437691870	1437691870	1	1	PARK, ANDREW PT	1/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1561 ONTARIO	SUITE 101	CORONA	CA	92881	6662	33	06065	33.84257433	-117.5332788	Riverside County
235550	Fee-for-Service	1487865978	1487865978	1	1	PRIDE-BOONE, JANICE MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151811	40	Pediatrics	0	In state provider	None	190 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3658	36	06071	34.1360043	-117.2826788	San Bernardino County
235557	Fee-for-Service	1821221870	1821221870	1	1	PRESS, CORINNA N PHD	5/13/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
235566	Fee-for-Service	1184120081	1184120081	1	1	PHILLIPS, CAROLYN MD	9/23/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
235589	Fee-for-Service	1467706523	1467706523	1	1	PEARA, SARAH K	5/29/2020	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
235645	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235648	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	9/20/2018	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
235649	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
235655	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	10/4/2016	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
235662	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	11/30/2018	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
235681	Fee-for-Service	1205098183	1205098183	1	1	PARK, JEAN MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117145	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
235682	Fee-for-Service	1861627242	1861627242	1	3	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	1	Border provider	None	5400 SOUTH RAINBOW BLVD.	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
235700	Fee-for-Service	1235226531	1235226531	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	193400000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
235711	Fee-for-Service	1417228396	1417228396	1	1	PASSIONATE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA STREET	SUITE 120	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
235712	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	2/19/2019	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
235721	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
235743	Fee-for-Service	1083621130	1083621130	1	1	PLAINVIEW HOSPITAL	2/9/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	888 OLD COUNTRY RD	None	PLAINVIEW	NY	11803	4914	00	None	40.774896	-73.4785515	Nassau County
235745	Fee-for-Service	1053713115	1053713115	1	1	POTLURI, KRISHNA K MD	2/1/2022	207P00000X	NA	Other	026	PHYSICIANS	168516	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
235758	Fee-for-Service	1265764963	1265764963	1	1	PERRYMAN, CHRISTINA S	3/5/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
235766	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
235767	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	9/11/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
235794	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
235796	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
235800	Fee-for-Service	1619173721	1619173721	1	1	PLUTO, CHARLES MD	5/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191839	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
235802	Fee-for-Service	1285712877	1285712877	1	1	PONG, THOMAS M MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39714	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
235821	Fee-for-Service	1730246182	1730246182	1	1	PRESTRIDGE, JAMES G	11/15/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
235825	Fee-for-Service	1639106198	1639106198	1	1	PATEL, MUKESHCMANDRA M	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43158	06	Cardiovascular Disease (M.D. only)	0	In state provider	SHANTI MOHAN MED CTR INC	16077 KAMANA RD	None	APPLE VALLEY	CA	92307	1331	36	06071	34.54331235	-117.2708109	San Bernardino County
235826	Fee-for-Service	1154409795	1154409795	1	1	POMPILI, MARIO F MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	43527	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
235835	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
235847	Fee-for-Service	1225212442	1225212442	1	1	POMERANTZ, JASON H MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79125	24	Plastic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
235868	Fee-for-Service	1568648434	1568648434	1	1	PACIFIC CLINICS	8/29/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	13001 RAMONA BOULEVARD	SUITE H AND T	IRWINDALE	CA	91706	3752	19	06037	34.07969659	-117.9895641	Los Angeles County
235870	Fee-for-Service	1770928962	1770928962	1	1	PHAN, JIMMY N	6/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141765	None	None	0	In state provider	None	900 S MAIN ST	SUITE 108	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
235878	Fee-for-Service	1356341606	1356341606	1	1	PEREZ, CARLOS G MD	3/31/1992	208M00000X	NA	Other	026	PHYSICIANS	77116	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	0000	37	06073	33.03623896	-117.2837308	San Diego County
235879	Fee-for-Service	1174612667	1174612667	1	1	PARK, WILLIAM C LMFT	8/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 EAST AVE	2-B	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
235897	Fee-for-Service	1114019890	1114019890	1	1	PATTERSON, ELIZABETH MD	8/2/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48500	08	Family Practice	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
235912	Fee-for-Service	1154385250	1154385250	1	1	PUNTEL, ROBERT A MD	7/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	1919 E THOMAS ROAD	MAIN BLDG	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
235914	Fee-for-Service	1235226531	1235226531	1	53	PERMANENTE MEDICAL GROUP INC	1/23/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
235931	Fee-for-Service	1235226531	1235226531	1	47	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
235937	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	10/16/2012	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
235939	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
235941	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
235952	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
235968	Fee-for-Service	1033367271	1033367271	1	1	PACIFIC MEDICAL, INC.	9/5/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2901 K ST	STE 170	SACRAMENTO	CA	95816	5124	34	06067	38.572497	-121.468059	Sacramento County
235970	Fee-for-Service	1861627242	1861627242	1	3	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	5400 SOUTH RAINBOW BLVD.	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
235982	Fee-for-Service	1306576723	1306576723	1	1	PENUELA, LEA CRNA	11/16/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
235996	Fee-for-Service	1871549899	1871549899	1	10	PUEBLO RAD MED GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	250 W PUEBLO ST	None	SANTA BARBARA	CA	93105	3805	42	06083	34.43089516	-119.7216367	Santa Barbara County
235998	Fee-for-Service	1417228396	1417228396	1	1	PASSIONATE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA STREET	SUITE 120	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
236001	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
236012	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
236020	Fee-for-Service	1639197924	1639197924	1	1	PEARCE, JAMES A MD	12/1/1994	207L00000X	NA	Other	026	PHYSICIANS	74367	05	Anesthesiology	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
236031	Fee-for-Service	1083621130	1083621130	1	1	PLAINVIEW HOSPITAL	2/9/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	888 OLD COUNTRY RD	None	PLAINVIEW	NY	11803	4914	00	None	40.774896	-73.4785515	Nassau County
236037	Fee-for-Service	1497268932	1497268932	1	1	PRICE, DANIELLE N PT	11/20/2018	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
236054	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	4/13/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
236061	Fee-for-Service	1235226531	1235226531	1	60	PERMANENTE MEDICAL GROUP INC	3/5/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	P INC	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
236080	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
236085	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
236100	Fee-for-Service	1942691704	1942691704	1	1	PEACE AND CARE HOSPICE INC	2/25/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	STE 301-A	BURBANK	CA	91502	3201	19	06037	34.18652984	-118.310858	Los Angeles County
236113	Fee-for-Service	1528078961	1528078961	1	1	PARK, JEONG SIK MD	11/7/2008	174400000X	NA	Other	026	PHYSICIANS	45408	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	660 SANITARIUM RD	STE 307	DEER PARK	CA	94576	0000	28	06055	38.54206023	-122.47561	Napa County
236114	Fee-for-Service	1154409795	1154409795	1	1	POMPILI, MARIO F MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	43527	33	Thoracic Surgery	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
236125	Fee-for-Service	1235226531	1235226531	1	33	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5000 MACARTHUR BLVD	None	OAKLAND	CA	94613	1301	01	06001	37.78221179	-122.1877	Alameda County
236126	Fee-for-Service	1356943948	1356943948	1	1	PEACEFUL VALLEY HOME CARE	10/2/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	208 W MAIN ST	SUITE L	VISALIA	CA	93291	6267	54	06107	36.330282	-119.2939155	Tulare County
236219	Fee-for-Service	1730542192	1730542192	1	1	PHAM, DAI H MD	7/3/2019	208M00000X	NA	Other	026	PHYSICIANS	158206	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
236221	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	4/22/2020	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
236226	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	10/29/2018	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
236230	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	10/4/2016	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
236240	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
236258	Fee-for-Service	1861627242	1861627242	1	3	PLATINUM HOSPITALISTS LLP	1/24/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	5400 SOUTH RAINBOW BLVD.	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
236259	Fee-for-Service	1841241585	1841241585	1	3	PSYCHIATRIC CENTERS AT SAN D	2/9/2012	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	DIEGO INC MED GRP	277 RANCHEROS DR	STE 301	SAN MARCOS	CA	92069	2993	37	06073	33.13859391	-117.1604009	San Diego County
236280	Fee-for-Service	1447754437	1447754437	1	1	PHUNG, VIVIEN MD	8/3/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164816	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
236287	Fee-for-Service	1629511886	1629511886	1	1	PRIME PULMONARY & SLEEP	6/30/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICINE CENTER INC	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	15	06029	35.36876049	-119.0948805	Kern County
236289	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
236301	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
236342	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	3/25/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
236344	Fee-for-Service	1104264472	1104264472	1	1	PYUN, SAROM H MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134211	08	Family Practice	0	In state provider	None	5562 PHILADELPHIA ST	SUITE 311	CHINO	CA	91710	2499	36	06071	34.03370384	-117.6837291	San Bernardino County
236367	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	3/31/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
236373	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
236390	Fee-for-Service	1942691704	1942691704	1	1	PEACE AND CARE HOSPICE INC	2/25/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	STE 301-A	BURBANK	CA	91502	3201	19	06037	34.18652984	-118.310858	Los Angeles County
236424	Fee-for-Service	1205412244	1205412244	1	2	PRECISION HEALTH CENTER	9/7/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3712 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1733	19	06037	34.0243965	-118.1933222	Los Angeles County
236427	Fee-for-Service	1609947464	1609947464	1	1	PERTL, URSULA G MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89997	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
236440	Fee-for-Service	1750632501	1750632501	1	1	PARK, JOHN PHD	6/14/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
236443	Fee-for-Service	1811161631	1811161631	1	1	PEREZ, NATALIE R	4/22/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	904 TOWN AND COUNTRY RD	None	ORANGE	CA	92867	4721	30	06059	33.77651249	-117.861444	Orange County
236459	Fee-for-Service	1710054739	1710054739	1	1	PHAM, BRANDON T MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77580	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
236501	Fee-for-Service	1053601633	1053601633	1	1	PERRINS, STEVEN B JR MD	10/5/2018	208600000X	NA	General Surgery	026	PHYSICIANS	155169	01	General Practice	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
236512	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
236513	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
236518	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
236528	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
236530	Fee-for-Service	1508989567	1508989567	1	1	POLLARD, GREGORY W	3/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
236547	Fee-for-Service	1073617338	1073617338	1	1	PAJE OPTOMETRIC APC	5/2/2003	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2414 S FAIRVIEW ST	STE 103	SANTA ANA	CA	92704	5318	30	06059	33.71437705	-117.9079237	Orange County
236552	Fee-for-Service	1841241585	1841241585	1	3	PSYCHIATRIC CENTERS AT SAN D	12/31/2018	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DIEGO INC MED GRP	277 RANCHEROS DR	STE 301	SAN MARCOS	CA	92069	2993	37	06073	33.13859391	-117.1604009	San Diego County
236575	Fee-for-Service	1629511886	1629511886	1	1	PRIME PULMONARY & SLEEP	6/30/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICINE CENTER INC	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	15	06029	35.36876049	-119.0948805	Kern County
236577	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	3/1/2019	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
236584	Fee-for-Service	1427247667	1427247667	1	1	PICK, DONALD L MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90733	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
236588	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
236598	Fee-for-Service	1548892763	1548892763	1	1	PALADY, GINA R LAC	11/4/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	407 S MOUNT SHASTA BLVD	None	MOUNT SHASTA	CA	96067	2559	47	06093	41.31045	-122.3111185	Siskiyou County
236612	Fee-for-Service	1851323026	1851323026	1	1	PEDRAZA, BENITO A MD	6/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78582	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
236614	Fee-for-Service	1740480979	1740480979	1	1	PERMAN, SARAH MD	3/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
236628	Fee-for-Service	1053472605	1053472605	1	1	PARK, ROBERT P PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
236631	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	5/18/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
236632	Fee-for-Service	1831455369	1831455369	1	1	POSNER, AMANDA J MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130191	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
236634	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	5/3/2019	171100000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
236652	Fee-for-Service	1467561126	1467561126	1	1	PAUL A. GRIFFIN MD A PROFESS	6/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	155 S 5TH ST, # B	155 S 5TH STREET	#B	COALINGA	CA	93210	0784	10	06019	36.13845412	-120.3582671	Fresno County
236656	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/24/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
236659	Fee-for-Service	1205290574	1205290574	1	1	PHUONG, JONATHAN S MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152191	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236661	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
236666	Fee-for-Service	1124151212	1124151212	1	1	PIRHEKAYATYSORIANO, TAHEREH	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11525	-	NOT APPLICABLE	0	In state provider	PSY	3580 WILSHIRE BLVD	STE 2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
236707	Fee-for-Service	1477522480	1477522480	1	1	PANDEY, PUSHKAR R MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51295	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
236714	Fee-for-Service	1205412244	1205412244	1	2	PRECISION HEALTH CENTER	9/7/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3712 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1733	19	06037	34.0243965	-118.1933222	Los Angeles County
236777	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	12/30/2018	207N00000X	NA	Dermatology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
236799	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	6/23/2017	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
236801	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	12/20/2018	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
236807	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	7/20/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
236815	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
236837	Fee-for-Service	1841241585	1841241585	1	3	PSYCHIATRIC CENTERS AT SAN D	12/31/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	DIEGO INC MED GRP	277 RANCHEROS DR	STE 301	SAN MARCOS	CA	92069	2993	37	06073	33.13859391	-117.1604009	San Diego County
236843	Fee-for-Service	1326493404	1326493404	1	1	PERKINS, PATRICIA A LMFT	8/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3700 DELTA FAIR BLVD	STE 200C	ANTIOCH	CA	94509	4072	07	06013	38.0038852	-121.8448833	Contra Costa County
236845	Fee-for-Service	1265006399	1265006399	1	1	PHILLIPS, NICOLE C CNP	5/17/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
236851	Fee-for-Service	1649595026	1649595026	1	1	PARIKH, MAMTA MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123686	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
236854	Fee-for-Service	1265946784	1265946784	1	1	PALMESE, JOYCE LMFT	6/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
236865	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	3/22/2019	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
236878	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
236883	Fee-for-Service	1568496925	1568496925	1	1	PETERSON, GORDON W MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	31371	13	Neurology (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 3401	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
236916	Fee-for-Service	1952441263	1952441263	2	1	PARKERS PHARMACY INC	5/9/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	102 WEST 5TH ST	None	HOLTVILLE	CA	92250	1214	13	06025	32.81091468	-115.380443	Imperial County
236919	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	4/5/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
236921	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
236942	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
236944	Fee-for-Service	1154337822	1154337822	1	1	PINSK, STEPHEN MD INC	5/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	400 MORRIS ST	STE H	SEBASTOPOL	CA	95472	3830	49	06097	38.40685624	-122.8200572	Sonoma County
236945	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/8/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
236946	Fee-for-Service	1811961980	1811961980	1	1	PINCKNEY, LEE E MD	7/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	28342	30	Radiology	0	In state provider	None	7910 FROST ST	STE 202	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
236950	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
236958	Fee-for-Service	1760425862	1760425862	1	11	PROVIDENCE MEDICAL INSTITUTE	5/20/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3475 TORRANCE BLVD	SUITE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
236980	Fee-for-Service	1356521843	1356521843	1	2	PULAKANTI, VENKATA S MD	9/9/2020	207R00000X	NA	Other	026	PHYSICIANS	51071	None	None	0	In state provider	None	1196 N PARK AVE	None	POMONA	CA	91768	3027	19	06037	34.06976919	-117.7549069	Los Angeles County
236993	Fee-for-Service	1700821691	1700821691	1	1	PACIFIC CARDIOVASCULAR	6/25/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOC MED GROUP INC	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
237051	Fee-for-Service	1720397524	1720397524	1	1	PROSSER, CAROLINE E OT	9/14/2018	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N JACKSON ST	202	GLENDALE	CA	91206	4330	19	06037	34.14852285	-118.2501237	Los Angeles County
237064	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	7/20/2019	106H00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
237077	Fee-for-Service	1194305631	1194305631	1	1	PANA, ANNA AU	8/20/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
237089	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
237090	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
237093	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
237097	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237099	Fee-for-Service	1851683288	1851683288	1	1	PITTS, MARYANN A MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122106	40	Pediatrics	0	In state provider	None	500 TULLY RD	None	SAN JOSE	CA	95111	1917	43	06085	37.30579894	-121.8506333	Santa Clara County
237102	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
237134	Fee-for-Service	1548867971	1548867971	1	1	PROFESSIONAL SOLUTIONS HOME	11/24/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH, INC	18520 BURBANK BLVD	SUITE 203	TARZANA	CA	91356	6249	19	06037	34.17230948	-118.5368985	Los Angeles County
237138	Fee-for-Service	1649595026	1649595026	1	1	PARIKH, MAMTA MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123686	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
237139	Fee-for-Service	1770999765	1770999765	1	1	PENG, TAMMY MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136879	03	Allergy	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
237154	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	7/22/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
237165	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
237168	Fee-for-Service	1811489107	1811489107	1	1	PEREZ, KAREN J LMFT	1/4/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
237171	Fee-for-Service	1821487414	1821487414	1	1	PACIFIC CENTRAL COAST HEALTH	4/12/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	685 MORRO AVENUE	STE C	MORRO BAY	CA	93442	2233	40	06079	35.364564	-120.8511755	San Luis Obispo County
237198	Fee-for-Service	1174849186	1174849186	1	1	PURI, SUNITA MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119239	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
237210	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
237212	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
237214	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	4/5/2020	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
237217	Fee-for-Service	1316586316	1316586316	1	1	PEETE, CHANTAL LMFT	7/29/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
237235	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/8/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
237238	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
237248	Fee-for-Service	1760425862	1760425862	1	11	PROVIDENCE MEDICAL INSTITUTE	5/20/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3475 TORRANCE BLVD	SUITE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
237281	Fee-for-Service	1700821691	1700821691	1	1	PACIFIC CARDIOVASCULAR	6/25/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ASSOC MED GROUP INC	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
237282	Fee-for-Service	1255366241	1255366241	1	1	PLANNED PARENTHOOD OF THE	2/26/1993	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	THE PACIFIC SOUTHWEST	1295 BROADWAY	# 201 & #202	CHULA VISTA	CA	91911	2976	37	06073	32.60364599	-117.0786521	San Diego County
237352	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	12/20/2018	207N00000X	NA	Dermatology	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
237358	Fee-for-Service	1730243049	1730243049	2	1	PRAKASH, SONAM MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74641	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
237372	Fee-for-Service	1144277633	1144277633	1	14	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	15 E AUDUBON DR	None	FRESNO	CA	93720	1542	10	06019	36.86091856	-119.7886861	Fresno County
237374	Fee-for-Service	1457321317	1457321317	1	4	PALOMAR HEALTH	7/10/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ALBERTSONS	1571 SAN ELIJO ROAD S	None	SAN MARCOS	CA	92078	2044	37	06073	33.09729386	-117.2002867	San Diego County
237378	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	7/20/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
237379	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	12/19/2016	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
237382	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
237384	Fee-for-Service	1376772855	1376772855	1	1	PLANT, JENNIFER L MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89919	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
237386	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YM0800X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237388	Fee-for-Service	1528286218	1528286218	1	1	PYCH, LINDSEY P DO	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11906	08	Family Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
237392	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
237393	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	9/11/2012	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237402	Fee-for-Service	1295267813	1295267813	1	1	PLESCIA, TREVOR A MD	8/25/2024	208600000X	NA	General Surgery	026	PHYSICIANS	158530	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
237408	Fee-for-Service	1639148794	1639148794	1	1	PAULSEN, RICHARD A CRNA	4/1/2001	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
237412	Fee-for-Service	1003893348	1003893348	1	1	POPA, ALINA S MD	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107794	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
237414	Fee-for-Service	1437105889	1437105889	1	1	POUND, DANIEL R MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81876	08	Family Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
237426	Fee-for-Service	1770999765	1770999765	1	1	PENG, TAMMY MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136879	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
237427	Fee-for-Service	1790793651	1790793651	1	2	PALO ALTO COUNTY HOSPITAL	2/16/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3201 1ST STREET	None	EMMETSBURG	IA	50536	2516	00	None	43.11921099	-94.69133087	Palo Alto County
237444	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	3/1/2019	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
237454	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
237481	Fee-for-Service	1992479208	1992479208	1	1	PADILLA, ITZEL AU	8/3/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2160 WEST ADAMS BLVD.	None	LOS ANGELES	CA	90018	2039	19	06037	34.03262662	-118.3138579	Los Angeles County
237494	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	5/18/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
237496	Fee-for-Service	1124091525	1124091525	1	1	PATEL, DHARMESH S	1/28/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2100 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4002	36	06071	34.133931	-117.289686	San Bernardino County
237498	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	2/5/2019	171100000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
237515	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
237522	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/8/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
237524	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
237526	Fee-for-Service	1033789516	1033789516	1	1	PEREZ, SAUL A CRNA	3/22/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
237535	Fee-for-Service	1760425862	1760425862	1	11	PROVIDENCE MEDICAL INSTITUTE	5/20/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3475 TORRANCE BLVD	SUITE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
237546	Fee-for-Service	1750439691	1750439691	1	1	PEAL, SEYMOUR MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24043	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
237557	Fee-for-Service	1740357680	1740357680	1	1	PUSHECK, TERESA L MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	70884	84	Surgery-Head and Neck	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
237579	Fee-for-Service	1942656376	1942656376	1	1	PAUL, NATALIE R LMFT	8/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21 HANOVER LANE	SUITE A	CHICO	CA	95926	2282	04	06007	39.75974044	-121.8650578	Butte County
237633	Fee-for-Service	1144277633	1144277633	1	6	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	1205 E ALMOND AVE	None	MADERA	CA	93637	2696	20	06039	36.94550984	-120.04627	Madera County
237640	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	12/30/2018	207N00000X	NA	Dermatology	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
237643	Fee-for-Service	1861489908	1861489908	1	1	PLOTZKER, RICHARD E MD	5/31/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	42237	10	Gastroenterology (M.D. only)	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
237644	Fee-for-Service	1073670931	1073670931	1	1	POTTS, BRIAN R MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93786	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
237660	Fee-for-Service	1144277633	1144277633	1	14	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	15 E AUDUBON DR	None	FRESNO	CA	93720	1542	10	06019	36.86091856	-119.7886861	Fresno County
237662	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	7/3/2015	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
237664	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	10/8/2018	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
237669	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	12/20/2018	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
237675	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YM0800X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237678	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	10/20/2016	103TB0200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
237679	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
237684	Fee-for-Service	1760425862	1760425862	1	1	PROVIDENCE MEDICAL INSTITUTE	5/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	621 S BUTTE STREET	None	SAN PEDRO	CA	90732	3510	19	06037	33.73839738	-118.3065444	Los Angeles County
237690	Fee-for-Service	1659875649	1659875649	1	1	PLACONE, TAYLAUR W MD	7/22/2021	207P00000X	NA	Other	026	PHYSICIANS	166058	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
237702	Fee-for-Service	1689763427	1689763427	1	1	PARTOVI, KIANDOKHT MD	8/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55287	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93729	8949	10	06019	36.74333844	-119.7831874	Fresno County
237715	Fee-for-Service	1790793651	1790793651	1	2	PALO ALTO COUNTY HOSPITAL	2/16/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3201 1ST STREET	None	EMMETSBURG	IA	50536	2516	00	None	43.11921099	-94.69133087	Palo Alto County
237720	Fee-for-Service	1497746747	1497746747	1	1	PHYSICIANS' SURGERY CENTER O	11/30/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	F VICTORVILLE LLC	12567 HESPERIA ROAD	None	VICTORVILLE	CA	92395	5847	36	06071	34.47951846	-117.290868	San Bernardino County
237731	Fee-for-Service	1235226531	1235226531	1	44	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
237738	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
237761	Fee-for-Service	1255588463	1255588463	1	1	PARK, ANDREW M MD	2/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105022	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5239	34	06067	38.570076	-121.4657145	Sacramento County
237784	Fee-for-Service	1235226531	1235226531	1	58	PERMANENTE MEDICAL GROUP INC	10/7/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
237785	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	6/25/2009	171100000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
237786	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	1/14/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
237790	Fee-for-Service	1457377897	1457377897	1	1	POPESCU, MARIA I MD PC	7/23/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3900 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.78398109	-116.4059049	Riverside County
237808	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
237813	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
237832	Fee-for-Service	1295808004	1295808004	1	1	PETERSEN, THERESE M NP	5/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
237838	Fee-for-Service	1528495884	1528495884	1	1	PELESIC, BETINA NP	10/4/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
237846	Fee-for-Service	1740357680	1740357680	1	1	PUSHECK, TERESA L MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	70884	04	Otology, Laryngology, Rhinology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
237876	Fee-for-Service	1356723605	1356723605	1	1	PACIFIC FAMILY MEDICINE CLIN	12/5/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	IC - MILLBRAE	1001 BROADWAY	STE 302	MILLBRAE	CA	94030	1978	41	06081	37.60544641	-122.3978603	San Mateo County
237912	Fee-for-Service	1457881245	1457881245	1	1	PATEL, JIGAR T MD	4/19/2021	208M00000X	NA	Other	026	PHYSICIANS	169784	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
237920	Fee-for-Service	1144277633	1144277633	1	6	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	1205 E ALMOND AVE	None	MADERA	CA	93637	2696	20	06039	36.94550984	-120.04627	Madera County
237929	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	2/11/2013	106H00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
237950	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
237952	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
237956	Fee-for-Service	1548793474	1548793474	1	1	PATEL, RAVIJA MD	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
237958	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	11/30/2018	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
237963	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237966	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
237968	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
237980	Fee-for-Service	1760570600	1760570600	1	10	PEDIATRIC MEDICAL ASSOCIATES	5/17/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	DICAL GROUP	5030 J ST	301	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
237986	Fee-for-Service	1861990053	1861990053	1	1	PACKARD, CANDICE A LMFT	4/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7293 DUMOSA AVE	SUITE 5, 7 & 8	YUCCA VALLEY	CA	92284	3700	36	06071	34.12094334	-116.4177385	San Bernardino County
237990	Fee-for-Service	1760425862	1760425862	1	9	PROVIDENCE MEDICAL INSTITUTE	9/14/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11550 INDIAN HILLS	STE 261	MISSION HILLS	CA	91345	1200	19	06037	34.28024575	-118.4588775	Los Angeles County
238018	Fee-for-Service	1235226531	1235226531	1	55	PERMANENTE MEDICAL GROUP INC	3/22/2019	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
238025	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
238030	Fee-for-Service	1518279520	1518279520	1	1	PAUL A WATKINS	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 MORPHY AVE	None	FAIRHOPE	AL	36532	1812	00	None	30.51996152	-87.889554	Baldwin County
238035	Fee-for-Service	1699779181	1699779181	1	1	PERKINS, WILLIAM G MD	3/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	41589	40	Pediatrics	0	In state provider	None	2850 LONG BEACH BLVD	STE 189	LONG BEACH	CA	90806	1596	19	06037	33.809103	-118.1893425	Los Angeles County
238067	Fee-for-Service	1376723759	1376723759	1	1	PONS, MAURICIO E MD	7/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87650	18	Ophthalmology	0	In state provider	None	865 THIRD AVE	STE 112	CHULA VISTA	CA	91911	1113	37	06073	32.62189562	-117.0722453	San Diego County
238073	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	4/15/2019	171100000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
238075	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	1/14/2019	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
238078	Fee-for-Service	1457377897	1457377897	1	1	POPESCU, MARIA I MD PC	7/23/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	3900 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.78398109	-116.4059049	Riverside County
238080	Fee-for-Service	1720213739	1720213739	1	1	PHELAN-SHAHIN, LAURA L LMFT	5/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1369 G ST	None	ARCATA	CA	95521	5820	12	06023	40.87252467	-124.0844127	Humboldt County
238089	Fee-for-Service	1558584102	1558584102	1	1	POSITIVE DIRECTIONS, INC	12/30/1998	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	816 3RD ST	None	MC FARLAND	CA	93250	1011	15	06029	35.684127	-119.2309435	Kern County
238094	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	4/22/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
238103	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238106	Fee-for-Service	1558851519	1558851519	1	1	PRORENATA LABS, LLC	4/11/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	8222 48TH ST	210	PHOENIX	AZ	85044	5364	00	None	33.372126	-111.9758895	Maricopa County
238139	Fee-for-Service	1073262135	1073262135	1	1	PALOMARES, OSVALDO MD	9/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191167	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
238156	Fee-for-Service	1093870453	1093870453	1	1	PEREZ, CECILIA Y OD	4/1/2000	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1149 S HILL ST	STE 365	LOS ANGELES	CA	90015	2290	19	06037	34.03906481	-118.2608419	Los Angeles County
238157	Fee-for-Service	1700952306	1700952306	4	1	PEACHLAND PHARMACY, INC.	11/9/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25050 PEACHLAND AVE	#102	NEWHALL	CA	91321	2523	19	06037	34.37812733	-118.5467925	Los Angeles County
238165	Fee-for-Service	1356723605	1356723605	1	1	PACIFIC FAMILY MEDICINE CLIN	12/5/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	IC - MILLBRAE	1001 BROADWAY	STE 302	MILLBRAE	CA	94030	1978	41	06081	37.60544641	-122.3978603	San Mateo County
238216	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	7/20/2019	207N00000X	NA	Dermatology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
238225	Fee-for-Service	1881836419	1881836419	1	1	PHAM, TRIEU H MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109643	08	Family Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
238239	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	6/9/2017	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
238241	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	12/16/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
238245	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	10/29/2018	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
238249	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YM0800X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
238252	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	9/20/2018	103TB0200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
238253	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	6/27/2017	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
238266	Fee-for-Service	1760570600	1760570600	1	10	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	DICAL GROUP	5030 J ST	301	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
238281	Fee-for-Service	1598814634	1598814634	1	1	PACIFIC SHORES MEDICAL	3/30/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	GROUP INC	19852 BEACH BLVD	STE 212	HUNTINGTON BEACH	CA	92648	3222	30	06059	33.67390653	-117.9884122	Orange County
238314	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
238322	Fee-for-Service	1184828675	1184828675	1	1	PATEL, NIRAV S DPM	7/7/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 CRAVEN ROAD	None	SAN MARCOS	CA	92078	4201	37	06073	33.12746646	-117.17028	San Diego County
238331	Fee-for-Service	1437594959	1437594959	1	1	PATEL, DEENA DO	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14834	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
238342	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	11/24/2019	208000000X	NA	Pediatric Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
238347	Fee-for-Service	1790791010	1790791010	1	1	PHI, BRYAN H N MD	8/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88288	01	General Practice	0	In state provider	None	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	30	06059	33.89443025	-117.9288328	Orange County
238348	Fee-for-Service	1609946029	1609946029	1	1	PANDAPAS, MARK G MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60995	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
238362	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	9/11/2012	171100000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
238365	Fee-for-Service	1457377897	1457377897	1	1	POPESCU, MARIA I MD PC	7/23/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3900 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.78398109	-116.4059049	Riverside County
238369	Fee-for-Service	1871660712	1871660712	1	1	PETRUCHA, RUTH A MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41590	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
238377	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
238384	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/24/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
238387	Fee-for-Service	1093042970	1093042970	1	1	PAULUS SANTOSO MD A PROFESSI	9/17/2009	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85478	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6969 BROCKTON AVE	SUITE A	RIVERSIDE	CA	92506	8309	33	06065	33.94701	-117.396786	Riverside County
238390	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238461	Fee-for-Service	1245421445	1245421445	1	1	PANUTICH, MICHAEL S MD	12/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96372	41	Internal Medicine	0	In state provider	None	415 OLD NEWPORT BLVD	STE 200	NEWPORT BEACH	CA	92663	4252	30	06059	33.62621345	-117.9266745	Orange County
238505	Fee-for-Service	1487923579	1487923579	1	1	PANGULURI, VIDYA MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135961	41	Internal Medicine	0	In state provider	None	1141 ROSE AVENUE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
238507	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	1/22/2018	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
238511	Fee-for-Service	1518033430	1518033430	1	1	PIAO, ZHEN E CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	HARBIN ACUPUN & HERB CNT	2445 FOREST AVE	None	SAN JOSE	CA	95128	1523	43	06085	37.32699146	-121.9482495	Santa Clara County
238526	Fee-for-Service	1124860507	1124860507	1	1	PROXIMA MEDICAL GROUP	4/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	800 S CENTRAL AVE	SUITE 206	GLENDALE	CA	91204	4379	19	06037	34.13654729	-118.2578243	Los Angeles County
238528	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
238534	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
238537	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	10/8/2018	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
238538	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
238539	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
238542	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
238544	Fee-for-Service	1669544490	1669544490	1	1	PABLA, HARPREET K MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82856	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
238572	Fee-for-Service	1598814634	1598814634	1	1	PACIFIC SHORES MEDICAL	3/30/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	GROUP INC	19852 BEACH BLVD	STE 212	HUNTINGTON BEACH	CA	92648	3222	30	06059	33.67390653	-117.9884122	Orange County
238594	Fee-for-Service	1992875371	1992875371	1	1	PLACER COUNTY CCS	7/1/2006	261QR0400X	NA	Physical Therapist	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	NEWCASTLE MTU	8951 VALLEY VIEW DR	None	NEWCASTLE	CA	95658	9723	31	06061	38.87147189	-121.1362388	Placer County
238602	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
238616	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
238620	Fee-for-Service	1891762985	1891762985	1	2	PIT RIVER HEALTH SERVICE, IN	6/28/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	150 BIA ROUTE 76	None	ALTURAS	CA	96101	0000	25	06049	41.52668074	-120.4796717	Modoc County
238630	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2018	208000000X	NA	Pediatric Primary Care	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
238650	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	12/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
238661	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
238670	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	3/31/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
238679	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238697	Fee-for-Service	1891388708	1891388708	1	1	PHAM, JASMINE N	8/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
238698	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2016	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
238717	Fee-for-Service	1306884465	1306884465	1	1	PUROHIT, PALLAVI D MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138795	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
238793	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
238814	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	3/16/2009	103TC2200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
238819	Fee-for-Service	1548343510	1548343510	1	20	PERMANENTE MEDICAL GROUP INC	11/7/2018	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
238821	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	11/7/2018	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
238825	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
238834	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	12/16/2008	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
238836	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	9/12/2018	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
238837	Fee-for-Service	1316341530	1316341530	1	1	PIH HEALTH PHYSICIANS	3/2/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2205 W. BEVERLY BLVD.	None	MONTEBELLO	CA	90640	2301	19	06037	34.02075854	-118.1232344	Los Angeles County
238882	Fee-for-Service	1295154839	1295154839	1	1	POLASA VENKATA, GOPI KRISHNA	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	156586	41	Internal Medicine	0	In state provider	MD	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
238889	Fee-for-Service	1144400300	1144400300	1	1	PATEL, MAYUR MD AMC	2/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56296	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA AVE	#506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
238892	Fee-for-Service	1235226531	1235226531	1	3	PERMANENTE MEDICAL GROUP INC	1/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
238900	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
238903	Fee-for-Service	1609985092	1609985092	1	1	PAYLESS DRUG STORE 6045	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	5409 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	7806	34	06067	38.664828	-121.274289	Sacramento County
238907	Fee-for-Service	1891762985	1891762985	1	2	PIT RIVER HEALTH SERVICE, IN	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	150 BIA ROUTE 76	None	ALTURAS	CA	96101	0000	25	06049	41.52668074	-120.4796717	Modoc County
238919	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	9/25/2018	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
238921	Fee-for-Service	1144277633	1144277633	1	4	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
238925	Fee-for-Service	1538333257	1538333257	1	1	PIROUTEK, MARY J MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97306	40	Pediatrics	0	In state provider	None	11234 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
238927	Fee-for-Service	1447419817	1447419817	1	1	PAN, JOHN C MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112012	25	Physical Medicine and Rehabilitation	0	In state provider	None	2885 KAISER DR	None	SANTA CLARA	CA	95051	5061	43	06085	37.34192094	-121.9780412	Santa Clara County
238934	Fee-for-Service	1538725346	1538725346	1	1	PINAUD, LUIZA LMFT	12/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
238937	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	171100000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
238939	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	4/26/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
238942	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
238957	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	4/22/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
238964	Fee-for-Service	1932499332	1932499332	1	1	PAHLAVAN, SOHRAB MD	10/16/2018	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	121930	20	Orthopedic Surgery	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
238965	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238982	Fee-for-Service	1497197560	1497197560	1	1	PELS, JACQUELINE L DO	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
238983	Fee-for-Service	1780606806	1780606806	1	1	PAYLESS DRUG STORE 6054	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	6639 WATT AVE	None	NORTH HIGHLANDS	CA	95660	3607	34	06067	38.688345	-121.384251	Sacramento County
238986	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
239006	Fee-for-Service	1114977873	1114977873	1	1	PRETZLAFF, ROBERT K MD	12/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86346	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
239035	Fee-for-Service	1538523667	1538523667	1	1	PARTHASARATHY, GOPANANDAN	9/27/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
239062	Fee-for-Service	1306377122	1306377122	1	1	PENCHEV, RADOSTIN R MD	9/2/2022	207L00000X	NA	Other	026	PHYSICIANS	175217	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
239080	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	5/18/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
239084	Fee-for-Service	1770720625	1770720625	1	1	POWELL, LEDFORD L MD	3/13/2009	208G00000X	NA	General Surgery	026	PHYSICIANS	66650	33	Thoracic Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 630	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
239089	Fee-for-Service	1942704150	1942704150	1	1	PANG, ERIC V MD	5/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184098	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239102	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	10/16/2012	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
239109	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	10/8/2018	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
239111	Fee-for-Service	1548028368	1548028368	1	1	PEDIATRIC CLINIC DE CHINO HI	5/30/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LLS MEDICAL GROUP INC	15944 LOS SERRANOS COUNT	STE 160	CHINO HILLS	CA	91709	3990	36	06071	33.9635227	-117.695881	San Bernardino County
239114	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
239119	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
239120	Fee-for-Service	1083091847	1083091847	1	1	PEREZ, JOHANA L CRNA	4/18/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
239121	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
239130	Fee-for-Service	1306922802	1306922802	1	1	PATEL, DARSHAN MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48315	05	Anesthesiology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
239152	Fee-for-Service	1235588898	1235588898	1	1	PARISKY, ALEXANDER M MD	6/22/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146727	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
239172	Fee-for-Service	1770823122	1770823122	1	1	PRESTIGIOUS IN HOME CARE	7/22/2013	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	314 SYCHAR RD	None	SAN DIEGO	CA	92114	4515	37	06073	32.70535457	-117.046817	San Diego County
239176	Fee-for-Service	1144400300	1144400300	1	1	PATEL, MAYUR MD AMC	2/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56296	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	#506	BURBANK	CA	91505	4816	19	06037	34.1577056	-118.329779	Los Angeles County
239190	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
239207	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	12/8/2018	208000000X	NA	Pediatric Primary Care	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
239210	Fee-for-Service	1144277633	1144277633	1	4	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
239211	Fee-for-Service	1982729752	1982729752	1	1	PINEDA, JOY H MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138151	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
239215	Fee-for-Service	1295149789	1295149789	1	1	PASSION AND LOVE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13601 WHITTIER BLVD	SUITE 413	WHITTIER	CA	90605	1982	19	06037	33.96101144	-118.0289736	Los Angeles County
239226	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	4/23/2018	171100000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
239230	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
239245	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
239247	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	10/2/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
239251	Fee-for-Service	1033100359	1033100359	1	1	PENN-DUECKER, CYNTHIA S	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43128	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67881307	-121.7823992	Alameda County
239256	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
239269	Fee-for-Service	1417211426	1417211426	1	1	POMONA COMMUNITY HEALTH	1/18/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1450 E HOLT AVE	None	POMONA	CA	91767	5822	19	06037	34.06299829	-117.7215562	Los Angeles County
239274	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	10/16/2012	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
239296	Fee-for-Service	1114977873	1114977873	1	1	PRETZLAFF, ROBERT K MD	12/21/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86346	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
239341	Fee-for-Service	1619188596	1619188596	1	1	PAI, SUSHMA V MD	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104547	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
239348	Fee-for-Service	1487095337	1487095337	1	2	PAYMAN P JOSEPH, MD, A	6/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PROFESSIONAL CORPORATION	4903 W PICO BLVD	STE 101	LOS ANGELES	CA	90019	4229	19	06037	34.04804329	-118.3435512	Los Angeles County
239361	Fee-for-Service	1427650407	1427650407	1	1	PARRIS, ROBERTO LMFT	1/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
239367	Fee-for-Service	1760572820	1760572820	2	1	PHELPS, BRIAN P MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
239369	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	11/7/2018	106H00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
239377	Fee-for-Service	1891101408	1891101408	1	1	PEREZ, MARY LCSW	6/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
239394	Fee-for-Service	1548343510	1548343510	1	26	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
239398	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	10/4/2016	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
239402	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YM0800X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
239405	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TB0200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
239408	Fee-for-Service	1548343510	1548343510	1	62	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
239427	Fee-for-Service	1437152907	1437152907	1	1	PENNOCK, JAY B MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
239449	Fee-for-Service	1366749103	1366749103	1	1	PRINZIVALLI, JEANNE LMFT	2/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10642 SANTA MONICA BLVD	209	LOS ANGELES	CA	90025	4525	19	06037	34.05272707	-118.4306058	Los Angeles County
239478	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
239480	Fee-for-Service	1932302320	1932302320	1	1	PREUSZ, CHRISTINA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2200 RANDALLIA DR	None	FORT WAYNE	IN	46805	4638	00	None	41.09614623	-85.11152248	Allen County
239489	Fee-for-Service	1588723233	1588723233	1	1	PARUNGAO, RAYMOND J MD	4/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68428	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
239494	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	6/25/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
239504	Fee-for-Service	1295149789	1295149789	1	1	PASSION AND LOVE HOSPICE INC	4/4/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13601 WHITTIER BLVD	SUITE 413	WHITTIER	CA	90605	1982	19	06037	33.96101144	-118.0289736	Los Angeles County
239513	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	6/25/2009	171100000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
239515	Fee-for-Service	1891225223	1891225223	1	1	PETROSYAN, NERSES MD	7/16/2020	208M00000X	NA	Other	026	PHYSICIANS	166518	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
239517	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/2/2019	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
239518	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	7/4/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
239531	Fee-for-Service	1174577043	1174577043	1	1	POMPEI, ROBERT A MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23738	30	Radiology	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
239533	Fee-for-Service	1760549141	1760549141	1	1	PEDIATRIC HEMATOLOGY	1/1/1979	2080P0207X	NA	Hematology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ONCOLOGY MED GRP	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
239534	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
239535	Fee-for-Service	1306342472	1306342472	1	1	PROHEALTH PARTNERS A MEDICAL	9/19/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP	12555 GARDEN GROVE BLVD	403	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
239540	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
239558	Fee-for-Service	1417211426	1417211426	1	1	POMONA COMMUNITY HEALTH	1/18/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	1450 E HOLT AVE	None	POMONA	CA	91767	5822	19	06037	34.06299829	-117.7215562	Los Angeles County
239561	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	9/11/2012	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
239627	Fee-for-Service	1780765123	1780765123	1	1	PIRNAT, GARY F DC	3/28/1995	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	12462 PUTNAM ST	STE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
239648	Fee-for-Service	1952560732	1952560732	1	1	POGHOSYAN, LIANA MD	7/21/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101825	08	Family Practice	0	In state provider	None	520 E BROADWAY	STE 101	GLENDALE	CA	91205	4943	19	06037	34.14630672	-118.2492813	Los Angeles County
239657	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	11/30/2018	207N00000X	NA	Dermatology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
239674	Fee-for-Service	1679917652	1679917652	1	1	PRINCIPLES, INC.	11/26/2018	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3217 N EASTERN AVE	UNIT 102 & 103	LOS ANGELES	CA	90032	2116	19	06037	34.082343	-118.178078	Los Angeles County
239687	Fee-for-Service	1548343510	1548343510	1	59	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	609 L STREET	None	SACRAMENTO	CA	95814	2326	34	06067	38.579544	-121.499118	Sacramento County
239689	Fee-for-Service	1730428988	1730428988	1	1	PAYNE, SACHI LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
239690	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	9/12/2018	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
239693	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
239765	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
239771	Fee-for-Service	1760680433	1760680433	1	1	PHILPOTT, LINDA M PHD	6/27/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
239790	Fee-for-Service	1043478878	1043478878	1	1	PALUMBO, JOSEPH M DO	12/26/2017	390200000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
239796	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	5/3/2019	208000000X	NA	Pediatric Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
239803	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
239805	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	5/25/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
239816	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
239822	Fee-for-Service	1548343510	1548343510	1	69	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
239831	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
239848	Fee-for-Service	1417211426	1417211426	1	1	POMONA COMMUNITY HEALTH	1/18/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1450 E HOLT AVE	None	POMONA	CA	91767	5822	19	06037	34.06299829	-117.7215562	Los Angeles County
239850	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
239861	Fee-for-Service	1386722981	1386722981	1	1	PACKIARAJ, LINDA V MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80714	25	Physical Medicine and Rehabilitation	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
239885	Fee-for-Service	1386631281	1386631281	1	1	PEARLSTEIN, SHWETA R MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90729	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	SUITE 171	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
239900	Fee-for-Service	1861649881	1861649881	1	1	PARK, JAE H LAC	11/15/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3020 WILSHIRE BLVD	STE 222	LOS ANGELES	CA	90010	1146	19	06037	34.06124239	-118.2878017	Los Angeles County
239901	Fee-for-Service	1588848410	1588848410	1	1	PATEL, MEETA M DO	10/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10929	None	None	0	In state provider	None	700 ALAMO PINTADO RD	None	SOLVANG	CA	93463	2269	42	06083	34.60203	-120.1262085	Santa Barbara County
239927	Fee-for-Service	1023682127	1023682127	1	1	PETERSEN, NEAL C CRNA	1/9/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
239944	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	3/16/2009	106H00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
239954	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	12/22/2016	163WP0807X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
239968	Fee-for-Service	1972550085	1972550085	1	1	PITTS, KIMBERLY M MD	1/5/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61880	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
239979	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	11/30/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
239982	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	10/20/2016	103TB0200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
239996	Fee-for-Service	1548318355	1548318355	1	1	PARIKH, SUNITA Y MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	49438	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
240019	Fee-for-Service	1356609473	1356609473	1	1	PUSCAS, IOAN M DO	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13951	01	General Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
240027	Fee-for-Service	1093828949	1093828949	1	1	PATRICK TUFTS M.D.	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	5140	00	None	41.31237665	-105.5574851	Albany County
240053	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
240074	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	9/25/2018	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
240089	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
240092	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	1/14/2019	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
240094	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
240100	Fee-for-Service	1063496651	1063496651	1	51	PACIFIC CENTRAL COAST HEALTH	2/7/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1250 PEACH ST	SUITE B	SAN LUIS OBISPO	CA	93401	2837	40	06079	35.28647825	-120.6599674	San Luis Obispo County
240118	Fee-for-Service	1235226531	1235226531	1	34	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
240124	Fee-for-Service	1003024191	1003024191	1	1	PEDDI, SRINIVAS MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118625	None	None	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
240134	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
240139	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
240154	Fee-for-Service	1497780050	1497780050	1	1	PEMBA, RIGA L MD	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64116	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
240195	Fee-for-Service	1225568645	1225568645	1	1	PHAM, TAI M MD	4/27/2021	390200000X	NA	Other	026	PHYSICIANS	157565	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
240201	Fee-for-Service	1225790322	1225790322	1	1	PHAM, TIFFANY OD	6/10/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3179 HAMNER AVE	1	NORCO	CA	92860	1983	33	06065	33.92804266	-117.558241	Riverside County
240213	Fee-for-Service	1811020639	1811020639	1	1	PROHEALTH PARTNERS, A	9/1/1995	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
240226	Fee-for-Service	1891985065	1891985065	1	1	PATEL, PIYUSH MD	3/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99466	40	Pediatrics	0	In state provider	None	17100 EUCLID AVE	PEDS ICU	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
240232	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	2/11/2013	106H00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
240239	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	11/17/2015	163WP0807X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
240243	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	11/30/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
240251	Fee-for-Service	1902236052	1902236052	1	1	PAKRAVAN, ELIHO A MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134231	30	Radiology	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
240265	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
240272	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	3/23/2016	103TB0200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
240310	Fee-for-Service	1376701649	1376701649	1	1	PORTER, MEKO Y DO	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12337	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
240313	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
240320	Fee-for-Service	1437762135	1437762135	1	1	POPPER, LISA L LMFT	11/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17284 NEWHOPE ST	STE 211	FOUNTAIN VALLEY	CA	92708	8202	30	06059	33.712389	-117.9258975	Orange County
240341	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
240347	Fee-for-Service	1790837169	1790837169	1	1	PATTENGILL, CATHERINE G	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68055	18	Ophthalmology	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
240358	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	11/30/2018	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
240365	Fee-for-Service	1548552888	1548552888	1	1	PASAMBA, MICHELLE O MD	10/6/2021	207L00000X	NA	Other	026	PHYSICIANS	174089	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
240377	Fee-for-Service	1235226531	1235226531	1	24	PERMANENTE MEDICAL GROUP INC	9/12/2018	171100000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
240380	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	1/14/2019	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
240383	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	7/22/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
240423	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
240426	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	10/16/2012	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
240444	Fee-for-Service	1225289895	1225289895	1	1	PROVIDENCE HEALTH & SERVICES	1/22/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TAL	5633 N LIDGERWOOD ST	None	SPOKANE	WA	99208	1224	00	None	47.709423	-117.406944	Spokane County
240453	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	4/15/2019	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
240488	Fee-for-Service	1669557930	1669557930	1	2	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	947 BLANCO CIR	STE A	SALINAS	CA	93901	4461	27	06053	36.65486931	-121.6375622	Monterey County
240501	Fee-for-Service	1811020639	1811020639	1	1	PROHEALTH PARTNERS, A	6/23/2020	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
240521	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	5/18/2018	207N00000X	NA	Dermatology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
240525	Fee-for-Service	1699700914	1699700914	1	1	PARSONS, GENEVIEVE MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91825	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
240527	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	4/22/2020	163WP0807X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
240534	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
240547	Fee-for-Service	1942730791	1942730791	1	1	PARK, YERI MD	10/12/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173430	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
240551	Fee-for-Service	1073661930	1073661930	1	1	PINCE, KEITH J MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67697	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
240553	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YM0800X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
240556	Fee-for-Service	1003925462	1003925462	1	1	PAYLESS DRUG STORE 5931	2/21/1997	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THRIFTY PAYLESS INC	2555 MAIN ST	None	OAKLEY	CA	94561	1853	07	06013	37.99784042	-121.7302021	Contra Costa County
240557	Fee-for-Service	1679955694	1679955694	1	1	PRODDATOORI, KRUTHIKA MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153221	41	Internal Medicine	0	In state provider	None	13851 E 14TH ST	STE 305	SAN LEANDRO	CA	94578	2630	01	06001	37.71458918	-122.1418781	Alameda County
240558	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	2/11/2013	103TB0200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
240582	Fee-for-Service	1447214390	1447214390	1	1	PACIFIC EYE MEDICAL	2/28/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	44241 15TH ST W	STE 201	LANCASTER	CA	93534	5501	19	06037	34.68712999	-118.1569096	Los Angeles County
240600	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
240614	Fee-for-Service	1336484104	1336484104	1	1	PAYAMI, MADDIHA DO	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14012	01	General Practice	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
240626	Fee-for-Service	1528049608	1528049608	1	1	PRATTY, JAMES S	3/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	41409	None	None	0	In state provider	None	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	36	06071	34.058745	-117.2000975	San Bernardino County
240627	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
240648	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
240671	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	3/9/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
240685	Fee-for-Service	1306018940	1306018940	1	1	PETERS, JOHN E PHD	9/14/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1035 SAN PABLO AVE	SUITE 5	ALBANY	CA	94706	2276	01	06001	37.88531142	-122.2973343	Alameda County
240689	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
240690	Fee-for-Service	1508056177	1508056177	1	1	PROTHERO, EDWARD L JR LMFT	5/25/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 COLUSA AVE	SUITE A	YUBA CITY	CA	95991	4148	51	06101	39.14074601	-121.6172196	Sutter County
240710	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
240716	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	4/27/2017	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
240730	Fee-for-Service	1225289895	1225289895	1	1	PROVIDENCE HEALTH & SERVICES	1/22/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TAL	5633 N LIDGERWOOD ST	None	SPOKANE	WA	99208	1224	00	None	47.709423	-117.406944	Spokane County
240743	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
240761	Fee-for-Service	1417564915	1417564915	1	1	PRUSSIAMERRITT, NANCY P RCP	4/23/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
240767	Fee-for-Service	1770617532	1770617532	1	2	PERRY, REBECCA E MD	8/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
240777	Fee-for-Service	1669557930	1669557930	1	2	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	947 BLANCO CIR	STE A	SALINAS	CA	93901	4461	27	06053	36.65486931	-121.6375622	Monterey County
240790	Fee-for-Service	1811020639	1811020639	1	1	PROHEALTH PARTNERS, A	9/8/2023	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
240795	Fee-for-Service	1689688988	1689688988	1	1	PORTERCARE ADVENTIST	6/28/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	7700 S BROADWAY	None	LITTLETON	CO	80122	2602	00	None	39.576573	-104.9859	Arapahoe County
240807	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	12/30/2018	207N00000X	NA	Dermatology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
240816	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	163WP0807X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
240819	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	4/2/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
240831	Fee-for-Service	1932872009	1932872009	1	1	PICKERING, KAYLEE LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
240842	Fee-for-Service	1730321092	1730321092	1	1	PATEL, NICHLESH MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115501	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
240843	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YM0800X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
240846	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	8/20/2013	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
240850	Fee-for-Service	1982254397	1982254397	1	1	PRACTICE OF BEING HUMAN PSYC	4/12/2024	103TA0400X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	HOLOGY PC	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
240871	Fee-for-Service	1447214390	1447214390	1	1	PACIFIC EYE MEDICAL	2/28/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	GROUP	44241 15TH ST W	STE 201	LANCASTER	CA	93534	5501	19	06037	34.68712999	-118.1569096	Los Angeles County
240876	Fee-for-Service	1700802816	1700802816	1	1	PILL HILL PODIATRY GROUP	9/1/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 30TH ST	STE 403	OAKLAND	CA	94609	3305	01	06001	37.81907725	-122.2648838	Alameda County
240881	Fee-for-Service	1992316855	1992316855	1	1	PRITCHETT, RAMONA LCSW	2/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	140 COMMONWEALTH AVE	SUITE 208	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
240888	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	11/30/2018	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
240894	Fee-for-Service	1992572622	1992572622	1	1	POBRE, FRANCES ANTOINETTE C	7/19/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	830 S CITRUS AVE	SUITE 201	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
240917	Fee-for-Service	1962164871	1962164871	1	1	PEPIN, MATTHEW B PT	3/10/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
240918	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
240928	Fee-for-Service	1184117210	1184117210	1	1	PRABHAKAR BHAT, SANGEETA MD	1/26/2022	208M00000X	NA	Other	026	PHYSICIANS	174757	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
240937	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	4/15/2019	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
240959	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	7/22/2019	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
240970	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
240974	Fee-for-Service	1093211609	1093211609	1	1	PATTISON DIALYSIS LLC	4/4/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2955 N CORRAL HOLLOW RD	STE 101	TRACY	CA	95376	8800	39	06077	37.75716215	-121.4533432	San Joaquin County
240987	Fee-for-Service	1174037626	1174037626	1	1	PAYLESS PHARMACY INC	7/31/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2860 DEL PASO	250	SACRAMENTO	CA	95834	9716	34	06067	38.654271	-121.524939	Sacramento County
240996	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	10/17/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
241002	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
241029	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
241035	Fee-for-Service	1033400676	1033400676	1	1	POBLETE, ROY A MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123997	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
241050	Fee-for-Service	1952423014	1952423014	1	1	PANOSSIAN, AYUNA MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86367	08	Family Practice	0	In state provider	None	401 S GLENOAKS BLVD	STE 101	BURBANK	CA	91502	2707	19	06037	34.18077992	-118.3029503	Los Angeles County
241060	Fee-for-Service	1619217593	1619217593	2	1	PUMPING ESSENTIALS, LLC	7/15/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1660 SCHOOL ST	105A	MORAGA	CA	94556	1124	30	06059	37.83335306	-122.1323053	Contra Costa County
241063	Fee-for-Service	1669557930	1669557930	1	2	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	947 BLANCO CIR	STE A	SALINAS	CA	93901	4461	27	06053	36.65486931	-121.6375622	Monterey County
241079	Fee-for-Service	1851391353	1851391353	1	1	PLATT, SHAWN G. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
241084	Fee-for-Service	1689688988	1689688988	1	1	PORTERCARE ADVENTIST	8/14/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	7700 S BROADWAY	None	LITTLETON	CO	80122	2602	00	None	39.576573	-104.9859	Arapahoe County
241098	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	1/27/2019	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
241105	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	3/28/2017	163WP0807X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
241109	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
241113	Fee-for-Service	1386734200	1386734200	1	1	PATEL, SEJAL C MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102237	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
241128	Fee-for-Service	1245491208	1245491208	1	1	PATEL, KIRAN R MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108529	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
241131	Fee-for-Service	1548343510	1548343510	1	54	PERMANENTE MEDICAL GROUP INC	10/16/2012	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
241136	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
241142	Fee-for-Service	1982254397	1982254397	1	1	PRACTICE OF BEING HUMAN PSYC	8/25/2021	103TA0400X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	HOLOGY PC	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
241152	Fee-for-Service	1871641787	1871641787	1	1	PATTON, CHRISTOPHER S MD	10/31/1993	2085R0204X	NA	Other	026	PHYSICIANS	69070	30	Radiology	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
241163	Fee-for-Service	1306992896	1306992896	1	2	PAUL, GREGG M MD	5/26/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40539	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
241168	Fee-for-Service	1720231194	1720231194	1	1	PERTUISET, NICOLE V LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
241175	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	5/3/2019	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
241185	Fee-for-Service	1194323121	1194323121	1	1	PACIS, ANA W CNP	2/12/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25880 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
241192	Fee-for-Service	1114945474	1114945474	1	1	PERLMAN, SUSAN L MD	12/11/2002	2084N0400X	NA	Neurology	026	PHYSICIANS	31939	13	Neurology (M.D. only)	0	In state provider	None	710 WESTWOOD PLZ	# C246	LOS ANGELES	CA	90095	8353	19	06037	34.06680182	-118.4450804	Los Angeles County
241207	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
241224	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	11/30/2018	208000000X	NA	Pediatric Primary Care	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
241245	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	7/26/2020	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
241248	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	3/25/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
241273	Fee-for-Service	1215032966	1215032966	1	1	PONEC, DONALD J MD	6/30/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53954	None	None	0	In state provider	NORTH COUNTY ULTRASOUND	3998 VISTA WAY	STE F	OCEANSIDE	CA	92056	4514	37	06073	33.18370179	-117.292963	San Diego County
241281	Fee-for-Service	1447221767	1447221767	1	1	PATEL, HETAL B MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130735	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
241285	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
241288	Fee-for-Service	1083026645	1083026645	1	1	PLUMLEE, RONALD J LCSW	8/20/2021	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
241292	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
241294	Fee-for-Service	1003201328	1003201328	1	1	PINE DRUG INC	10/29/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	618 S MAIN ST	None	SANTA ANA	CA	92701	5716	30	06059	33.74005081	-117.8677255	Orange County
241298	Fee-for-Service	1770580375	1770580375	1	1	PRUTHI, ASIT S MD	12/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	53056	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	252 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817172	-121.6460689	Monterey County
241307	Fee-for-Service	1407909062	1407909062	1	1	PACIFIC HEARING CLINIC INC	1/15/1986	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	496 1ST ST	STE 120	LOS ALTOS	CA	94022	3677	43	06085	37.37407154	-122.1144185	Santa Clara County
241308	Fee-for-Service	1477997260	1477997260	1	1	PFEIFLE, SHANNON L LCSW	2/24/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
241318	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
241342	Fee-for-Service	1750459996	1750459996	1	1	PREMIER PHARMACEUTICAL	4/1/2000	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	18080 SAN RAMON VALLEY	STE 104	SAN RAMON	CA	94583	4437	07	06013	37.75817575	-121.9669242	Contra Costa County
241344	Fee-for-Service	1043390461	1043390461	1	1	PROFIT, JOCHEN MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55888	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC:5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
241345	Fee-for-Service	1700597432	1700597432	1	1	PETER, ELIZABETH M	2/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10810 DROXFORD ST	None	CERRITOS	CA	90703	8066	19	06037	33.8604365	-118.1059065	Los Angeles County
241383	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	4/22/2020	207N00000X	NA	Dermatology	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
241385	Fee-for-Service	1629163100	1629163100	1	1	PARAST, MANA MD	3/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102496	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241391	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	1/6/2017	163WP0807X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
241397	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	12/19/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
241406	Fee-for-Service	1639288368	1639288368	1	1	PATZANAKIDIS, HELEN MD	6/28/2018	207R00000X	NA	Other	026	PHYSICIANS	83624	41	Internal Medicine	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
241424	Fee-for-Service	1447447248	1447447248	1	8	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
241425	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
241430	Fee-for-Service	1982254397	1982254397	1	1	PRACTICE OF BEING HUMAN PSYC	2/21/2024	103TA0400X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	HOLOGY PC	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
241441	Fee-for-Service	1902046428	1902046428	1	1	PARIDARI, MAHDI MD INC	3/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98666	08	Family Practice	0	In state provider	None	22030 SHERMAN WAY	STE 105	CANOGA PARK	CA	91303	3016	19	06037	34.20099551	-118.6071615	Los Angeles County
241450	Fee-for-Service	1568467843	1568467843	1	1	PAP, DIANE T MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83447	42	Nuclear Medicine	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
241464	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
241469	Fee-for-Service	1487756342	1487756342	1	1	POWAY FIRE DEPT AMBULANC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13325 CIVIC CENTER DR	None	POWAY	CA	92064	5755	37	06073	32.95454269	-117.0426496	San Diego County
241494	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	3/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
241509	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
241510	Fee-for-Service	1225476609	1225476609	1	2	PETERS, ROBERT D MD	7/2/2018	207YS0123X	NA	ENT/Otolaryngology	026	PHYSICIANS	154801	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLVD 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
241531	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/3/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
241534	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	5/18/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
241548	Fee-for-Service	1649677881	1649677881	1	1	PYYKKO, NATASHA N CRNA	2/25/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
241554	Fee-for-Service	1538336581	1538336581	1	1	PRESTON, ROBERT J MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134885	89	Surgery-Traumatic	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
241560	Fee-for-Service	1295445369	1295445369	1	1	PONCE, ADRIANA CNP	5/21/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
241568	Fee-for-Service	1902868789	1902868789	1	2	PARAS, RODERICK R MD	10/5/2022	207RX0202X	NA	Oncology	026	PHYSICIANS	89506	None	None	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
241569	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	9/25/2018	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
241572	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
241577	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
241584	Fee-for-Service	1982796165	1982796165	1	1	PATTARA, SANTI MD	5/31/1980	2084P0800X	NA	Psychiatry	026	PHYSICIANS	35983	36	Psychiatry	0	In state provider	None	2101 E 4TH ST	STE 185B	SANTA ANA	CA	92705	3814	30	06059	33.74827724	-117.8368641	Orange County
241606	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	12/8/2018	207RA0201X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
241632	Fee-for-Service	1891762985	1891762985	1	3	PIT RIVER HEALTH SERVICE, IN	7/3/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	C.	37403 TORONTO AVE	None	BURNEY	CA	96013	4381	45	06089	40.88337656	-121.6555221	Shasta County
241633	Fee-for-Service	1700597432	1700597432	1	1	PETER, ELIZABETH M	2/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10810 DROXFORD ST	None	CERRITOS	CA	90703	8066	19	06037	33.8604365	-118.1059065	Los Angeles County
241634	Fee-for-Service	1043390461	1043390461	1	1	PROFIT, JOCHEN MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55888	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH ROAD	MC:5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
241647	Fee-for-Service	1508944992	1508944992	1	1	PROSHKINA, IRINA F MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97702	08	Family Practice	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
241671	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	7/12/2019	207N00000X	NA	Dermatology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
241678	Fee-for-Service	1518425487	1518425487	1	1	PHAM, THAO DO	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	20307	41	Internal Medicine	0	In state provider	None	445 EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74351322	-121.417915	San Joaquin County
241681	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	12/20/2018	163WP0807X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
241687	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
241688	Fee-for-Service	1124096284	1124096284	1	1	PALMER,MELISSA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
241709	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	5/7/2009	103TB0200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
241712	Fee-for-Service	1447447248	1447447248	1	8	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
241715	Fee-for-Service	1982254397	1982254397	1	1	PRACTICE OF BEING HUMAN PSYC	8/25/2021	103TA0400X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HOLOGY PC	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
241725	Fee-for-Service	1982843140	1982843140	1	1	PONTE, MAYA L MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106431	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
241750	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
241769	Fee-for-Service	1669850525	1669850525	1	1	PARK, YOUNG I DO	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16796	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
241782	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
241797	Fee-for-Service	1699295139	1699295139	1	1	PURCELL, NICOLE M LMFT	6/17/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2035 E BALL RD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
241799	Fee-for-Service	1811571102	1811571102	1	1	PUENTES, DIEGO	9/23/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
241801	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
241809	Fee-for-Service	1295922391	1295922391	1	1	PAJOUHI, PEGAH MD	12/6/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	104962	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
241816	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
241823	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	1/10/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
241833	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	4/15/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
241841	Fee-for-Service	1053933440	1053933440	1	1	PUROHIT, RACHANA K MD	10/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185913	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
241848	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
241857	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
241860	Fee-for-Service	1780661173	1780661173	1	1	POON, GWENETH MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76054	30	Radiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
241862	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
241866	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
241885	Fee-for-Service	1740509264	1740509264	1	1	PARMA, CAROLYN M MD	11/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157074	01	General Practice	0	In state provider	None	3003 OAK ROAD	STE 104	WALNUT CREEK	CA	94597	4507	07	06013	37.92940805	-122.0581829	Contra Costa County
241893	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	5/3/2019	207RA0201X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
241920	Fee-for-Service	1891762985	1891762985	1	3	PIT RIVER HEALTH SERVICE, IN	6/28/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	C.	37403 TORONTO AVE	None	BURNEY	CA	96013	4381	45	06089	40.88337656	-121.6555221	Shasta County
241961	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
241968	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	10/16/2012	163WP0807X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
241975	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	9/25/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
241985	Fee-for-Service	1871549899	1871549899	1	16	PUEBLO RAD MED GRP INC	4/27/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1310 LAS TABLES RD	STE 103	TEMPLETON	CA	93465	9746	40	06079	35.55442349	-120.722643	San Luis Obispo County
241997	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	12/11/2015	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
242007	Fee-for-Service	1104926930	1104926930	1	1	PATRICK, SCOTT S MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65796	05	Anesthesiology	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
242033	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
242041	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
242057	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
242068	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
242086	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	9/12/2018	208000000X	NA	Pediatric Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
242103	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242110	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	7/22/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
242124	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
242137	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
242145	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
242150	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
242154	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	7/1/1991	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
242160	Fee-for-Service	1659312536	1659312536	1	1	PUGA, LEOPOLDO MD	6/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85474	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
242161	Fee-for-Service	1295892099	1295892099	1	1	PUELL, MICHAEL MD	1/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40811	01	General Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
242182	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	9/12/2018	207RA0201X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
242190	Fee-for-Service	1649342346	1649342346	1	1	PORTEOUS, BRIANJAMES R	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4341 BIRCH ST	STE 100	NEWPORT BEACH	CA	92660	1916	30	06059	33.66783772	-117.8668328	Orange County
242243	Fee-for-Service	1215416763	1215416763	1	1	PANAMENO, JUAN CARLOS RCP	8/16/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
242248	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	2/24/2020	106H00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
242255	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	11/27/2007	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
242262	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	11/24/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
242284	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	12/14/2017	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
242298	Fee-for-Service	1093597601	1093597601	1	1	PUGH, MICKEAL PHD	4/7/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9675 BRIGHTON WAY	422	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
242320	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	8/28/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
242328	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	11/30/2018	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
242343	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
242351	Fee-for-Service	1871577049	1871577049	1	1	PANACEK, EDWARD A MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	47762	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 SUNRISE AVE	None	ROSEVILLE	CA	95661	3479	31	06061	38.740806	-121.272001	Placer County
242353	Fee-for-Service	1134306970	1134306970	1	1	PREMIER HEALTHCARE SERVICES,	6/5/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	19191 S VERMONT AVE	STE 160	TORRANCE	CA	90502	1050	19	06037	33.85645867	-118.2905747	Los Angeles County
242357	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
242368	Fee-for-Service	1043469992	1043469992	1	1	PILIKA, ASTI MD	12/6/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	116184	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
242373	Fee-for-Service	1235226531	1235226531	1	20	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	43971 BOSCELL RD	None	FREMONT	CA	94538	5138	01	06001	37.49901202	-121.9707678	Alameda County
242390	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	1/30/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242391	Fee-for-Service	1275545642	1275545642	1	1	PEDIATRIC & NEONATOLOGY	2/4/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MED GRP OF ORANGE CO INC	12555 GARDEN GROVE BLVD	STE 206	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
242393	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/2/2019	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
242397	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
242402	Fee-for-Service	1003850173	1003850173	1	1	PABLO URETA AVENDANO M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE S	None	MINNEAPOLIS	MN	55404	4818	00	None	44.95652346	-93.26250787	Hennepin County
242404	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	4/7/2014	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
242425	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
242432	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
242437	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
242441	Fee-for-Service	1295979441	1295979441	1	1	PILLAI, REX M MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119038	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
242445	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
242459	Fee-for-Service	1063496651	1063496651	1	39	PACIFIC CENTRAL COAST HEALTH	4/1/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1325 E CHURCH ST	SUITE 301	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
242470	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	11/24/2019	207RA0201X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
242471	Fee-for-Service	1134578024	1134578024	1	1	PATEL, NAYAN MD	9/11/2019	207R00000X	NA	Other	026	PHYSICIANS	155541	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
242504	Fee-for-Service	1205277365	1205277365	1	1	PERRONE, FRANCESCA NP	6/7/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
242529	Fee-for-Service	1457450439	1457450439	1	1	POLADIAN, ARA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40162	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10876 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2236	19	06037	34.15223524	-118.3680824	Los Angeles County
242535	Fee-for-Service	1518427541	1518427541	1	1	PROPHETE, LALLIANA D CNP	7/22/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
242536	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	12/8/2015	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
242543	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	11/7/2018	163WP0807X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
242548	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	8/14/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
242555	Fee-for-Service	1366144420	1366144420	1	1	PARK, JASON CPO	6/6/2023	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	14450 HOOVER ST	None	WESTMINSTER	CA	92683	5319	30	06059	33.75270953	-117.9983297	Orange County
242572	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
242597	Fee-for-Service	1346449337	1346449337	1	1	PANCHOLY, BHARAT MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104641	33	Thoracic Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
242608	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
242616	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	6/25/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
242631	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	11/17/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
242635	Fee-for-Service	1134515695	1134515695	1	1	PHAN, TIFFANI MD	6/1/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161105	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
242639	Fee-for-Service	1801887658	1801887658	1	1	PORTLAND ADVENTIST	8/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	10123 SE MARKET ST	None	PORTLAND	OR	97216	2599	00	None	45.51158947	-122.5586205	Multnomah County
242642	Fee-for-Service	1639550122	1639550122	1	1	PHAM, MY D DO	9/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16592	08	Family Practice	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
242645	Fee-for-Service	1235226531	1235226531	1	54	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
242665	Fee-for-Service	1568658524	1568658524	1	1	PHAM, DANIEL D MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89077	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
242670	Fee-for-Service	1659371995	1659371995	1	1	PORTOUW, STEVEN J MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85996	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
242677	Fee-for-Service	1215027008	1215027008	1	1	PARK, BRIAN K MD	6/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54964	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
242679	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242685	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	4/26/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
242690	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
242700	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
242712	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
242716	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YM0800X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
242722	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	12/8/2018	208000000X	NA	Pediatric Primary Care	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
242725	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
242730	Fee-for-Service	1548343510	1548343510	1	5	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
242758	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	4/2/2009	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
242763	Fee-for-Service	1649505298	1649505298	1	1	PHAM, SHARON T MD	9/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109695	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
242769	Fee-for-Service	1073909636	1073909636	1	1	PAHLKOTTER, MARANDA K MD	1/17/2025	2086X0206X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
242778	Fee-for-Service	1104993104	1104993104	1	1	PAUL, HENYA A MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74190	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
242782	Fee-for-Service	1740415850	1740415850	1	1	PAU, CANDACE Y MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113354	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
242798	Fee-for-Service	1821100298	1821100298	1	1	PACIFIC INTERNAL MEDICIN	11/5/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES MEDICAL GROUP	2100 WEBSTER ST	STE 423	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
242823	Fee-for-Service	1912322595	1912322595	1	1	PREMIER SPECIALTY SURGICAL C	3/18/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ENTER, LLC	7230 MEDICAL CENTER DR	SUITE 502-503	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
242825	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	10/8/2018	106H00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
242832	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	10/16/2012	163WP0807X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
242835	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	12/8/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
242864	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
242868	Fee-for-Service	1225058837	1225058837	1	1	PAIGNE, KITTYA MD	6/17/2010	207R00000X	NA	Other	026	PHYSICIANS	79550	41	Internal Medicine	0	In state provider	None	17660 LAKEWOOD BLVD	None	BELLFLOWER	CA	90706	6410	19	06037	33.87138705	-118.142548	Los Angeles County
242870	Fee-for-Service	1780731612	1780731612	1	1	PIZZARELLO, BARBARA T	1/1/2000	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3914 MURPHY CANYON RD	STE A170	SAN DIEGO	CA	92123	4415	37	06073	32.81569938	-117.1166115	San Diego County
242900	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
242904	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	9/12/2018	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
242919	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
242931	Fee-for-Service	1801887658	1801887658	1	1	PORTLAND ADVENTIST	8/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	10123 SE MARKET ST	None	PORTLAND	OR	97216	2599	00	None	45.51158947	-122.5586205	Multnomah County
242950	Fee-for-Service	1154673754	1154673754	1	1	PRISK, JESSICA LCSW	11/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
242964	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242971	Fee-for-Service	1457516353	1457516353	1	1	PINEDA, ISABEL A	10/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
242973	Fee-for-Service	1235226531	1235226531	1	59	PERMANENTE MEDICAL GROUP INC	4/5/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
242978	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	4/7/2014	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
242981	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	9/12/2018	302R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
242983	Fee-for-Service	1982993192	1982993192	1	1	PAIK, JASON C MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122176	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
242991	Fee-for-Service	1801351085	1801351085	1	1	PEACE FROM WITHIN THERAPY IN	7/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6311 ROMAINE ST	7329, ROOM D	LOS ANGELES	CA	90038	2617	19	06037	34.08893835	-118.3293764	Los Angeles County
242993	Fee-for-Service	1992125272	1992125272	1	1	PANDIT, VIRAJ MD	2/21/2025	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
242998	Fee-for-Service	1609042431	1609042431	1	1	PAULSEN, JEFFREY M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109734	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
242999	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
243003	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YM0800X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
243010	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	2/5/2019	208000000X	NA	Pediatric Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
243013	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
243015	Fee-for-Service	1588656268	1588656268	1	1	PETALUMA HEALTH CTR, INC	7/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1179 NORTH MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
243037	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	9/11/2012	207LP2900X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
243038	Fee-for-Service	1174702294	1174702294	1	1	PATEL, TINA S OD	8/12/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2845 COCHRAN STREET	SUITE D	SIMI VALLEY	CA	93065	2796	56	06111	34.280973	-118.742589	Ventura County
243046	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	9/25/2018	207RA0201X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
243063	Fee-for-Service	1154556314	1154556314	1	1	PUOPOLO, JUSTIN J DO	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13160	30	Radiology	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
243077	Fee-for-Service	1639281413	1639281413	1	1	PRIMARY CARE CONSULTANTS	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RANCHOS FAMILY HEALTH SV	11976 ROAD 37	# 12	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
243110	Fee-for-Service	1518596444	1518596444	1	1	PUSAPATI, SNEHA MD	11/16/2023	207R00000X	NA	Other	026	PHYSICIANS	191126	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
243113	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	4/22/2020	106H00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
243120	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	2/11/2013	163WP0807X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
243123	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
243148	Fee-for-Service	1336893254	1336893254	1	1	PALMER, MADISON CNP	8/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
243150	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
243166	Fee-for-Service	1578622189	1578622189	1	1	PRESBY, JOAN E	8/31/1991	207R00000X	NA	Other	026	PHYSICIANS	72895	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
243169	Fee-for-Service	1114222817	1114222817	1	1	PROGENITY INC	3/22/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	5230 SOUTH STATE ROAD	None	ANN ARBOR	MI	48108	7936	00	None	42.21163928	-83.73376159	Washtenaw County
243181	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
243191	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	11/24/2019	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
243207	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
243225	Fee-for-Service	1942350988	1942350988	1	1	PARK, NANAH S MD	7/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136651	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
243242	Fee-for-Service	1881711901	1881711901	1	1	PIVONKA JONES, JAMIE A PHD	3/13/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25845 BARTON ROAD	None	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
243253	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
243259	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	7/22/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
243264	Fee-for-Service	1134268501	1134268501	1	1	PEARLSTEIN, A RANDOLPH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27308	41	Internal Medicine	0	In state provider	MD, INC	9400 BRIGHTON WAY	STE 201	BEVERLY HILLS	CA	90210	4709	19	06037	34.07043476	-118.4011952	Los Angeles County
243266	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	10/12/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
243279	Fee-for-Service	1659487742	1659487742	2	1	PAI, JAMES S	10/16/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3055 W ORANGE AVE	STE 108	ANAHEIM	CA	92804	3191	30	06059	33.8247435	-117.99621	Orange County
243291	Fee-for-Service	1497881700	1497881700	1	1	PRASAD, RAVI PHD	11/17/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
243293	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
243296	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	9/12/2018	208000000X	NA	Pediatric Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
243301	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
243302	Fee-for-Service	1588656268	1588656268	1	1	PETALUMA HEALTH CTR, INC	7/1/2000	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1179 NORTH MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
243304	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
243324	Fee-for-Service	1073691606	1073691606	1	1	PRESTON, PAUL G MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41657	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
243326	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	2/5/2019	207LP2900X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
243334	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
243338	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	5/2/2011	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
243343	Fee-for-Service	1851706196	1851706196	1	1	PATEL, NEHA MD	2/12/2025	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	184837	40	Pediatrics	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
243347	Fee-for-Service	1780720474	1780720474	1	1	PATEL, SIMA B MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137305	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
243357	Fee-for-Service	1902873730	1902873730	1	1	PAGE, THOMAS E MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39699	40	Pediatrics	0	In state provider	None	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	37	06073	33.12634291	-117.0682058	San Diego County
243365	Fee-for-Service	1639281413	1639281413	1	1	PRIMARY CARE CONSULTANTS	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	RANCHOS FAMILY HEALTH SV	11976 ROAD 37	# 12	MADERA	CA	93636	8612	20	06039	36.922833	-119.876138	Madera County
243395	Fee-for-Service	1447447248	1447447248	1	16	PACIFIC INPATIENT MEDICAL GR	8/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
243396	Fee-for-Service	1760570600	1760570600	1	21	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP	6347 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668257	-121.316301	Sacramento County
243400	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	2/24/2020	207N00000X	NA	Dermatology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
243407	Fee-for-Service	1306577689	1306577689	1	1	PHAM, JONHNY PT	10/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
243408	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	163WP0807X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
243411	Fee-for-Service	1760570600	1760570600	1	14	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	S	6555 COYLE AVE	310	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
243416	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	9/25/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
243435	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	3/16/2009	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
243460	Fee-for-Service	1093277394	1093277394	1	1	PUTTERMAN, ELANA MD	2/10/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
243470	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	10/28/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
243479	Fee-for-Service	1497824882	1497824882	2	1	PANGILINAN, ARTURO P MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36228	02	General Surgery	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
243482	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	4/15/2019	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
243491	Fee-for-Service	1013695881	1013695881	1	1	PRIME MEDICAL TRANSPORT LLC	10/25/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2301 W BELMONT AVE	201 A	FRESNO	CA	93728	2541	10	06019	36.75011784	-119.8436847	Fresno County
243492	Fee-for-Service	1215060199	1215060199	1	1	PROHEALTH PARTNERS, A	9/1/1995	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	MEDICAL GROUP	3816 WOODRUFF AVE	STE 412	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
243495	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
243497	Fee-for-Service	1851560965	1851560965	1	1	PHAM, DUNG D MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102779	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
243504	Fee-for-Service	1619593365	1619593365	1	1	PATEL, NEELAM CNP	12/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
243534	Fee-for-Service	1174646954	1174646954	1	1	POWROZNIK, JAMES A LMFT	5/5/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5588 N PALM AVE	None	FRESNO	CA	93704	1913	10	06019	36.818874	-119.8082415	Fresno County
243536	Fee-for-Service	1205017688	1205017688	1	1	PRESLEY, ARNOLD PSYD	8/13/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
243542	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
243554	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	12/8/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
243555	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
243570	Fee-for-Service	1114083409	1114083409	1	1	POTTER, BRUCE J	1/31/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	440 E KING AVE	None	TULARE	CA	93274	4223	54	06107	36.20989636	-119.3429817	Tulare County
243574	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
243579	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YM0800X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
243584	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	11/30/2018	208000000X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
243590	Fee-for-Service	1588656268	1588656268	1	1	PETALUMA HEALTH CTR, INC	7/1/2000	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1179 NORTH MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
243593	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
243598	Fee-for-Service	1477690105	1477690105	1	1	PETERSEN, WILLIAM L DO	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	34179 GOLDEN LANTERN ST	STE 201	DANA POINT	CA	92629	2800	30	06059	33.46628263	-117.6980563	Orange County
243610	Fee-for-Service	1891348447	1891348447	1	3	PROVIDENCE FACEY MEDICAL FOU	3/22/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10174 MASON AVE	None	CHATSWORTH	CA	91311	3301	19	06037	34.255611	-118.5798115	Los Angeles County
243611	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	9/9/2013	207LP2900X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
243622	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
243625	Fee-for-Service	1740553775	1740553775	1	2	PARKS, DAVID J MD INC	11/4/2013	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78517	18	Ophthalmology	0	In state provider	None	42543 8TH STREET WEST	SUITE 105	LANCASTER	CA	93534	7200	19	06037	34.65631551	-118.145529	Los Angeles County
243627	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
243644	Fee-for-Service	1811429376	1811429376	1	1	PATEL, KEYUR MD	9/3/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
243647	Fee-for-Service	1316574361	1316574361	1	1	PARACHA, SONIA	1/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
243656	Fee-for-Service	1750308656	1750308656	1	2	POLYCLINIC MEDICAL CENTER, I	8/6/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NC	2145 NILES ST	None	BAKERSFIELD	CA	93305	5007	15	06029	35.37652092	-118.9682408	Kern County
243663	Fee-for-Service	1770929986	1770929986	1	1	PRITI MODI, M.D. INC.	3/5/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1608 TULLY RD	None	MODESTO	CA	95350	4031	50	06099	37.668168	-121.012182	Stanislaus County
243680	Fee-for-Service	1891855078	1891855078	1	1	PARK, JAMES J MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81229	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
243681	Fee-for-Service	1447447248	1447447248	1	16	PACIFIC INPATIENT MEDICAL GR	10/11/2024	208M00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	OUP INC	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
243683	Fee-for-Service	1760570600	1760570600	1	21	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	6347 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668257	-121.316301	Sacramento County
243685	Fee-for-Service	1033413075	1033413075	1	1	PREFERRED PROSTHETICS INC	2/28/2013	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3215 N CALIFORNIA STREET	SUITE 2	STOCKTON	CA	95204	3433	39	06077	37.98127088	-121.2934355	San Joaquin County
243690	Fee-for-Service	1912388604	1912388604	2	1	PHARMEDQUEST PHARMACY SERVIC	10/22/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1555 S GAREY AVE	None	POMONA	CA	91766	5222	19	06037	34.04317024	-117.7497127	Los Angeles County
243693	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	1/22/2019	207N00000X	NA	Dermatology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
243699	Fee-for-Service	1760570600	1760570600	1	14	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	S	6555 COYLE AVE	310	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
243700	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	10/19/2007	163WP0807X	NA	Other	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
243701	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
243726	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
243742	Fee-for-Service	1043389406	1043389406	1	1	PRINCE, MARY M	2/29/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
243760	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
243766	Fee-for-Service	1932669421	1932669421	1	1	PANEK, DAVID J MD	6/24/2022	208M00000X	NA	Other	026	PHYSICIANS	177744	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
243769	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	2/5/2019	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
243785	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
243795	Fee-for-Service	1215431788	1215431788	1	1	PATEL, BANSI V MD DO	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	20745	None	None	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
243801	Fee-for-Service	1346566064	1346566064	1	2	PRIMARY CARE MEDICAL TRANSPO	5/13/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RTATION CORP	10601 CIVIC CENTER DR.	STE. 120B	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
243802	Fee-for-Service	1679917652	1679917652	1	2	PRINCIPLES, INC.	3/10/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3217 N EASTERN AVE	UNIT 101, 102, 103	LOS ANGELES	CA	90032	2116	19	06037	34.082343	-118.178078	Los Angeles County
243829	Fee-for-Service	1629031455	1629031455	1	1	PARK, WILLIAM MD	9/30/1991	207P00000X	NA	Other	026	PHYSICIANS	72990	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
243837	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	5/3/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
243842	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	5/23/2017	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
243843	Fee-for-Service	1962802553	1962802553	1	1	PRIEST, SCOTT D CPO	10/14/2014	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	917 W CENTER AVE	None	VISALIA	CA	93291	5915	54	06107	36.330867	-119.302038	Tulare County
243844	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
243855	Fee-for-Service	1306629399	1306629399	1	1	PELHAM, WILLIAM E PHD	8/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
243864	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
243869	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	11/30/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
243872	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	6/25/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
243875	Fee-for-Service	1588656268	1588656268	1	1	PETALUMA HEALTH CTR, INC	7/1/2000	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1179 NORTH MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
243878	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
243889	Fee-for-Service	1801299524	1801299524	1	1	PHILLIPS, SARAH E LCSW	10/5/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BOULEVARD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
243899	Fee-for-Service	1891348447	1891348447	1	3	PROVIDENCE FACEY MEDICAL FOU	3/22/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10174 MASON AVE	None	CHATSWORTH	CA	91311	3301	19	06037	34.255611	-118.5798115	Los Angeles County
243900	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	207LP2900X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
243909	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	11/30/2018	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
243915	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
243918	Fee-for-Service	1689398935	1689398935	1	1	PERCY, CHIKYRA A LCSW	10/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14021 AMARGOSA RD	SUITE 100	VICTORVILLE	CA	92392	6404	36	06071	34.50419053	-117.3300794	San Bernardino County
243927	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	9/12/2018	207RA0201X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
243945	Fee-for-Service	1871549899	1871549899	1	15	PUEBLO RAD MED GRP INC	4/27/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	522 E PLAZA DR	None	SANTA MARIA	CA	93454	6908	42	06083	34.93727355	-120.4288678	Santa Barbara County
243955	Fee-for-Service	1043393465	1043393465	1	1	PEREZ, OMAR MD INC	3/3/1980	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30938	41	Internal Medicine	0	In state provider	PEREZ MEDICAL CLINIC	10728 RAMONA BLVD	STE A	EL MONTE	CA	91731	2601	19	06037	34.07197813	-118.0397504	Los Angeles County
243971	Fee-for-Service	1447447248	1447447248	1	16	PACIFIC INPATIENT MEDICAL GR	8/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
243977	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	9/20/2018	106H00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
243984	Fee-for-Service	1548343510	1548343510	1	2	PERMANENTE MEDICAL GROUP INC	9/20/2018	163WP0807X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
243989	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	4/6/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
244012	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TB0200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
244039	Fee-for-Service	1063496651	1063496651	1	49	PACIFIC CENTRAL COAST HEALTH	9/4/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	901 OAK PARK BLVD	SUITE 101	PISMO BEACH	CA	93449	3409	40	06079	35.13460775	-120.6050814	San Luis Obispo County
244049	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	10/16/2012	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
244054	Fee-for-Service	1114532231	1114532231	1	1	PRIME RX SAN GABRIEL, INC.	3/3/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	533 W LAS TUNAS DR	102	SAN GABRIEL	CA	91776	1133	19	06037	34.10247828	-118.1075627	Los Angeles County
244057	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	12/8/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
244065	Fee-for-Service	1538691118	1538691118	1	1	PINA GOMES, CHANTAL M DO	6/30/2020	390200000X	NA	Other	026	PHYSICIANS	17258	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
244067	Fee-for-Service	MSS00051F	None	1	1	PARTNERS IN CARE	11/11/2010	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION INC	5251 OFFICE PARK DRIVE	SUITE 110	BAKERSFIELD	CA	93309	0686	15	06029	35.36594362	-119.0610068	Kern County
244069	Fee-for-Service	1982052882	1982052882	1	1	PATEL, VILOKI	6/19/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244071	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
244097	Fee-for-Service	1205578622	1205578622	1	1	PHAM, JOHNNY CNP	9/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	775 E FOOTHILL BLVD	None	POMONA	CA	91767	1223	19	06037	34.1072493	-117.7374988	Los Angeles County
244099	Fee-for-Service	1487847547	1487847547	1	1	PACIFIC WOMENS CENTER, INC	10/19/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 CORPORATE DRIVE	SUITE 210	LADERA RANCH	CA	92694	2107	30	06059	33.55834891	-117.6292039	Orange County
244120	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
244121	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
244130	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
244133	Fee-for-Service	1871541714	1871541714	1	1	POPE, THOMAS L MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53869	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
244139	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
244142	Fee-for-Service	1013989540	1013989540	1	1	PAUKERT, THOMAS T MD	10/2/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36333	47	Miscellaneous	0	In state provider	None	3020 BEARD RD	None	NAPA	CA	94558	3442	28	06055	38.32034449	-122.2949781	Napa County
244145	Fee-for-Service	1528557550	1528557550	1	1	PAGE, BRADY MD	10/3/2023	207R00000X	NA	Other	026	PHYSICIANS	174079	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
244149	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
244157	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YM0800X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
244163	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	6/25/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
244166	Fee-for-Service	1548343510	1548343510	1	51	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
244182	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
244190	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	2/26/2013	207LP2900X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
244199	Fee-for-Service	1235226531	1235226531	1	13	PERMANENTE MEDICAL GROUP INC	11/30/2018	207RA0201X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
244202	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
244215	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	9/25/2018	207RA0201X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
244221	Fee-for-Service	1043356272	1043356272	1	1	PRAIRIE MEDICAL GRP INC	5/20/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	10110 CULVER BLVD	None	CULVER CITY	CA	90232	3102	19	06037	34.0194521	-118.3978587	Los Angeles County
244235	Fee-for-Service	1114972213	1114972213	1	1	PRASAD, INDIRARANI D MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52652	36	Psychiatry	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
244254	Fee-for-Service	1598760563	1598760563	1	1	PAU, PATRICK W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62511	41	Internal Medicine	0	In state provider	None	175 N JACKSON AVE	STE 202	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
244266	Fee-for-Service	1548343510	1548343510	1	28	PERMANENTE MEDICAL GROUP INC	12/20/2018	106H00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
244276	Fee-for-Service	1235226531	1235226531	1	17	PERMANENTE MEDICAL GROUP INC	9/12/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
244278	Fee-for-Service	1942388772	1942388772	1	1	PATEL, KEYUR V MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51224	45	Nephrology (Renal-Kidney)	0	In state provider	None	2950 SYCAMORE DR	STE 104	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
244285	Fee-for-Service	1063496651	1063496651	1	40	PACIFIC CENTRAL COAST HEALTH	7/6/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	116 S PALISADE DR	SUITE 200	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
244290	Fee-for-Service	1003377946	1003377946	1	1	PIENING, DANIEL T MD	7/21/2023	207P00000X	NA	Other	026	PHYSICIANS	184666	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
244304	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	4/22/2020	103TB0200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
244314	Fee-for-Service	1215611868	1215611868	1	1	PREMPEH, NANA AGYA A MD	7/24/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
244323	Fee-for-Service	1497169494	1497169494	1	1	PROHEALTH PARTNERS A MEDICAL	9/8/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	79	Neurology-Child	0	In state provider	GROUP INC	17822 BEACH BLVD	SUITE 373	HUNTINGTON BEACH	CA	92647	7115	30	06059	33.70331388	-117.9890471	Orange County
244334	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
244343	Fee-for-Service	1235226531	1235226531	1	31	PERMANENTE MEDICAL GROUP INC	9/25/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
244358	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
244359	Fee-for-Service	1437681731	1437681731	1	1	PRASAD, NAMRITA D MD	10/13/2020	207R00000X	NA	Other	026	PHYSICIANS	164414	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
244380	Fee-for-Service	1770999468	1770999468	1	1	PATEL, SAGAR D MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
244407	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
244408	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	11/24/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
244412	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/18/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
244419	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	7/25/2017	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
244427	Fee-for-Service	1629557558	1629557558	1	1	PHOONG, MALAY A PHD	10/11/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
244429	Fee-for-Service	1013989540	1013989540	1	1	PAUKERT, THOMAS T MD	10/2/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36333	45	Nephrology (Renal-Kidney)	0	In state provider	None	3020 BEARD RD	None	NAPA	CA	94558	3442	28	06055	38.32034449	-122.2949781	Napa County
244438	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
244443	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
244447	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	5/3/2019	208000000X	NA	Pediatric Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
244470	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
244474	Fee-for-Service	1457594319	1457594319	1	1	PEIRIS, BAMINIHANNADIGE N MD	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129785	41	Internal Medicine	0	In state provider	None	8510 BALBOA BLVD	STE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
244476	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	11/21/2016	207LP2900X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
244491	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	5/2/2011	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
244502	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
244505	Fee-for-Service	1801372305	1801372305	1	1	PORRELLO PEREZ, BARBARA M DC	8/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173707	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
244516	Fee-for-Service	1508208877	1508208877	1	1	PROVIDENT PLACE	12/4/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15448 MONDAMON ROAD	None	APPLE VALLEY	CA	92307	4557	36	06071	34.53222813	-117.2641344	San Bernardino County
244539	Fee-for-Service	1790041267	1790041267	1	1	PHAM, HOANG-ANH MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118304	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
244544	Fee-for-Service	1295873990	1295873990	1	1	PROCARE HEALTH SERVICES	6/19/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	15034 PROVIDENCE LN	None	NORTH HILLS	CA	91343	3477	19	06037	34.2378807	-118.4609532	Los Angeles County
244553	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	5/18/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
244558	Fee-for-Service	1831659457	1831659457	1	1	PIERSON, KATHERINE C MD	9/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190510	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
244567	Fee-for-Service	1942388772	1942388772	1	1	PATEL, KEYUR V MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51224	41	Internal Medicine	0	In state provider	None	2950 SYCAMORE DR	STE 104	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
244591	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
244607	Fee-for-Service	1821286857	1821286857	1	1	PAGELER, NATALIE M MD	1/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92622	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
244611	Fee-for-Service	1497169494	1497169494	1	1	PROHEALTH PARTNERS A MEDICAL	9/8/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	17822 BEACH BLVD	SUITE 373	HUNTINGTON BEACH	CA	92647	7115	30	06059	33.70331388	-117.9890471	Orange County
244623	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
244632	Fee-for-Service	1477654440	1477654440	1	2	PEREZ, ANGEL G MD	8/26/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	79348	-	NOT APPLICABLE	0	In state provider	None	2015 W 1ST STREET	SUITE J	SANTA ANA	CA	92703	3516	30	06059	33.74538578	-117.8965217	Orange County
244646	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
244664	Fee-for-Service	1225065360	1225065360	1	1	PARKER, KALA N MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78484	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
244678	Fee-for-Service	1114007432	1114007432	1	1	PERINATAL & PEDIATRIC	9/1/1998	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	SPECIALISTS MED GROUP	5301 F ST	STE 313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
244684	Fee-for-Service	1609414416	1609414416	1	1	PASO ROBLES PHYSICAL THERAPY	12/1/2023	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5255 EL CAMINO REAL	SUITE C	ATASCADERO	CA	93422	3351	40	06079	35.49280107	-120.6762923	San Luis Obispo County
244692	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
244696	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
244699	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	11/24/2019	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
244707	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	1/23/2018	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
244718	Fee-for-Service	1013989540	1013989540	1	1	PAUKERT, THOMAS T MD	10/2/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36333	41	Internal Medicine	0	In state provider	None	3020 BEARD RD	None	NAPA	CA	94558	3442	28	06055	38.32034449	-122.2949781	Napa County
244725	Fee-for-Service	1487648754	1487648754	1	1	POLISHUK, PAUL V MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84309	34	Urology and Urological Surgery	0	In state provider	None	215 S HICKORY STREET	SUITES 114 & 116	ESCONDIDO	CA	92025	4360	37	06073	33.12335985	-117.0753842	San Diego County
244729	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
244732	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YM0800X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
244734	Fee-for-Service	1528088705	1528088705	1	1	PALLESCHI, JAMES R MD	4/15/2008	208800000X	NA	Other	026	PHYSICIANS	24352	34	Urology and Urological Surgery	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
244736	Fee-for-Service	1801808357	1801808357	1	1	PLAZITA MEDICAL CLINIC	12/7/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1150 MAIN ST	STE 3	WATSONVILLE	CA	95076	3760	44	06087	36.9163164	-121.7698107	Santa Cruz County
244737	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	4/15/2019	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
244744	Fee-for-Service	1750308656	1750308656	1	1	POLYCLINIC MEDICAL CENTER, I	8/5/2002	164W00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2145 NILES ST	None	BAKERSFIELD	CA	93305	5007	15	06029	35.37652092	-118.9682408	Kern County
244752	Fee-for-Service	1962422709	1962422709	1	4	PACIFIC EYE INSTITUTE	7/31/2019	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8112 MILLIKEN AVE	STE 203	RANCHO CUCAMONGA	CA	91730	7473	36	06071	34.10480366	-117.5570863	San Bernardino County
244758	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
244764	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	9/11/2012	207LP2900X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
244767	Fee-for-Service	1730725722	1730725722	1	1	PEAK CARE HOSPICE INC	1/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 248	GLENDALE	CA	91203	4444	19	06037	34.151958	-118.255149	Los Angeles County
244778	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
244788	Fee-for-Service	1427086628	1427086628	1	1	PEPEK, PAULINE MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	61153	40	Pediatrics	0	In state provider	None	2071 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
244789	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	12/8/2018	207RA0201X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
244792	Fee-for-Service	1326020710	1326020710	1	1	PARK, RUSSELL D PHD	5/10/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
244810	Fee-for-Service	1760001697	1760001697	1	1	POON, CHARLES B DO	6/28/2023	207P00000X	NA	Other	026	PHYSICIANS	20304	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
244831	Fee-for-Service	1568857571	1568857571	1	1	PATEL, DHAIRYASHEEL MD	9/21/2020	390200000X	NA	Other	026	PHYSICIANS	170246	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
244840	Fee-for-Service	1548343510	1548343510	1	64	PERMANENTE MEDICAL GROUP INC	2/19/2020	207N00000X	NA	Dermatology	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
244876	Fee-for-Service	1982892386	1982892386	1	1	PATEL, DINESH K MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48975	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
244879	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
244897	Fee-for-Service	1760570600	1760570600	1	23	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	DICAL GROUP	5030 J ST	301	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
244901	Fee-for-Service	1447447248	1447447248	1	15	PACIFIC INPATIENT MEDICAL GR	2/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	678 2ND ST	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
244911	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
244915	Fee-for-Service	1205043700	1205043700	1	1	PULMONARY & HOSPITALIST	6/9/2009	193400000X	NA	Other	026	PHYSICIANS	72627	29	Pulmonary Diseases (M.D. only)	0	In state provider	ASSOCIATES INC	375 HUNTING DR	STE E	SAN MARINO	CA	91108	2043	19	06037	0	0	None
244934	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	10/28/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
244948	Fee-for-Service	1366490492	1366490492	1	1	PATEL, SANJAY P MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73413	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
244952	Fee-for-Service	1841472370	1841472370	1	1	PEARE, GREGORY D MD	3/12/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	2281 W 24TH	STE 2	YUMA	AZ	85364	6197	00	None	32.68368	-114.64776	Yuma County
244965	Fee-for-Service	1407889686	1407889686	1	1	PEDERSEN, MARY JO LMFT	3/4/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2355 LAKE MARIE DR	None	SANTA MARIA	CA	93455	5709	42	06083	34.86593004	-120.3758873	Santa Barbara County
244966	Fee-for-Service	1114007432	1114007432	1	1	PERINATAL & PEDIATRIC	3/6/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SPECIALISTS MED GROUP	5301 F ST	STE 313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
244971	Fee-for-Service	1609414416	1609414416	1	1	PASO ROBLES PHYSICAL THERAPY	12/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	5255 EL CAMINO REAL	SUITE C	ATASCADERO	CA	93422	3351	40	06079	35.49280107	-120.6762923	San Luis Obispo County
244975	Fee-for-Service	1770005357	1770005357	1	1	PARK, SOLOMON MD	12/13/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
244980	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	7/24/2017	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
244981	Fee-for-Service	1215381660	1215381660	1	1	PITTMAN, WILLIAM MD	5/13/2019	207R00000X	NA	Other	026	PHYSICIANS	152984	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
244982	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
244987	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/2/2019	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
244995	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	12/30/2015	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245017	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	12/8/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
245019	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	10/2/2017	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
245021	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
245026	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	6/25/2009	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
245038	Fee-for-Service	1962422709	1962422709	1	4	PACIFIC EYE INSTITUTE	2/27/2008	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	8112 MILLIKEN AVE	STE 203	RANCHO CUCAMONGA	CA	91730	7473	36	06071	34.10480366	-117.5570863	San Bernardino County
245045	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
245048	Fee-for-Service	1861803157	1861803157	1	1	PATEL, HARSHAD P MD	9/13/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156730	None	None	0	In state provider	None	2865 ATLANTIC AVE	STE 109	LONG BEACH	CA	90806	7404	19	06037	33.809418	-118.185058	Los Angeles County
245052	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	11/30/2018	207LP2900X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
245056	Fee-for-Service	1730725722	1730725722	1	1	PEAK CARE HOSPICE INC	1/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 248	GLENDALE	CA	91203	4444	19	06037	34.151958	-118.255149	Los Angeles County
245066	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	4/6/2016	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
245076	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
245117	Fee-for-Service	1518200492	1518200492	1	1	PHAM, MADISON YEN MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13920	01	General Practice	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
245120	Fee-for-Service	1205002235	1205002235	1	1	PHILLIPS, JOANNA J MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86595	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
245124	Fee-for-Service	1538541255	1538541255	1	1	PENG, JEFFREY C MD	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144595	01	General Practice	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
245128	Fee-for-Service	1992847743	1992847743	1	1	PFEFFER, GLENN MD	1/31/1985	208600000X	NA	General Surgery	026	PHYSICIANS	54799	20	Orthopedic Surgery	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
245129	Fee-for-Service	1336172378	1336172378	1	1	POSALSKI, IRVING MD	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	27436	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 1185W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
245137	Fee-for-Service	1295026417	1295026417	1	1	PAN, GEORGE Z MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132921	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
245146	Fee-for-Service	1881988467	1881988467	1	1	PESSEGUEIRO, EVA C MD	6/4/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	120619	36	Psychiatry	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
245165	Fee-for-Service	1548343510	1548343510	1	18	PERMANENTE MEDICAL GROUP INC	6/15/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
245175	Fee-for-Service	1679506240	1679506240	2	1	PHARMACY CORPORATION OF AMER	8/2/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AMERICA	32980 ALVARADO-NILES RD	STE 836	UNION CITY	CA	94587	3186	01	06001	37.59385889	-122.0450728	Alameda County
245184	Fee-for-Service	1760570600	1760570600	1	23	PEDIATRIC MEDICAL ASSOCIATES	5/17/2023	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	DICAL GROUP	5030 J ST	301	SACRAMENTO	CA	95819	3800	34	06067	38.566359	-121.442094	Sacramento County
245186	Fee-for-Service	1184634016	1184634016	1	1	PENDERGRAPH,BERNADETTE	1/1/2001	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	64117	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
245189	Fee-for-Service	1447447248	1447447248	1	15	PACIFIC INPATIENT MEDICAL GR	2/27/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	678 2ND ST	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
245201	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	10/16/2012	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
245218	Fee-for-Service	1376693200	1376693200	1	1	PACIFIC HEIGHTS MED GRP	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2340 CLAY ST	6TH FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
245220	Fee-for-Service	1538259049	1538259049	1	1	POLARIS EYE & LASER	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84931	18	Ophthalmology	0	In state provider	A MEDICAL CORPORATION	15055 LOS GATOS BLVD	300	LOS GATOS	CA	95032	2056	43	06085	37.24949045	-121.9553291	Santa Clara County
245225	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
245232	Fee-for-Service	1457040834	1457040834	1	1	PAX ANESTHESIA CRNA NURSING	6/14/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	APC	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
245244	Fee-for-Service	1184056467	1184056467	1	1	PARKER, KELSEY J LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
245254	Fee-for-Service	1114007432	1114007432	1	1	PERINATAL & PEDIATRIC	3/6/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SPECIALISTS MED GROUP	5301 F ST	STE 313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
245258	Fee-for-Service	1427546738	1427546738	1	1	PEGUEROS, JUSTIN A MD	9/15/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165167	None	None	0	In state provider	None	1601 N MONTE VISTA AVE	STE 190	CLAREMONT	CA	91711	6601	19	06037	34.112259	-117.698539	Los Angeles County
245263	Fee-for-Service	1568558948	1568558948	1	1	PATTARELLI, PHILIP P MD	9/30/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	72661	None	None	0	In state provider	None	6191 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.826362	-119.7831265	Fresno County
245270	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
245271	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
245280	Fee-for-Service	1346436896	1346436896	1	1	PEART, CHRISTOPHER D DO	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10384	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
245282	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	5/3/2019	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245294	Fee-for-Service	1235226531	1235226531	1	37	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5720 STONEBRIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
245302	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/9/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
245307	Fee-for-Service	1093042970	1093042970	1	3	PAULUS SANTOSO MD A PROFESSI	2/21/2012	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85478	None	None	0	In state provider	None	760 S WASHBURN AVE	SUITE 14	CORONA	CA	92882	3303	33	06065	33.87374611	-117.567875	Riverside County
245308	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
245310	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	4/2/2009	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
245315	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	11/30/2018	208000000X	NA	Pediatric Primary Care	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
245334	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	8/28/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
245339	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
245347	Fee-for-Service	1609001122	1609001122	1	1	PAUSEBACK, LUCY F J LAC	7/19/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
245354	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
245356	Fee-for-Service	1821184367	1821184367	1	1	PERSAUD, DHARMENDRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 SOUTH AVE	BOX 108	ROCHESTER	NY	14620	2733	00	None	43.135614	-77.606163	Monroe County
245366	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2018	207RA0201X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
245393	Fee-for-Service	1164512893	1164512893	1	1	PATEL, JAYANTI N MD	6/30/1982	208600000X	NA	General Surgery	026	PHYSICIANS	26621	02	General Surgery	0	In state provider	EUCLID MEDICAL CLINIC	1223 N EUCLID ST	None	ANAHEIM	CA	92801	1954	30	06059	33.851259	-117.941807	Orange County
245400	Fee-for-Service	1891811311	1891811311	1	1	PEACE HEALTH MEDICAL GROUP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN MEDICAL STREET	1615 DELAWARE STREET	None	LONGVIEW	WA	98632	2310	00	None	46.1309207	-122.9408931	Cowlitz County
245416	Fee-for-Service	1336172378	1336172378	1	1	POSALSKI, IRVING MD	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	27436	77	Infectious Disease	0	In state provider	None	8635 W 3RD ST	STE 1185W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
245431	Fee-for-Service	1861527343	1861527343	1	1	POSLEY, KEITH A MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	80235	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245442	Fee-for-Service	1306922232	1306922232	1	1	PARKE, PAMELA J	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44781	07	Dermatology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
245454	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
245468	Fee-for-Service	1043215379	1043215379	1	2	PIH HEALTH HOSPITAL WHITTIER	1/7/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
245469	Fee-for-Service	1487107603	1487107603	1	1	PRESIDENTIAL HOME HEALTH	5/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	22151 VENTURA BLVD	SUITE 206	WOODLAND HILLS	CA	91311	2575	19	06037	34.16870042	-118.6099445	Los Angeles County
245480	Fee-for-Service	1508527144	1508527144	1	1	PRN CARE HOME HEALTH INC	6/13/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	STE 103	NORTH HOLLYWOOD	CA	91606	4985	19	06037	34.179921	-118.3703275	Los Angeles County
245488	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
245505	Fee-for-Service	1770150369	1770150369	1	1	PROMED HOME HEALTH CARE INC	9/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1817 W AVE K	UNIT 207	LANCASTER	CA	93534	6423	19	06037	34.67503117	-118.1641399	Los Angeles County
245512	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
245533	Fee-for-Service	1417488107	1417488107	1	1	PORTER, ABBIE M LMFT	10/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
245542	Fee-for-Service	1013351535	1013351535	1	1	PAREDES, KALI E LMFT	2/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104309	-	NOT APPLICABLE	0	In state provider	None	285 4TH ST	None	WOODLAND	CA	95695	3501	57	06113	38.67901569	-121.769301	Yolo County
245551	Fee-for-Service	1992006878	1992006878	1	1	PATEL, CHIRAG B MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	500 W THOMAS RD	STE 500	PHOENIX	AZ	85013	4220	00	None	33.481485	-112.080816	Maricopa County
245556	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
245557	Fee-for-Service	1396130159	1396130159	1	1	PADREZ, KEVIN A MD	4/11/2019	207P00000X	NA	Other	026	PHYSICIANS	147326	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
245559	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
245563	Fee-for-Service	1235226531	1235226531	1	56	PERMANENTE MEDICAL GROUP INC	5/3/2019	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
245571	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	12/27/2016	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245591	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	2/5/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
245596	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	11/21/2016	101YM0800X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
245598	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	12/16/2008	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
245604	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2018	208000000X	NA	Pediatric Primary Care	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
245617	Fee-for-Service	1801811195	1801811195	1	1	PERRY, WILLIAM PHD	11/1/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
245621	Fee-for-Service	1457321317	1457321317	1	10	PALOMAR HEALTH	9/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	120 CRAVEN ROAD	SUITE 103 & 105	SAN MARCOS	CA	92078	4235	37	06073	33.12748853	-117.1662795	San Diego County
245625	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
245629	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	11/30/2018	207LP2900X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
245637	Fee-for-Service	1093042970	1093042970	1	5	PAULUS SANTOSO MD A PROFESSI	6/29/2020	207VX0000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	817 W GRAND BLVD	None	CORONA	CA	92882	3265	33	06065	33.87329891	-117.5736189	Riverside County
245643	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
245652	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	11/24/2019	207RA0201X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
245665	Fee-for-Service	1770560138	1770560138	1	1	PHAM, HUAN N MD	6/11/2008	2471C3402X	NA	Other	026	PHYSICIANS	89509	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
245694	Fee-for-Service	1063496651	1063496651	1	44	PACIFIC CENTRAL COAST HEALTH	2/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1551 BISHOP	SUITE 510	SAN LUIS OBISPO	CA	93401	4665	40	06079	35.27475609	-120.6454494	San Luis Obispo County
245714	Fee-for-Service	1962532341	1962532341	1	1	PHAM, DUYEN T MD	10/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89778	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245715	Fee-for-Service	1417134339	1417134339	1	1	PHILIPS, ALICE R LMFT	12/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20200 REDWOOD ROAD	SUITE 9	CASTRO VALLEY	CA	94546	4354	01	06001	37.698075	-122.0739205	Alameda County
245725	Fee-for-Service	1629735816	1629735816	1	1	PLATINUM CARE INVESTMENTS IN	2/21/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ORTATION	123 W B ST	F	ONTARIO	CA	91762	3502	36	06071	34.064478	-117.6521355	San Bernardino County
245728	Fee-for-Service	1821298449	1821298449	2	1	PLANET HOME HEALTH CARE INC	6/28/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	221 E GLENOAKS BLVD	SUITE 240	GLENDALE	CA	91207	2128	19	06037	34.15856042	-118.253151	Los Angeles County
245740	Fee-for-Service	1093042970	1093042970	1	4	PAULUS SANTOSO MD A PROFESSI	8/9/2018	207VX0000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6969 BROCKTON AVE	SUITE A-B	RIVERSIDE	CA	92506	3809	33	06065	33.94701	-117.396786	Riverside County
245742	Fee-for-Service	1548343510	1548343510	1	30	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
245762	Fee-for-Service	1386311587	1386311587	1	1	PADILLA, ELISSA	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
245767	Fee-for-Service	1366547655	1366547655	1	1	PILAPIL, MARICEL A MD	8/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85956	45	Nephrology (Renal-Kidney)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245774	Fee-for-Service	1548343510	1548343510	1	36	PERMANENTE MEDICAL GROUP INC	11/30/2018	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
245799	Fee-for-Service	1922088467	1922088467	1	1	POLLARD, ROBERT B MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	58107	08	Family Practice	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
245800	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
245803	Fee-for-Service	1427044494	1427044494	1	1	PROPST, JON W MD	11/30/1990	207L00000X	NA	Other	026	PHYSICIANS	66978	05	Anesthesiology	0	In state provider	None	313 PLAZA DR	STE 12	SANTA MARIA	CA	93454	6931	42	06083	34.93740805	-120.4328911	Santa Barbara County
245842	Fee-for-Service	1780789990	1780789990	1	1	PROVOST, DENISE MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81016	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245845	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
245848	Fee-for-Service	1235226531	1235226531	1	51	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
245858	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	11/24/2019	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245881	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
245882	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	10/16/2012	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
245888	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	11/24/2019	208000000X	NA	Pediatric Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
245889	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
245894	Fee-for-Service	1114915485	1114915485	1	1	PHAN, HAI T MD	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 100	SAN BERNARDINO	CA	92404	3841	36	06071	34.1358627	-117.2757898	San Bernardino County
245895	Fee-for-Service	1992114961	1992114961	1	1	PASS, HOLLIS E	6/15/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	980 ROOSEVELT	STE 100	IRVINE	CA	92620	3670	30	06059	33.69380208	-117.7653165	Orange County
245910	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
245916	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	4/15/2019	207LP2900X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
245933	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	5/2/2011	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
245938	Fee-for-Service	1588697924	1588697924	1	1	PHILIP, SHAILENDRI E MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65202	None	None	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
245941	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	6/25/2009	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
245959	Fee-for-Service	1457321317	1457321317	1	8	PALOMAR HEALTH	9/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	30530 RANCHO CALIFORNIA	None	TEMECULA	CA	92591	3277	33	06065	33.50860426	-117.1275323	Riverside County
246011	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	2/27/2013	163WP0807X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
246021	Fee-for-Service	1508025289	1508025289	1	1	POOL, KARA-LEE MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113409	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
246030	Fee-for-Service	1205324969	1205324969	1	1	PARK, JONATHAN MD	7/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165509	None	None	0	In state provider	None	4108 EDISON AVE	SUITE 112	CHINO	CA	91710	8418	36	06071	33.9972783	-117.7147771	San Bernardino County
246031	Fee-for-Service	1457457863	1457457863	1	1	PEREZ, PETER J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77332	08	Family Practice	0	In state provider	ALIVIO BAY MEDICAL GROUP	2647 INTERNATIONAL BLVD	STE 111	OAKLAND	CA	94601	1500	01	06001	37.7809526	-122.2318629	Alameda County
246057	Fee-for-Service	1366547655	1366547655	1	1	PILAPIL, MARICEL A MD	8/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85956	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
246087	Fee-for-Service	1548343510	1548343510	1	17	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
246094	Fee-for-Service	1336530492	1336530492	1	1	PESAVENTO, CARLA J LMFT	10/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11555 LOS OSOS VALLEY RD	STE 203	SAN LUIS OBISPO	CA	93405	6454	40	06079	35.25756207	-120.6915732	San Luis Obispo County
246108	Fee-for-Service	1992306443	1992306443	1	1	PROMISE HOME HEALTH CARE	1/10/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 170	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
246111	Fee-for-Service	1427237163	1427237163	1	1	PREMIER EMERGENCY	4/5/2005	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PHYSICIANS OF CA MED GR	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
246117	Fee-for-Service	1528144045	1528144045	1	1	PETTY, STEVE MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78580	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
246134	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
246146	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	4/7/2014	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
246167	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
246172	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
246175	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	12/8/2018	101YM0800X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
246179	Fee-for-Service	1235226531	1235226531	1	22	PERMANENTE MEDICAL GROUP INC	9/25/2018	208000000X	NA	Pediatric Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
246182	Fee-for-Service	1114915485	1114915485	1	1	PHAN, HAI T MD	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	399 E HIGHLAND AVE	STE 100	SAN BERNARDINO	CA	92404	3841	36	06071	34.1358627	-117.2757898	San Bernardino County
246200	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
246204	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	2/5/2019	207LP2900X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
246213	Fee-for-Service	1174871818	1174871818	1	1	PADILLA PEREIRA, ISABELLA M	3/25/2022	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
246220	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
246226	Fee-for-Service	1497783971	1497783971	1	1	PARK,EDWARD DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5750 W THUNDERBIRD RD	STE G700	GLENDALE	AZ	85306	0000	00	None	33.612507	-112.1822145	Maricopa County
246229	Fee-for-Service	1679065908	1679065908	1	1	PATEL, VIKASH DO	1/16/2023	207L00000X	NA	Other	026	PHYSICIANS	19620	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
246230	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	5/3/2019	207RA0201X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
246261	Fee-for-Service	1245427962	1245427962	1	1	PHAM, NGA V MD INC	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69545	41	Internal Medicine	0	In state provider	None	1569 LEXANN AVE	STE 112	SAN JOSE	CA	95121	1664	43	06085	37.30790568	-121.8141983	Santa Clara County
246297	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	11/30/2018	163WP0807X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
246311	Fee-for-Service	1467098020	1467098020	1	1	PIERT, EDWYNA P LMFT	5/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
246317	Fee-for-Service	1093989204	1093989204	1	1	PEZESHK, PARHAM MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124166	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LOS ANGELES	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles
246336	Fee-for-Service	1578512711	1578512711	1	1	PREMIER EMERGENCY PHYSIC	1/27/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CALIFORNIA	1401 BAILEY AVE	None	NEEDLES	CA	92363	3103	36	06071	34.832997	-114.618293	San Bernardino County
246420	Fee-for-Service	1841342243	1841342243	1	1	POLAK, CLARA LUCY MD INC	6/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	480 4TH AVE	STE 202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
246422	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
246424	Fee-for-Service	1346320231	1346320231	1	1	PELLEGRINI, LAWRENCE J DO	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
246434	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	12/1/2016	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
246437	Fee-for-Service	1922184076	1922184076	1	1	POLLACK, STELLA D MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	42623	08	Family Practice	0	In state provider	None	2000 O STREET	STE 210	SACRAMENTO	CA	95811	5286	34	06067	38.57106572	-121.4822412	Sacramento County
246453	Fee-for-Service	1235226531	1235226531	1	35	PERMANENTE MEDICAL GROUP INC	4/15/2019	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
246460	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	8/11/2017	101YM0800X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
246461	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	6/19/2017	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
246484	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	7/3/2015	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
246488	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
246491	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	12/8/2018	207LP2900X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
246502	Fee-for-Service	1366901241	1366901241	1	1	PADWAL, JENNIFER	8/25/2024	213ER0200X	NA	Other	026	PHYSICIANS	178986	30	Radiology	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
246505	Fee-for-Service	1033430343	1033430343	1	1	PAUL DEL PRADO	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
246506	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
246517	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
246576	Fee-for-Service	1871549899	1871549899	1	1	PUEBLO RAD MED GRP INC	4/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
246588	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	7/20/2019	163WP0807X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
246669	Fee-for-Service	1578502316	1578502316	1	1	PROCEL, COURTNEY W LCSW	11/7/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25955	-	NOT APPLICABLE	0	In state provider	None	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	19	06037	34.05373818	-118.3839685	Los Angeles County
246683	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
246696	Fee-for-Service	1235131343	1235131343	1	1	PINDERSKI, ERIC J MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62042	41	Internal Medicine	0	In state provider	None	12660 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91607	3429	19	06037	34.1575795	-118.409499	Los Angeles County
246709	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
246722	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	8/31/2017	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
246747	Fee-for-Service	1750423992	1750423992	1	1	PACIFIC VISION MED CTR	3/24/2009	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	1	Border provider	None	580 5TH ST	STE 500	BROOKINGS	OR	97415	8239	00	None	42.056847	-124.287983	Curry County
246748	Fee-for-Service	1548343510	1548343510	1	23	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
246749	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	11/21/2016	101YM0800X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
246764	Fee-for-Service	1982763090	1982763090	1	1	PLANNED PARENTHOOD	11/17/1981	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CONCORD CENTER	2185 PACHECO ST	None	CONCORD	CA	94520	2309	07	06013	37.97878977	-122.0345486	Contra Costa County
246773	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
246774	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
246776	Fee-for-Service	1033182290	1033182290	1	1	PHILLIPS, ROBERT A MD	3/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88363	33	Thoracic Surgery	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
246779	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	5/3/2019	207LP2900X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
246794	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
246802	Fee-for-Service	1932128121	1932128121	1	1	PAULEKAS, MARK MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43159	02	General Surgery	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
246807	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	11/30/2018	207RA0201X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
246812	Fee-for-Service	1740209188	1740209188	1	1	PLENINGER, PERRIN A MD	7/1/1998	2084N0400X	NA	Neurology	026	PHYSICIANS	50125	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA MEDICAL PLZ	# B200	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
246819	Fee-for-Service	1114576519	1114576519	1	1	PECK, SADIA	3/10/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
246849	Fee-for-Service	1689105645	1689105645	1	1	PERSONAL TOUCH ELDER CARE, I	7/5/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4026 BOURDEAUX LANE	None	HEMET	CA	92544	7809	33	06065	33.76100848	-116.9292195	Riverside County
246863	Fee-for-Service	1760879712	1760879712	1	1	POTVIN, HANNAH MD	7/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162820	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
246872	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	9/20/2018	163WP0807X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
246873	Fee-for-Service	1043688633	1043688633	1	1	PATEL RASOOL, MISBAH MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151374	01	General Practice	0	In state provider	None	2813 S MAIN ST	None	CORONA	CA	92882	5942	33	06065	33.84741266	-117.570694	Riverside County
246874	Fee-for-Service	1457884157	1457884157	1	1	POUDEL, BISHNU B MD	10/5/2022	207R00000X	NA	Other	026	PHYSICIANS	175713	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
246888	Fee-for-Service	1114042611	1114042611	1	1	PATRICK, LEAH R DO	1/23/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9488	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
246893	Fee-for-Service	1063718039	1063718039	1	1	PINEDA, JASON R B CRNA	6/5/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
246929	Fee-for-Service	1629142526	1629142526	1	1	PATEL, NILU CRNA	8/10/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
246934	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	4/9/2019	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
246964	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
246982	Fee-for-Service	1295296002	1295296002	1	1	PADUA, SARAH A MD	11/27/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188551	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
246999	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
247006	Fee-for-Service	1821473935	1821473935	1	1	PREMIUM URGENT CARE ,INC	4/15/2021	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6643 MILBURN	104	FRESNO	CA	93722	2164	10	06019	36.83380123	-119.8789205	Fresno County
247010	Fee-for-Service	1235226531	1235226531	1	46	PERMANENTE MEDICAL GROUP INC	4/7/2014	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
247019	Fee-for-Service	1184721284	1184721284	1	1	PARKER, PETER J MD INC	3/30/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	GLENOAKS URGENT CARE MED	1100-06 1/2 W GLEN OAKS	None	GLENDALE	CA	91202	0000	19	06037	34.15926579	-118.2562523	Los Angeles County
247024	Fee-for-Service	1285260224	1285260224	1	1	PANAH, ELNAZ MD	4/12/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
247036	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	4/15/2019	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
247037	Fee-for-Service	1912238106	1912238106	1	1	PETROVICH, ERIC A	4/22/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAK PLACE	SUITE 9	AUBURN	CA	95603	2458	31	06061	38.94059662	-121.0995593	Placer County
247061	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
247063	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
247064	Fee-for-Service	1033182290	1033182290	1	1	PHILLIPS, ROBERT A MD	3/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88363	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
247068	Fee-for-Service	1235226531	1235226531	1	15	PERMANENTE MEDICAL GROUP INC	4/2/2009	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
247083	Fee-for-Service	1003913971	1003913971	1	1	PEDIAHEALTH MED GRP INC	2/28/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	901 CAMPUS DR	STE 210	DALY CITY	CA	94015	4930	41	06081	37.66535778	-122.4763793	San Mateo County
247084	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	2/11/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
247086	Fee-for-Service	1932128121	1932128121	1	1	PAULEKAS, MARK MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43159	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
247092	Fee-for-Service	1457321317	1457321317	1	3	PALOMAR HEALTH	1/19/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	OUTPATIENT LAB	255 NORTH ELM STREET	SUITE 205	ESCONDIDO	CA	92025	3431	37	06073	33.12666024	-117.0719931	San Diego County
247094	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	2/5/2019	207RA0201X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
247113	Fee-for-Service	1013347590	1013347590	1	1	PARKS, CHARLES B DPM	5/13/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
247151	Fee-for-Service	1386367076	1386367076	1	1	PORTER, LYSSIA LMFT	2/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
247162	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	10/29/2018	163WP0807X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
247170	Fee-for-Service	1609216969	1609216969	1	1	PATEL, ALEEMA A MD	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136768	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247192	Fee-for-Service	1417310558	1417310558	1	1	PANGANIBAN, CHRISTINE M MD	3/3/2018	207R00000X	NA	Other	026	PHYSICIANS	150433	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
247195	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	10/8/2021	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
247221	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
247242	Fee-for-Service	1689991606	1689991606	1	1	PATEL, PARUL MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117184	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 NO NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
247252	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	9/11/2012	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
247285	Fee-for-Service	1063496651	1063496651	1	27	PACIFIC CENTRAL COAST HEALTH	7/14/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1700 NORTH ROSE AVE	SUITE 470	OXNARD	CA	93030	7659	56	06111	34.21746	-119.155545	Ventura County
247286	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
247290	Fee-for-Service	1598720690	1598720690	1	1	POLANSKY, STEVEN MD	5/10/1977	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	29450	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
247306	Fee-for-Service	1184721284	1184721284	1	1	PARKER, PETER J MD INC	3/30/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GLENOAKS URGENT CARE MED	1100-06 1/2 W GLEN OAKS	None	GLENDALE	CA	91202	0000	19	06037	34.15926579	-118.2562523	Los Angeles County
247311	Fee-for-Service	1285260224	1285260224	1	1	PANAH, ELNAZ MD	4/12/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
247322	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	11/24/2019	101YM0800X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
247330	Fee-for-Service	1245370105	1245370105	1	1	POPAT, KISHOR D. MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39601	06	Cardiovascular Disease (M.D. only)	0	In state provider	KISHOR D POPAT MD A PROF	1505 SHEPARD DR	STE 203	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
247343	Fee-for-Service	1053719492	1053719492	1	1	PREVAL, MARIE C NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247349	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
247351	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
247370	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
247373	Fee-for-Service	1932128121	1932128121	1	1	PAULEKAS, MARK MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43159	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
247377	Fee-for-Service	1528081098	1528081098	1	1	PATEL, ALPA S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71125	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	# 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
247380	Fee-for-Service	1891264891	1891264891	1	1	PORTILLO, JENIFER LMFT	5/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
247381	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	4/15/2019	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
247391	Fee-for-Service	1083683635	1083683635	1	1	POLSTER, DAVID F MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	27435	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1662 E MAIN ST	STE 319	EL CAJON	CA	92021	5209	37	06073	32.81045723	-116.9198877	San Diego County
247413	Fee-for-Service	1497019558	1497019558	1	1	PEREZ, MARK A CSW	4/12/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
247418	Fee-for-Service	1881949691	1881949691	1	1	PATEL, SHREYA MD	4/26/2019	390200000X	NA	Other	026	PHYSICIANS	141520	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
247429	Fee-for-Service	1912991597	1912991597	1	4	PATHOLOGY ASSOCIATES OF	4/1/2002	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOUTHERN CALIFORNIA	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
247437	Fee-for-Service	1871549899	1871549899	1	22	PUEBLO RADIOLOGY MEDICAL GRO	4/19/2018	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2320 BATH ST	STE 113	SANTA BARBARA	CA	93105	4377	42	06083	34.43082689	-119.7223032	Santa Barbara County
247450	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	12/30/2018	163WP0807X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
247458	Fee-for-Service	1700094927	1700094927	1	1	PATE & INGRAM HOME #2	5/24/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2303 W 116TH ST	None	HAWTHORNE	CA	90250	1970	19	06037	33.92856823	-118.3189301	Los Angeles County
247485	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/20/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
247499	Fee-for-Service	1770691859	1770691859	1	1	PREMIER ANESTHESIA OF CALIFO	9/18/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	975 SOUTH FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
247509	Fee-for-Service	1043244726	1043244726	1	1	PASTEUR INC	7/2/2008	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	16530 VENTURA BLVD	STE 407	ENCINO	CA	91436	0000	19	06037	34.15766626	-118.4934057	Los Angeles County
247510	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	6/3/2019	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
247543	Fee-for-Service	1982154019	1982154019	1	1	PROHEALTH PARTNERS A MEDICAL	3/11/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	3700 KATELLA AVE	STE C	LOS ALAMITOS	CA	90720	6409	30	06059	33.80299714	-118.0681431	Orange County
247545	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
247570	Fee-for-Service	1124065594	1124065594	1	1	PLATNICK, KENNETH B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 EXEMPLA CIR	STE 360	LAFAYETTE	CO	80026	3395	00	None	39.96886441	-105.0878037	Boulder County
247572	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
247592	Fee-for-Service	1356532337	1356532337	1	1	PLA, ZAMIRA LMFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49858	-	NOT APPLICABLE	0	In state provider	None	5628 E SLAUSON AVENUE	None	COMMERCE	CA	90040	2922	19	06037	33.98593459	-118.163681	Los Angeles County
247601	Fee-for-Service	1104961721	1104961721	1	1	PLACER JOINT UNION HSD	12/18/2005	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	13000 NEW AIRPORT RD	None	AUBURN	CA	95603	9596	31	06061	38.94036707	-121.0798907	Placer County
247608	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	2/5/2019	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
247613	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	11/30/2018	101YM0800X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
247617	Fee-for-Service	1245370105	1245370105	1	1	POPAT, KISHOR D. MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39601	41	Internal Medicine	0	In state provider	KISHOR D POPAT MD A PROF	1505 SHEPARD DR	STE 203	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
247637	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
247638	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	3/16/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
247644	Fee-for-Service	1760568695	1760568695	1	1	POLITE, DANIEL K MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54614	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
247646	Fee-for-Service	1124274899	1124274899	1	1	POTTER, SARAH J MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15890	41	Internal Medicine	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
247659	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
247668	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	2/11/2013	207RA0201X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
247672	Fee-for-Service	1194713362	1194713362	2	1	PHARMAPRIME LLC	3/20/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	418 N VARNEY ST	None	BURBANK	CA	91502	1732	19	06037	34.17989532	-118.3164381	Los Angeles County
247681	Fee-for-Service	1083683635	1083683635	1	1	POLSTER, DAVID F MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	27435	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1662 E MAIN ST	STE 319	EL CAJON	CA	92021	5209	37	06073	32.81045723	-116.9198877	San Diego County
247699	Fee-for-Service	1093202335	1093202335	1	1	PATEL, KEVAL D DO	8/28/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22490	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
247729	Fee-for-Service	1013089846	1013089846	1	1	PALAVALLI, JAYASUDHA S M	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90727	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
247730	Fee-for-Service	1861443517	1861443517	1	1	PHAM, MYLIEN S MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80529	30	Radiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
247731	Fee-for-Service	1063496651	1063496651	1	37	PACIFIC CENTRAL COAST HEALTH	2/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1551 BISHOP ST	SUITE 230	SAN LUIS OBISPO	CA	93401	4661	40	06079	35.27475609	-120.6454494	San Luis Obispo County
247736	Fee-for-Service	1063496651	1063496651	1	60	PACIFIC CENTRAL COAST HEALTH	11/1/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	295 POSADA LANE	SUITE A	TEMPLETON	CA	93465	4055	40	06079	35.55315971	-120.7214435	San Luis Obispo County
247739	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	12/30/2018	163WP0807X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
247740	Fee-for-Service	1003970310	1003970310	1	1	PETERS, JOHN T PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
247741	Fee-for-Service	1154611432	1154611432	1	1	PHAM, NANCY MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146627	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
247748	Fee-for-Service	1194796342	1194796342	1	1	PHAN, HO H MD	6/11/2008	390200000X	NA	Other	026	PHYSICIANS	77798	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
247755	Fee-for-Service	1780780973	1780780973	1	1	PHAMLE, THUTHUY T MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89224	08	Family Practice	0	In state provider	None	35500 DUMBARTON CT	None	NEWARK	CA	94560	1127	01	06001	37.54845303	-122.0528	Alameda County
247759	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
247774	Fee-for-Service	1609322650	1609322650	1	1	PEREIRA, EMILY	10/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
247776	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/13/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
247795	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	7/12/2019	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
247829	Fee-for-Service	1891762985	1891762985	1	1	PIT RIVER HEALTH SERVICE, IN	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	36977 PARK AVE	None	BURNEY	CA	96013	4067	45	06089	40.87640189	-121.6730441	Shasta County
247832	Fee-for-Service	1114015971	1114015971	1	1	PROVIDENCE HEALTH AND SERVIC	5/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	L CENTER	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
247833	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	10/5/2017	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
247834	Fee-for-Service	1275022089	1275022089	1	1	PARIKH, HARDIK P MD	4/20/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	164253	None	None	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
247851	Fee-for-Service	1285200055	1285200055	1	1	PAPADOR, JOSEPH D DO	11/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20832	08	Family Practice	0	In state provider	None	2901 N VENTURA RD	SUITE 100	OXNARD	CA	93036	1126	56	06111	34.24479149	-119.1814409	Ventura County
247858	Fee-for-Service	1184488850	1184488850	1	1	POUQUETTE, CHRISTINA L PHD	11/29/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
247863	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
247878	Fee-for-Service	1306406251	1306406251	1	1	PATRICK SWEET MD PC	10/7/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	635 S MAGNOLIA AVE	None	EL CAJON	CA	92020	6012	37	06073	32.788683	-116.962304	San Diego County
247888	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	12/8/2018	106H00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
247894	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
247900	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	5/3/2019	101YM0800X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
247918	Fee-for-Service	1083612022	1083612022	1	1	PRIME MEDICAL SUPPLY INC	7/1/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 CARBIDE DR	None	CORONA	CA	92881	7269	33	06065	33.85005003	-117.5403678	Riverside County
247925	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
247927	Fee-for-Service	1508858903	1508858903	1	1	PATEL, NILESH N MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66234	77	Infectious Disease	0	In state provider	None	130 W ROUTE 66	STE 302	GLENDORA	CA	91740	6252	19	06037	34.12865951	-117.8651745	Los Angeles County
247931	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	2/11/2013	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
247948	Fee-for-Service	1548343510	1548343510	1	47	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
247957	Fee-for-Service	1235226531	1235226531	1	29	PERMANENTE MEDICAL GROUP INC	11/30/2018	207RA0201X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
247982	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	7/20/2019	176B00000X	NA	Licensed Midwife	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
247985	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
248002	Fee-for-Service	1285986893	1285986893	1	1	PRAHL, LISA K LCSW	1/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
248007	Fee-for-Service	1609222546	1609222546	1	1	PORWAL, NIVIN DO	3/22/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18913	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
248011	Fee-for-Service	1972867307	1972867307	1	1	POYA, HASTI M MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119690	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248012	Fee-for-Service	1295313443	1295313443	1	1	PARK, KEVIN S PT	2/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
248027	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	4/22/2020	163WP0807X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
248029	Fee-for-Service	1467400580	1467400580	1	1	PATEL, NILESH H MD	3/5/2021	2085R0204X	NA	Other	026	PHYSICIANS	75762	None	None	0	In state provider	None	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
248036	Fee-for-Service	1194796342	1194796342	1	1	PHAN, HO H MD	6/11/2008	390200000X	NA	Other	026	PHYSICIANS	77798	01	General Practice	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
248048	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
248059	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/20/2021	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
248080	Fee-for-Service	1538130711	1538130711	1	1	PONNUSWAMY, RAJESWARI S MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80719	08	Family Practice	0	In state provider	None	1203 MISSION ST	None	SANTA CRUZ	CA	95060	3549	44	06087	36.96939671	-122.0373587	Santa Cruz County
248084	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	12/7/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
248093	Fee-for-Service	1366522427	1366522427	1	1	PHILLIPS, ANDREW F MD	10/3/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78557	18	Ophthalmology	0	In state provider	None	2617 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3234	30	06059	33.7878445	-117.8254845	Orange County
248094	Fee-for-Service	1013088996	1013088996	1	1	PESTANA, LYN K MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48971	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248095	Fee-for-Service	1679555726	1679555726	1	1	PECK, ANNETTE PAVLOVA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
248107	Fee-for-Service	1497452700	1497452700	1	1	PIH HEALTH PHYSICIANS	8/29/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
248117	Fee-for-Service	1891762985	1891762985	1	1	PIT RIVER HEALTH SERVICE, IN	5/15/2019	261QR1300X	NMT Provider	Rural Health Center	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	36977 PARK AVE	None	BURNEY	CA	96013	4067	45	06089	40.87640189	-121.6730441	Shasta County
248121	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
248125	Fee-for-Service	1114015971	1114015971	1	1	PROVIDENCE HEALTH AND SERVIC	5/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	L CENTER	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
248129	Fee-for-Service	1265110092	1265110092	1	1	PATEL, VISHAL S OD	7/18/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13010 HESPERIA RD	STE 101	VICTORVILLE	CA	92395	5837	36	06071	34.48843676	-117.2909745	San Bernardino County
248131	Fee-for-Service	1760570600	1760570600	1	19	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	S	1580 CREEKSIDE DR	250	FOLSOM	CA	95630	3886	34	06067	38.668914	-121.148028	Sacramento County
248148	Fee-for-Service	1548343510	1548343510	1	57	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3558 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
248170	Fee-for-Service	1538361415	1538361415	1	1	POWERS, JESSICA F MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119859	78	Neoplastic Diseases/Oncology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
248174	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	9/12/2018	106H00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
248184	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	11/24/2019	1041C0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
248186	Fee-for-Service	1164051918	1164051918	1	1	PRIME PALLIATIVE CARE INC	6/10/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	SUITE 513	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
248189	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	11/21/2016	101YM0800X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
248203	Fee-for-Service	1891761169	1891761169	1	1	PATEL,PRATIK M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1492 S MILL AVE # 307	None	TEMPE	AZ	85281	0000	00	None	33.412797	-111.9418605	Maricopa County
248208	Fee-for-Service	1457010548	1457010548	1	1	PHAM, TINA LMFT	12/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
248212	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
248214	Fee-for-Service	1396932299	1396932299	1	1	PHAN, ANITA A MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101468	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
248215	Fee-for-Service	1548343510	1548343510	1	38	PERMANENTE MEDICAL GROUP INC	3/10/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
248218	Fee-for-Service	1508858903	1508858903	1	1	PATEL, NILESH N MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66234	41	Internal Medicine	0	In state provider	None	130 W ROUTE 66	STE 302	GLENDORA	CA	91740	6252	19	06037	34.12865951	-117.8651745	Los Angeles County
248268	Fee-for-Service	1568791390	1568791390	1	1	PLANNED PARENTHOOD LOS ANGEL	11/8/2011	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3637 S LA BREA AVENUE	None	LOS ANGELES	CA	90016	5311	19	06037	34.01991	-118.355626	Los Angeles County
248272	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	10/8/2018	176B00000X	NA	Licensed Midwife	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
248275	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
248301	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	10/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
248311	Fee-for-Service	1679594303	1679594303	1	1	PANINA, COLLEEN H MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77846	40	Pediatrics	0	In state provider	None	2340 CLAY ST	FL 3	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
248315	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	11/7/2018	163WP0807X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
248336	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
248346	Fee-for-Service	1447262480	1447262480	1	1	PIKUS, CYNTHIA F PHD	2/1/1999	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
248350	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/12/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
248351	Fee-for-Service	1063496651	1063496651	1	61	PACIFIC CENTRAL COAST HEALTH	11/1/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1941 JOHNSON AVENUE	SUITE 101	SAN LUIS OBISPO	CA	93401	4140	40	06079	35.27804785	-120.649711	San Luis Obispo County
248356	Fee-for-Service	1841457033	1841457033	1	1	PHAM, THANG V LCSW	10/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	19	06037	34.12158153	-117.723276	Los Angeles County
248360	Fee-for-Service	1194931337	1194931337	1	1	PATEL, RASHIKLAL R MD	4/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51638	38	Geriatrics	0	In state provider	None	1105 E FOSTER RD	STE H	SANTA MARIA	CA	93455	6438	42	06083	34.88316028	-120.4181087	Santa Barbara County
248372	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	7/12/2019	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
248381	Fee-for-Service	1235521022	1235521022	1	1	POPKIN, JEFFREY F LCSW	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	7610	-	NOT APPLICABLE	0	In state provider	None	1021 4TH STREET	SUITE B	TAFT	CA	93268	2433	15	06029	35.1491189	-119.4534659	Kern County
248394	Fee-for-Service	1497452700	1497452700	1	1	PIH HEALTH PHYSICIANS	1/30/2024	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
248404	Fee-for-Service	1700044849	1700044849	1	1	PAUL VAN HEUKELOM MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
248406	Fee-for-Service	1891762985	1891762985	1	1	PIT RIVER HEALTH SERVICE, IN	6/28/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	36977 PARK AVE	None	BURNEY	CA	96013	4067	45	06089	40.87640189	-121.6730441	Shasta County
248412	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	8/28/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
248413	Fee-for-Service	1255607172	1255607172	1	1	PARIKH, RISHI B MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128964	05	Anesthesiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
248437	Fee-for-Service	1649267816	1649267816	1	1	PATTERSON, BRUCE L MD	3/5/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	555 BLACK OAK DR	STE 200	MEDFORD	OR	97504	8491	00	None	42.318873	-122.835653	Jackson County
248452	Fee-for-Service	1003864125	1003864125	1	1	PROUT, TYLER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 S PARK ST	None	MADISON	WI	53715	1507	00	None	43.0654364	-89.40092987	Dane County
248460	Fee-for-Service	1538361415	1538361415	1	1	POWERS, JESSICA F MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119859	68	Hematology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
248464	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	11/24/2019	106H00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
248465	Fee-for-Service	1629178637	1629178637	1	1	PRATT, EDIE E Z MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64158	14	Neurological Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
248472	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	2/5/2019	1041C0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
248475	Fee-for-Service	1164051918	1164051918	1	1	PRIME PALLIATIVE CARE INC	6/10/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	SUITE 513	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
248477	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	2/5/2019	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
248502	Fee-for-Service	1306464318	1306464318	1	1	PORRAS, EDWIN PT	6/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
248503	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
248530	Fee-for-Service	1073543872	1073543872	1	1	PATRICE A DUVERNAY	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	324 E 10TH AVE	STE 100	SALT LAKE CTY	UT	84103	2870	00	None	40.78074719	-111.8799317	Salt Lake County
248559	Fee-for-Service	1063646545	1063646545	1	1	PHAN, ANDREW T MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107482	40	Pediatrics	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
248561	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	9/20/2018	176B00000X	NA	Licensed Midwife	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
248563	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	8/31/2017	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
248589	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	10/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
248594	Fee-for-Service	1417584855	1417584855	1	1	PARTANI, EKTA MD	5/3/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185435	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
248605	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	2/11/2013	163WP0807X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
248623	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
248638	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/12/2021	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
248648	Fee-for-Service	1194931337	1194931337	1	1	PATEL, RASHIKLAL R MD	4/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51638	41	Internal Medicine	0	In state provider	None	1105 E FOSTER RD	STE H	SANTA MARIA	CA	93455	6438	42	06083	34.88316028	-120.4181087	Santa Barbara County
248660	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	3/31/2020	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
248674	Fee-for-Service	1902109580	1902109580	1	1	PLANNED PARENTHOOD LOS	1/16/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANGELES	533 E PALMDALE BLVD	STE A-1	PALMDALE	CA	93550	2375	19	06037	34.5796702	-118.1198284	Los Angeles County
248684	Fee-for-Service	1497452700	1497452700	1	1	PIH HEALTH PHYSICIANS	2/9/2024	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
248694	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	10/28/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
248725	Fee-for-Service	1275363954	1275363954	1	1	POTTER, MARLENA	3/5/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2222 2ND ST	STE 10	LIVERMORE	CA	94550	4555	01	06001	37.68103913	-121.7680792	Alameda County
248733	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
248745	Fee-for-Service	1417968413	1417968413	1	1	PACIFIC SHORES MED GRP	8/1/1995	207RX0202X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
248749	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	2/5/2019	106H00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
248757	Fee-for-Service	1417235672	1417235672	1	1	POONIA, ARASHDEEP S MD	8/14/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	129530	45	Nephrology (Renal-Kidney)	0	In state provider	None	1505 SHEPARD DR	103	SANTA MARIA	CA	93454	7020	42	06083	34.93433773	-120.4213014	Santa Barbara County
248761	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	6/25/2009	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
248764	Fee-for-Service	1235226531	1235226531	1	10	PERMANENTE MEDICAL GROUP INC	9/25/2018	101YM0800X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
248791	Fee-for-Service	1073791505	1073791505	1	1	PALMARIS IMAGING OF CA INC	6/16/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
248800	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
248802	Fee-for-Service	1942287230	1942287230	1	1	PALUAY, PEDRO MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2606 ELISHA AVE	None	ZION	IL	60099	2608	00	None	42.4473975	-87.82695565	Lake County
248803	Fee-for-Service	1528298981	1528298981	1	1	PATTON, GREGORY A MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115963	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
248805	Fee-for-Service	1922689884	1922689884	1	1	PERERA, NIRESH MD	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	189078	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
248808	Fee-for-Service	1336191345	1336191345	1	1	PALEFSKY, JOEL M MD	9/30/1988	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	54209	77	Infectious Disease	0	In state provider	None	505 PARNASSUS AVE	# M997	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
248814	Fee-for-Service	1164682738	1164682738	1	1	PASQUALI, THEODORE A MD	2/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126375	18	Ophthalmology	0	In state provider	None	3300 E SOUTH ST	STE 105	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
248848	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	2/24/2020	176B00000X	NA	Licensed Midwife	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
248850	Fee-for-Service	1063496651	1063496651	1	45	PACIFIC CENTRAL COAST HEALTH	2/24/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2 JAMES WAY	SUITE 207	PISMO BEACH	CA	93449	4976	40	06079	35.13869436	-120.630734	San Luis Obispo County
248851	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
248866	Fee-for-Service	1487677001	1487677001	1	1	PHILLIPS, RHEA M MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54003	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
248877	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	1/11/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
248893	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	2/11/2013	163WP0807X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
248912	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
248924	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/12/2021	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
248947	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
248969	Fee-for-Service	1497452700	1497452700	1	1	PIH HEALTH PHYSICIANS	2/15/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
248982	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
249006	Fee-for-Service	1730316191	1730316191	1	1	PATEL, ANAND MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113177	30	Radiology	0	In state provider	None	4101 TORRANCE BOULEVARD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
249019	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	6/15/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
249026	Fee-for-Service	1720004088	1720004088	1	1	PONSFORD, LISA R CNP	3/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	660 BAKER STREET	STE A-102	COSTA MESA	CA	92626	4407	30	06059	33.68014263	-117.8842009	Orange County
249040	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
249047	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2016	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
249049	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	5/3/2019	1041C0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
249076	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
249095	Fee-for-Service	1407945629	1407945629	1	1	PLANNED PARENTHOOD WORLD	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MAR VISTA	1316 3RD STREET PROMENAD	STE 201	SANTA MONICA	CA	90401	1382	19	06037	34.01670895	-118.497462	Los Angeles County
249106	Fee-for-Service	1942401880	1942401880	1	1	PLATA, ERICA J LMFT	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
249128	Fee-for-Service	1861627242	1861627242	1	2	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
249131	Fee-for-Service	1225598485	1225598485	1	1	PETERSON, DANIELLE MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
249133	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	4/22/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
249137	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
249146	Fee-for-Service	1093152324	1093152324	1	3	PALLIATIVE CARE CONSULTANTS	11/13/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF SANTA BARBARA	515 MICHELTORENA ST	C	SANTA BARBARA	CA	93103	2257	42	06083	34.43172339	-119.7024817	Santa Barbara County
249156	Fee-for-Service	1194065433	1194065433	1	1	PIRTLE, LISA L LCSW	3/31/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
249158	Fee-for-Service	1255610986	1255610986	1	1	PRRK HOLDINGS LLC	11/21/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	299 PROSPECT PLACE	None	CORONADO	CA	92118	1967	37	06073	32.69394335	-117.1680759	San Diego County
249167	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	5/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
249168	Fee-for-Service	1346531175	1346531175	1	1	PATTERSON, SARAH L MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123829	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
249179	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	12/20/2018	163WP0807X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
249200	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	3/16/2009	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
249214	Fee-for-Service	1548615388	1548615388	1	1	PRELUDE CORPORATION	11/7/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	26051 MERIT CIR	SUITE103	LAGUNA HILLS	CA	92653	7008	30	06059	33.57409601	-117.6747949	Orange County
249215	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/13/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
249237	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	7/12/2019	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
249251	Fee-for-Service	1316062813	1316062813	1	1	PHILLIPS, JACQUELINE F NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
249255	Fee-for-Service	1407941602	1407941602	3	1	PECK MICHAEL	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
249259	Fee-for-Service	1497452700	1497452700	1	1	PIH HEALTH PHYSICIANS	3/6/2024	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
249266	Fee-for-Service	1891729042	1891729042	1	1	PODELL, RONALD M MD	5/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	32378	36	Psychiatry	0	In state provider	None	2080 CENTURY PARK E	STE 308	LOS ANGELES	CA	90067	2006	19	06037	34.05887194	-118.4122914	Los Angeles County
249272	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	11/30/2018	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
249292	Fee-for-Service	1043465438	1043465438	1	1	PANCHAL, BELLA S	7/15/2009	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8409 PIONEER BLVD	None	WHITTIER	CA	90606	2947	19	06037	33.968394	-118.081687	Los Angeles County
249306	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	1/1/1979	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
249316	Fee-for-Service	1295939874	1295939874	1	1	PALMER, LOLITA V MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112491	02	General Surgery	0	In state provider	None	3 MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
249326	Fee-for-Service	1699182774	1699182774	1	1	PROUIX, MATTHEW P LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
249327	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	1/23/2017	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
249334	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	4/27/2017	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
249338	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	11/30/2018	1041C0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
249340	Fee-for-Service	1912268129	1912268129	1	1	PAIK, JEANIE MD	6/11/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168810	18	Ophthalmology	0	In state provider	None	220 MERIDIAN AVE	None	SAN JOSE	CA	95126	2903	43	06085	37.325295	-121.9137735	Santa Clara County
249353	Fee-for-Service	1063917847	1063917847	1	1	PACHECO, CAITLIN W MD	2/9/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	167076	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
249364	Fee-for-Service	1144701939	1144701939	1	1	PANJAITAN, ALYSSA C CCC-SLP	6/12/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
249369	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	2/11/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
249370	Fee-for-Service	1235511924	1235511924	1	1	PATEL, MITESH S MD	9/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173818	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
249376	Fee-for-Service	1760892798	1760892798	1	1	PATTERSON, JOSEPH T MD	9/1/2020	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	139852	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
249397	Fee-for-Service	1861617169	1861617169	1	1	PROJECT SIX	3/4/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16102 ACRE ST	None	NORTH HILLS	CA	91343	4824	19	06037	34.2301381	-118.4832487	Los Angeles County
249406	Fee-for-Service	1093955247	1093955247	1	1	PATTON-KU, DANA A MD	9/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105763	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249417	Fee-for-Service	1861627242	1861627242	1	2	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
249425	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	10/29/2018	176B00000X	NA	Licensed Midwife	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
249428	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
249455	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	10/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
249463	Fee-for-Service	1508220112	1508220112	1	1	POPESCU, ANDREI MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	163216	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6696	19	06037	34.05682871	-118.360716	Los Angeles County
249465	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	9/12/2018	163WP0807X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
249487	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
249495	Fee-for-Service	1144664095	1144664095	1	1	PARIKH, VANNA V MD	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144567	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
249499	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	12/17/2021	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
249501	Fee-for-Service	1962852939	1962852939	1	1	PRIMARY CARE AT HOME INC	3/28/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	400-29TH ST	SUITE 306	OAKLAND	CA	94609	3550	01	06001	37.81784861	-122.2652263	Alameda County
249513	Fee-for-Service	1609116474	1609116474	1	1	PURI, SIDHARTH MD	7/18/2019	390200000X	NA	Other	026	PHYSICIANS	162045	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
249519	Fee-for-Service	1063496651	1063496651	1	34	PACIFIC CENTRAL COAST HEALTH	4/30/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	895 AEROVISTA PLACE	STE 103	SAN LUIS OBISPO	CA	93401	8725	40	06079	35.24285786	-120.6403241	San Luis Obispo County
249524	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
249531	Fee-for-Service	1326149360	1326149360	1	1	PERRONE, GREGORY A OD	1/31/1990	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1127 4TH ST	STE A	SAN RAFAEL	CA	94901	3006	21	06041	37.97319727	-122.5289881	Marin County
249550	Fee-for-Service	1770710030	1770710030	1	1	POOLE, KAMERON A MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116648	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 E MAIN ST	STE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
249555	Fee-for-Service	1871552950	1871552950	1	1	PAI PANANDIKER, ATMARAM S MD	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130278	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
249557	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
249587	Fee-for-Service	1083800999	1083800999	1	1	PERRYMAN, SCOTT V MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85617	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
249595	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	6/19/2017	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
249613	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	6/25/2009	106H00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
249617	Fee-for-Service	1376921577	1376921577	1	1	PALOS VERDES VILLA, LLC	5/26/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	29661 S WESTERN AVE	None	RANCHO PALOS VERD	CA	90275	1314	19	06037	33.746958	-118.309649	Los Angeles County
249624	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
249625	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
249654	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
249675	Fee-for-Service	1841889433	1841889433	1	1	PROLIFIC HOME HEALTH	11/3/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2116 N GLENOAKS BLVD	STE 2	BURBANK	CA	91504	2811	19	06037	34.19806822	-118.3265669	Los Angeles County
249705	Fee-for-Service	1861627242	1861627242	1	2	PLATINUM HOSPITALISTS LLP	1/24/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
249709	Fee-for-Service	1255184495	1255184495	1	1	PALLADINO, BRITTANY NP	11/21/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
249710	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
249715	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	11/30/2018	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
249742	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	7/20/2019	171100000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
249753	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	2/24/2020	163WP0807X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
249756	Fee-for-Service	1891719233	1891719233	1	1	POLSTON, GREGORY P MD	11/6/2008	207LP2900X	NA	Other	026	PHYSICIANS	70548	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
249766	Fee-for-Service	1477211027	1477211027	1	1	PARK, RUTH LMFT	10/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	141245	-	NOT APPLICABLE	0	In state provider	None	1207 EAST FRUIT STREET	A, B, B2, B3, C, D, E, F	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
249769	Fee-for-Service	1760674295	1760674295	1	1	PAN0SSIAN, ABRAHAM M MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99283	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
249776	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
249789	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	8/13/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
249792	Fee-for-Service	1962852939	1962852939	1	1	PRIMARY CARE AT HOME INC	11/15/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	400-29TH ST	SUITE 306	OAKLAND	CA	94609	3550	01	06001	37.81784861	-122.2652263	Alameda County
249811	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	12/7/2018	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
249832	Fee-for-Service	1396786091	1396786091	1	1	PARTOWNAVID, PARISA MD	5/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76951	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
249843	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
249844	Fee-for-Service	1871552950	1871552950	1	1	PAI PANANDIKER, ATMARAM S MD	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130278	30	Radiology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
249850	Fee-for-Service	1972540961	1972540961	1	1	POLINER, ROBERT B MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
249872	Fee-for-Service	1568666022	1568666022	1	1	POOYAN, RAMIN DO	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11219	46	Hand Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	STE W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
249883	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
249904	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
249906	Fee-for-Service	1295433415	1295433415	1	1	PAPR	11/12/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	C.	8349 RESEDA BLVD.	SUITE G	NORTHRIDGE	CA	91324	5914	19	06037	34.222248	-118.536099	Los Angeles County
249912	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	12/8/2018	1041C0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
249913	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	2/11/2013	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
249918	Fee-for-Service	1649937749	1649937749	1	1	PAUL, BRITANI CNM	3/30/2023	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 203	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
249940	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
249942	Fee-for-Service	1295855195	1295855195	1	1	PERHAM, ARMIN MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101066	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
249944	Fee-for-Service	1609810902	1609810902	1	1	PIVAVATH, SUDHAKAR NJ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
249955	Fee-for-Service	1386992642	1386992642	1	1	PARAMO, MELISSA R LMFT	12/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
249958	Fee-for-Service	1083766455	1083766455	1	1	PRETORIUS, ROBERT G	4/30/1985	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	33282	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249972	Fee-for-Service	1982155289	1982155289	1	1	PIMENTEL, NERMAN	8/11/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
249990	Fee-for-Service	1447447248	1447447248	1	7	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	OUP INC	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
249999	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	11/30/2018	176B00000X	NA	Licensed Midwife	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
250002	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
250029	Fee-for-Service	1912991662	1912991662	1	1	PHELPS, DENNIS B MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	INC	2320 BATH ST	STE 301	SANTA BARBARA	CA	93105	4345	42	06083	34.43082689	-119.7223032	Santa Barbara County
250031	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	12/20/2018	207Q00000X	NA	Adult Primary Care	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
250033	Fee-for-Service	1003068099	1003068099	1	1	PAGNIUCCI, LYDIA K	4/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
250042	Fee-for-Service	1548343510	1548343510	1	56	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	THE PERMANENTE MED GROUP	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
250063	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
250072	Fee-for-Service	1215078688	1215078688	1	1	PINGS, CAROLE C LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
250076	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	5/30/2022	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
250078	Fee-for-Service	1962852939	1962852939	1	1	PRIMARY CARE AT HOME INC	1/1/2020	No Taxonomy Provided	NA	None	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	400-29TH ST	SUITE 306	OAKLAND	CA	94609	3550	01	06001	37.81784861	-122.2652263	Alameda County
250100	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	12/7/2018	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
250127	Fee-for-Service	1336295138	1336295138	1	2	PLEASANTON PHYSICAL THERAPY	11/27/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PY	2280 DIAMOND BLVD	320	CONCORD	CA	94520	5775	07	06013	37.97715317	-122.0605709	Contra Costa County
250128	Fee-for-Service	1437605615	1437605615	1	1	PHI LIFE SCIENCES LLC	9/21/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	645 MEETING ST	SUITE 3	CHARLESTON	SC	29403	4279	00	None	32.804811	-79.9462935	Charleston County
250131	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
250135	Fee-for-Service	1497910251	1497910251	1	1	PALTA, RENEE DO	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10322	41	Internal Medicine	0	In state provider	None	210 W SAN BERNADINO ROAD	None	COVINA	CA	91722	5108	19	06037	34.088004	-117.893475	Los Angeles County
250160	Fee-for-Service	1568666022	1568666022	1	1	POOYAN, RAMIN DO	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11219	20	Orthopedic Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	STE W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
250165	Fee-for-Service	1780655795	1780655795	1	1	PICKARD, RALPH H MD	8/24/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168137	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250173	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	1/11/2017	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
250188	Fee-for-Service	1528029303	1528029303	1	1	PHILLIPS, PAMELA J MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127913	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
250192	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	2/5/2019	106H00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
250198	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	2/26/2013	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
250200	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	5/15/2017	1041C0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
250207	Fee-for-Service	1386643989	1386643989	1	1	POJUNAS, KATHLEEN W MD	7/31/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	59788	30	Radiology	0	In state provider	None	401 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4227	42	06083	34.42940104	-119.7230763	Santa Barbara County
250223	Fee-for-Service	1831473081	1831473081	1	1	PARVIZI, GOLNAR MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133864	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
250231	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
250236	Fee-for-Service	1831727304	1831727304	1	1	PATEL, SAGAR S DO	1/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19640	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
250240	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	4/17/2017	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
250275	Fee-for-Service	1306406251	1306406251	1	2	PATRICK SWEET MD PC	10/7/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1550 N IMPERIAL AVE	SUITE 3	EL CENTRO	CA	92243	6304	13	06025	32.80696546	-115.5702795	Imperial County
250278	Fee-for-Service	1447447248	1447447248	1	7	PACIFIC INPATIENT MEDICAL GR	2/27/2022	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OUP INC	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
250286	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	12/30/2018	176B00000X	NA	Licensed Midwife	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
250287	Fee-for-Service	1962590802	1962590802	1	1	PEINADO, ALBERT J MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	57073	41	Internal Medicine	0	In state provider	None	2323 16TH ST	STE 504	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
250290	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
250303	Fee-for-Service	1518022920	1518022920	1	1	PANICCIA, GREGORY S MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76979	36	Psychiatry	0	In state provider	None	2535 CAMINO DEL RIO S	STE 345	SAN DIEGO	CA	92108	3754	37	06073	32.76923898	-117.1376556	San Diego County
250314	Fee-for-Service	1912991662	1912991662	1	1	PHELPS, DENNIS B MD	10/4/2005	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	35221	46	Hand Surgery	0	In state provider	INC	2320 BATH ST	STE 301	SANTA BARBARA	CA	93105	4345	42	06083	34.43082689	-119.7223032	Santa Barbara County
250318	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	12/30/2018	171100000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
250320	Fee-for-Service	1295393973	1295393973	1	1	PATE-TERRY, JOLIE J LCSW	7/26/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
250321	Fee-for-Service	1700855798	1700855798	1	1	PERLOV, DANIEL R MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87533	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
250327	Fee-for-Service	1336962554	1336962554	1	1	PATTON, LARISSA LMFT	11/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
250343	Fee-for-Service	1083119267	1083119267	1	1	PATEL, SHRUTI R MD	5/16/2024	1835X0200X	NA	Other	026	PHYSICIANS	174900	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250352	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
250364	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	10/1/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
250369	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
250373	Fee-for-Service	1427070671	1427070671	1	1	PEREIRA-MATSUMOTO SHARON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74217	30	Radiology	0	In state provider	MD	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
250376	Fee-for-Service	1922608959	1922608959	1	1	PRIMAL CARE HOSPICE INC	1/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	815 S CENTRAL AVE	STE 26	GLENDALE	CA	91204	4301	19	06037	34.13606127	-118.2578932	Los Angeles County
250390	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
250416	Fee-for-Service	1710932751	1710932751	1	1	PATEL, BAKUL K MD	1/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45267	41	Internal Medicine	0	In state provider	None	26781 PORTOLA PKWY	STE 4E	FOOTHILL RANCH	CA	92610	1758	30	06059	33.6785505	-117.6626791	Orange County
250419	Fee-for-Service	1063447050	1063447050	1	1	PLANNED PARENTHOOD -	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF THE PACIFIC SOUTHWEST	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	37	06073	33.12861918	-117.0906689	San Diego County
250426	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
250427	Fee-for-Service	1427079169	1427079169	1	1	PATEL, JAYESH J	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72056	None	None	0	In state provider	None	1525 WEBSTER ST	STE A	FAIRFIELD	CA	94533	4935	48	06095	38.2570563	-122.0475622	Solano County
250431	Fee-for-Service	1538240098	1538240098	1	1	PETERSON, JEFFREY S MD	4/13/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65906	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250457	Fee-for-Service	1427394410	1427394410	1	3	PALLAPATI, ARUNA MD INC	9/6/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98165	40	Pediatrics	0	In state provider	None	900 S MAIN STREET	SUITE 205	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
250459	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	3/23/2017	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
250475	Fee-for-Service	1922539618	1922539618	1	1	PRINCE, DEAN MD	4/3/2024	208600000X	NA	General Surgery	026	PHYSICIANS	176491	02	General Surgery	0	In state provider	None	15211 VANOWEN ST	STE 208	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
250478	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	11/30/2018	106H00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
250483	Fee-for-Service	1760400386	1760400386	1	1	PAZ, ALEJANDRO MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	42579	01	General Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
250488	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
250489	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	12/27/2016	1041C0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
250490	Fee-for-Service	1710418744	1710418744	1	1	PARK, BRIAN L MD	9/1/2023	2080P0204X	NA	Other	026	PHYSICIANS	188062	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
250516	Fee-for-Service	1548343510	1548343510	1	29	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
250523	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	10/19/2007	103TC2200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
250532	Fee-for-Service	1871170811	1871170811	1	1	PLASENCIA, REUBEN R MD	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
250540	Fee-for-Service	1306837927	1306837927	1	1	PANNU, AMRITPAL S MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62711	41	Internal Medicine	0	In state provider	None	2339 W CLEVELAND AVE	STE 103	MADERA	CA	93637	8753	20	06039	36.97466548	-120.085749	Madera County
250550	Fee-for-Service	1477689644	1477689644	1	1	PETREE, JANIS M NP	12/21/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250555	Fee-for-Service	1598119349	1598119349	1	1	PATEL, NEEL MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171800	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250570	Fee-for-Service	1679105464	1679105464	1	1	PITTSON, NICOLE M CNP	8/17/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250574	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	11/7/2018	176B00000X	NA	Licensed Midwife	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
250576	Fee-for-Service	1366806275	1366806275	1	1	PALACIOS, JACYNDA R T	4/26/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	879 W 190TH ST	4TH FL	GARDENA	CA	90248	4223	19	06037	33.85927671	-118.2896516	Los Angeles County
250577	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
250592	Fee-for-Service	1114958121	1114958121	1	1	PUTHUMANA, JYOTHY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	680 N LAKE SHORE DR	STE 1000	CHICAGO	IL	60611	8709	00	None	41.89498774	-87.61585515	Cook County
250603	Fee-for-Service	1912991662	1912991662	1	1	PHELPS, DENNIS B MD	10/4/2005	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	35221	20	Orthopedic Surgery	0	In state provider	INC	2320 BATH ST	STE 301	SANTA BARBARA	CA	93105	4345	42	06083	34.43082689	-119.7223032	Santa Barbara County
250606	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
250607	Fee-for-Service	1982390589	1982390589	1	1	POLY THERAPIST PSYCHOLOGY CO	8/15/2023	261QM0850X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RPORATION	15119 HORIZON ST	7	FONTANA	CA	92336	5272	36	06071	0	0	None
250609	Fee-for-Service	1700855798	1700855798	1	1	PERLOV, DANIEL R MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87533	05	Anesthesiology	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
250616	Fee-for-Service	1760487987	1760487987	1	1	PRESBYTERIAN INTERCOMMUNITY	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15050 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707774	-118.0098054	Los Angeles County
250634	Fee-for-Service	1417362757	1417362757	1	1	PYLE, CASEY W DO	2/3/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	14591	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
250639	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
250646	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
250652	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	1/21/2022	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
250657	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
250661	Fee-for-Service	1427070671	1427070671	1	1	PEREIRA-MATSUMOTO SHARON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74217	78	Neoplastic Diseases/Oncology	0	In state provider	MD	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
250664	Fee-for-Service	1093733776	1093733776	1	1	PATER DIGNITAS INC	11/1/2004	310400000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	23795 WR HOLMAN HWY	None	MONTEREY	CA	93940	5903	27	06053	36.57664711	-121.9143421	Monterey County
250666	Fee-for-Service	1922608959	1922608959	1	1	PRIMAL CARE HOSPICE INC	1/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	815 S CENTRAL AVE	STE 26	GLENDALE	CA	91204	4301	19	06037	34.13606127	-118.2578932	Los Angeles County
250675	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	2/19/2020	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
250690	Fee-for-Service	1023054269	1023054269	1	1	PATEL, PURNIMA K MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32125	41	Internal Medicine	0	In state provider	STE 160	36243 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9549	33	06065	33.591528	-117.2393325	Riverside County
250706	Fee-for-Service	1548343510	1548343510	1	43	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
250710	Fee-for-Service	1417263344	1417263344	1	1	PIWOWARSKI, SHARON LMFT	7/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
250718	Fee-for-Service	1821236068	1821236068	1	1	PAN, YING MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97302	18	Ophthalmology	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
250747	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	2/26/2013	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
250757	Fee-for-Service	1265435416	1265435416	1	2	PAIN MANAGEMENT SPECIALISTS	7/10/2024	174400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	MEDICAL GROUP	1201 E OCEAN AVE	STE B	LOMPOC	CA	93436	7096	42	06083	34.63888288	-120.4436487	Santa Barbara County
250767	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	2/5/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
250771	Fee-for-Service	1760400386	1760400386	1	1	PAZ, ALEJANDRO MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	42579	08	Family Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
250773	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	7/20/2019	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
250777	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	6/25/2009	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
250794	Fee-for-Service	1558366500	1558366500	1	1	PHAM,SCOTT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.536159	-96.7416975	Minnehaha County
250815	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	9/20/2018	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
250816	Fee-for-Service	1104006832	1104006832	1	1	PATIL, CHIRAG G MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90189	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
250863	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	12/30/2018	176B00000X	NA	Licensed Midwife	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
250866	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
250893	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	9/20/2018	171100000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
250904	Fee-for-Service	1760487987	1760487987	1	1	PRESBYTERIAN INTERCOMMUNITY	10/1/1992	251E00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15050 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707774	-118.0098054	Los Angeles County
250921	Fee-for-Service	1336290451	1336290451	1	1	PARENTI, HEATHER L LCSW	10/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
250928	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
250929	Fee-for-Service	1063496651	1063496651	1	23	PACIFIC CENTRAL COAST HEALTH	7/1/2015	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1745 NORTH BROADWAY	STE 101	SANTA MARIA	CA	93454	1927	42	06083	34.971759	-120.4356175	Santa Barbara County
250935	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	11/27/2007	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
250936	Fee-for-Service	1700292927	1700292927	1	1	PADDA, MANMEET S MD APC	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85290	10	Gastroenterology (M.D. only)	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	2638	33	06065	33.8123212	-117.2217309	Riverside County
250938	Fee-for-Service	1982858809	1982858809	1	1	PATEL, TRUSHAR J MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117321	30	Radiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
250939	Fee-for-Service	1396893699	1396893699	1	1	PHILO, LEONARD E MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139782	10	Gastroenterology (M.D. only)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
250941	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	6/2/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
250946	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	12/14/2017	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
250953	Fee-for-Service	1184280877	1184280877	1	1	POSEL, CLAIRE LMFT	9/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
250964	Fee-for-Service	1548343510	1548343510	1	67	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
251027	Fee-for-Service	1770559338	1770559338	1	1	PATEL, DAKSHA N MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148023	36	Psychiatry	0	In state provider	None	15615 POMERADO RD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
251036	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2015	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
251044	Fee-for-Service	1265435416	1265435416	1	2	PAIN MANAGEMENT SPECIALISTS	11/14/2016	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1201 E OCEAN AVE	STE B	LOMPOC	CA	93436	7096	42	06083	34.63888288	-120.4436487	Santa Barbara County
251056	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	5/3/2019	106H00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
251061	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	4/17/2017	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251065	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	12/27/2016	1041C0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
251102	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
251113	Fee-for-Service	1770533192	1770533192	1	1	PATTERSON, KIM C LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
251114	Fee-for-Service	1316066145	1316066145	1	1	PENNY LANE CENTERS	6/20/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5628 E. SLAUSON AVE	None	COMMERCE	CA	90040	2922	19	06037	33.98593459	-118.163681	Los Angeles County
251143	Fee-for-Service	1871506741	1871506741	1	1	PLESONS, DENNIS J MD	9/30/1983	2084P0800X	NA	Psychiatry	026	PHYSICIANS	40884	36	Psychiatry	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
251150	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	9/12/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251155	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
251182	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	3/29/2019	207Q00000X	NA	Adult Primary Care	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
251208	Fee-for-Service	1063489342	1063489342	1	1	PENNSYLVANIA HOSPITAL OF THE	8/24/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	UNIVERSITY OF PENN H SY	800 SPRUCE STREET	None	PHILADELPHIA	PA	19107	6192	00	None	39.94581734	-75.15555483	Philadelphia County
251209	Fee-for-Service	1033135454	1033135454	1	1	PINKNEY, BRETT R PT	5/4/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	588 NORTH SUNRISE AVENUE	SUITE 100	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
251210	Fee-for-Service	1275787533	1275787533	1	1	PRESLEY, LAWRENCE V MD	12/9/2009	390200000X	NA	Other	026	PHYSICIANS	109976	05	Anesthesiology	0	In state provider	None	937 EAST MAIN STREET	None	SANTA MARIA	CA	93454	1739	42	06083	34.95309189	-120.4209855	Santa Barbara County
251215	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	4/15/2019	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
251224	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
251226	Fee-for-Service	1396893699	1396893699	1	1	PHILO, LEONARD E MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139782	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
251230	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	6/2/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
251236	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
251244	Fee-for-Service	1124461207	1124461207	1	1	PALANIAPPA, NANDINI MD	7/25/2018	390200000X	NA	Other	026	PHYSICIANS	147243	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
251271	Fee-for-Service	1336312446	1336312446	1	1	PURI, GEETHA MD	7/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50585	36	Psychiatry	0	In state provider	None	12830 HESPERIA ROAD	SUITE A	VICTORVILLE	CA	92395	7788	36	06071	34.48395212	-117.2903629	San Bernardino County
251276	Fee-for-Service	1952644106	1952644106	1	1	POE, WILLIAM E III MD	11/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134924	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251291	Fee-for-Service	1316006885	1316006885	1	1	PLATT, GERALD W MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118517	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAYD	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
251314	Fee-for-Service	1114516036	1114516036	1	1	PALAFOX, MARIBEL LMFT	1/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
251322	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
251345	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	11/30/2018	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
251350	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251351	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	9/25/2018	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
251376	Fee-for-Service	1770994675	1770994675	1	1	PIROUZ, ASLAN MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137405	41	Internal Medicine	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
251388	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	9/20/2018	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
251395	Fee-for-Service	1245327840	1245327840	1	1	POMERANTZ, MARK F MD	5/5/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	48284	None	None	0	In state provider	None	4934 VERDUGO	None	CAMARILLO	CA	93012	8631	56	06111	34.21594032	-119.0048014	Ventura County
251439	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	10/8/2018	176B00000X	NA	Licensed Midwife	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251441	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
251455	Fee-for-Service	1669679130	1669679130	1	1	PRZEKLASA AUTH, MELISSA J MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94129	13	Neurology (M.D. only)	0	In state provider	None	2880 ATLANTIC AVENUE	STE 260	LONG BEACH	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles County
251467	Fee-for-Service	1366746661	1366746661	1	1	PIATEK, CAROLINE I MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115210	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
251469	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	4/22/2020	207Q00000X	NA	Adult Primary Care	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
251481	Fee-for-Service	1144677550	1144677550	1	1	PATEL, KARNA MD	7/2/2019	208M00000X	NA	Other	026	PHYSICIANS	152882	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1092	37	06073	32.89687721	-117.2418677	San Diego County
251491	Fee-for-Service	1053586800	1053586800	1	1	PATEL, BINOY G PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
251496	Fee-for-Service	1063489342	1063489342	1	1	PENNSYLVANIA HOSPITAL OF THE	8/24/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	UNIVERSITY OF PENN H SY	800 SPRUCE STREET	None	PHILADELPHIA	PA	19107	6192	00	None	39.94581734	-75.15555483	Philadelphia County
251505	Fee-for-Service	1235226531	1235226531	1	4	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	C B O HAYWARD	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
251508	Fee-for-Service	1548028236	1548028236	1	1	PATTERSON, DAYVON PT	5/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4339 E MORADA LN	150	STOCKTON	CA	95212	1634	39	06077	38.039067	-121.259493	San Joaquin County
251512	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
251516	Fee-for-Service	1962622373	1962622373	1	1	PALMER, DAVID A DO	7/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9914	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
251517	Fee-for-Service	1235226531	1235226531	1	62	PERMANENTE MEDICAL GROUP INC	9/24/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
251523	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	4/24/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
251526	Fee-for-Service	1326435025	1326435025	1	1	PYATKA, NATALIYA MD	8/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167963	13	Neurology (M.D. only)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
251544	Fee-for-Service	1053590315	1053590315	1	1	PAK, MIHWA C MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81890	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
251578	Fee-for-Service	1548315807	1548315807	1	1	PONDROM, JULIE C MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81468	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
251583	Fee-for-Service	1750366068	1750366068	2	3	PROTRANSPORT 1	9/12/2024	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	720 PORTAL STREET	None	COTATI	CA	94931	3060	34	06067	38.34259317	-122.7210478	Sonoma County
251592	Fee-for-Service	1144277633	1144277633	1	3	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	GROUP	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
251600	Fee-for-Service	1386664977	1386664977	1	1	PREGLER, JANET P MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71571	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA STE 49	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
251610	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	2/11/2013	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
251631	Fee-for-Service	1235226531	1235226531	1	32	PERMANENTE MEDICAL GROUP INC	6/25/2009	106H00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
251635	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251639	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	5/11/2018	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
251644	Fee-for-Service	1245389725	1245389725	1	1	PAJO CORPORATION	9/25/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2080 CENTURY PARK E	SUITE 1210	CENTURY CITY	CA	90067	2015	19	06037	34.05887194	-118.4122914	Los Angeles County
251651	Fee-for-Service	1740291590	1740291590	2	1	PARKEVILLE LLC	12/13/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	15435 S WESTERN AVE	#117	GARDENA	CA	90249	4324	19	06037	33.89088955	-118.3091776	Los Angeles County
251678	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	7/20/2019	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
251714	Fee-for-Service	1265543110	1265543110	1	1	PATRICK B SOLARI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
251716	Fee-for-Service	1659469625	1659469625	1	1	PEDIATRIC PARTNERS MPC	2/9/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2279 EAGLE GLEN PKWY	STE D110	CORONA	CA	92883	0790	33	06065	33.82106514	-117.52201	Riverside County
251723	Fee-for-Service	1821563842	1821563842	1	1	PARK, EZEKIEL	8/8/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	21515 HAWTHORNE BLVD	STE G100	TORRANCE	CA	90503	6503	19	06037	33.83306687	-118.3530111	Los Angeles County
251724	Fee-for-Service	1942562277	1942562277	1	1	PARK, SHIN YOUNG MD	1/2/2018	208600000X	NA	General Surgery	026	PHYSICIANS	147258	02	General Surgery	0	In state provider	None	236 SAN JOSE	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
251726	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	2/27/2013	176B00000X	NA	Licensed Midwife	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251731	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
251738	Fee-for-Service	1669627527	1669627527	1	1	PINTO, TINA K PT	3/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
251742	Fee-for-Service	1669679130	1669679130	1	1	PRZEKLASA AUTH, MELISSA J MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94129	36	Psychiatry	0	In state provider	None	2880 ATLANTIC AVENUE	STE 260	LONG BEACH	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles County
251751	Fee-for-Service	1285130906	1285130906	1	1	POHLEN, MICHAEL S MD	6/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163881	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251756	Fee-for-Service	1366746661	1366746661	1	1	PIATEK, CAROLINE I MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115210	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
251758	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	4/24/2009	171100000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
251778	Fee-for-Service	1881819258	1881819258	1	1	PAK, JIMMY JW MD	9/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77390	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
251791	Fee-for-Service	1124053111	1124053111	1	1	PLANNED PARENTHOOD OF THE	4/21/1988	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	10717 CAMINO RUIZ	STE 258	SAN DIEGO	CA	92126	2360	37	06073	32.91373261	-117.1437822	San Diego County
251796	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
251818	Fee-for-Service	1508259094	1508259094	1	1	PATEL, AMITA PT	11/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
251819	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
251851	Fee-for-Service	1144203167	1144203167	1	1	PHARMACY OF THE STARS IN	8/30/2004	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY OF THE STARS	1900 AVENUE OF THE STARS	STE A105	LOS ANGELES	CA	90067	4313	19	06037	34.06000538	-118.4170751	Los Angeles County
251877	Fee-for-Service	1316021942	1316021942	1	4	PILAR M DE CASTRO & CO	7/16/1991	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8571 BEL AIR ST	None	BUENA PARK	CA	90620	4001	30	06059	33.83830867	-117.9886738	Orange County
251879	Fee-for-Service	1144277633	1144277633	1	3	PATHOLOGY ASSOCIATES	2/13/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
251881	Fee-for-Service	1669407656	1669407656	1	3	PLANNED PARENTHOOD -	12/4/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1463 SOUTH 4TH STREET	None	EL CENTRO	CA	92243	4749	13	06025	32.78037178	-115.5523224	Imperial County
251898	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
251915	Fee-for-Service	1235226531	1235226531	1	39	PERMANENTE MEDICAL GROUP INC	10/3/2012	193200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
251923	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	6/2/2004	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251925	Fee-for-Service	1134970676	1134970676	1	1	PENALOZA, ERICA OT	4/8/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
251927	Fee-for-Service	1235226531	1235226531	1	23	PERMANENTE MEDICAL GROUP INC	9/11/2012	1041C0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
251937	Fee-for-Service	1316101371	1316101371	1	1	PFRUNDER, SHANNON R CRNA	2/27/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	0801	36	06071	34.073505	-117.3505995	San Bernardino County
251954	Fee-for-Service	1760466775	1760466775	1	1	PEDERSON, KAARYN C OD	1/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
251963	Fee-for-Service	1811053010	1811053010	1	1	PLUMLEY, BRANDI A LMFT	1/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
251964	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
251971	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	9/11/2017	111N00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
252015	Fee-for-Service	1548343510	1548343510	1	58	PERMANENTE MEDICAL GROUP INC	12/20/2018	176B00000X	NA	Licensed Midwife	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
252017	Fee-for-Service	1548343510	1548343510	1	63	PERMANENTE MEDICAL GROUP INC	9/12/2018	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1630 E SHAW AVE	None	FRESNO	CA	93710	8105	10	06019	36.8088456	-119.7572815	Fresno County
252038	Fee-for-Service	1760570600	1760570600	1	17	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1100 TRANCAS ST	270	NAPA	CA	94558	2900	28	06055	38.32316569	-122.2981938	Napa County
252039	Fee-for-Service	1366746661	1366746661	1	1	PIATEK, CAROLINE I MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115210	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
252045	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	12/30/2018	207Q00000X	NA	Adult Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
252084	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
252089	Fee-for-Service	1831586387	1831586387	1	1	POW-ANPONGKUL, PETE MD	8/9/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	144575	None	None	0	In state provider	None	11180 WARNER AVE	STE 351	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
252099	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
252109	Fee-for-Service	1154580074	1154580074	1	1	PRASAD, ADITYA S MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103484	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
252186	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	7/17/2017	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252214	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	6/15/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252255	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
252261	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	2/5/2019	111N00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
252264	Fee-for-Service	1144428475	1144428475	1	1	PIERANTONI, VICENTE MD	12/10/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54108	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
252275	Fee-for-Service	1467637942	1467637942	1	1	PATHCARE DIAGNOSTICS	2/2/2006	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	INC	1810 FULLERTON AVE	SUITE 102	CORONA	CA	92881	3103	33	06065	33.85971	-117.5503495	Riverside County
252276	Fee-for-Service	1992523419	1992523419	1	1	PRESCRIBED ESSENCE INC	1/3/2025	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5411 VALLEY BLVD	None	LOS ANGELES	CA	90032	3518	19	06037	34.07433404	-118.1656038	Los Angeles County
252313	Fee-for-Service	1124321252	1124321252	1	1	PENG, JUNE MD	12/11/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	191994	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
252322	Fee-for-Service	1578659405	1578659405	1	1	PAIKAL, DAVID MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76744	18	Ophthalmology	0	In state provider	None	16661 VENTURA BLVD	STE 522	ENCINO	CA	91436	1976	19	06037	34.15820737	-118.496492	Los Angeles County
252332	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	2/24/2020	171100000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
252360	Fee-for-Service	1013540046	1013540046	1	1	PAGTAKHAN, MIA ALMIRA A PT	11/24/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
252362	Fee-for-Service	1902035876	1902035876	1	1	PREMIER HEALTHCARE SRVS LLC	1/20/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	650 E HOSPITALITY LN	STE 100	SAN BERNARDINO	CA	92408	3584	36	06071	34.06586846	-117.27162	San Bernardino County
252363	Fee-for-Service	1528070091	1528070091	1	1	PORTERFIELD, KIM A MD	8/25/1989	207L00000X	NA	Other	026	PHYSICIANS	66849	05	Anesthesiology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
252381	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
252387	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
252389	Fee-for-Service	1881741056	1881741056	1	1	PEARSON, CHRISTOPHER MD	11/30/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	32552	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 W OLIVE AVE	STE D	BURBANK	CA	91506	2499	19	06037	34.16941338	-118.3209306	Los Angeles County
252411	Fee-for-Service	1912042276	1912042276	1	1	PRASAD, RAVI S MD	10/10/2008	2085N0700X	NA	MRI Provider	026	PHYSICIANS	102976	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
252475	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252481	Fee-for-Service	1619607488	1619607488	1	1	PAJARO VALLEY HEALTH CARE	9/1/2022	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT HOSPITAL CORP	75 NIELSON STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
252499	Fee-for-Service	1376546036	1376546036	1	1	PRYSI, SCOTT S MD	12/11/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	73136	01	General Practice	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
252504	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	8/1/1984	103TC2200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252520	Fee-for-Service	1033158670	1033158670	1	1	PHILLIPS, GORDON MD	4/30/1985	207P00000X	NA	Other	026	PHYSICIANS	54853	08	Family Practice	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
252528	Fee-for-Service	1821466087	1821466087	1	1	PATEL, NAOMI N PT	1/22/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
252542	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
252548	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	11/30/2018	111N00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
252608	Fee-for-Service	1124176912	1124176912	1	1	PELLEGRINO, MARK D. MD	2/28/1994	207R00000X	NA	Other	026	PHYSICIANS	69878	41	Internal Medicine	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
252618	Fee-for-Service	1255628178	1255628178	1	1	PLUID, JACOB B DO	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
252625	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	2/24/2020	207Q00000X	NA	Adult Primary Care	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
252649	Fee-for-Service	1770557704	1770557704	1	1	PERRI, JOHN F DO	8/9/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	11042	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	841 KUHN DRIVE	STE 200	CHULA VISTA	CA	91914	4523	37	06073	32.65289649	-116.9665862	San Diego County
252664	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
252676	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
252703	Fee-for-Service	1356599591	1356599591	1	1	PACIFIC MEDICAL INC	9/5/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1355 COFFEE RD	#210	MODESTO	CA	95355	3188	50	06099	37.66338505	-120.9757504	Stanislaus County
252713	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
252721	Fee-for-Service	1457321317	1457321317	1	9	PALOMAR HEALTH	9/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	120 CRAVEN ROAD	SUITE 101	SAN MARCOS	CA	92078	4237	37	06073	33.12748853	-117.1662795	San Diego County
252722	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
252747	Fee-for-Service	1124474481	1124474481	1	1	PEARCE, MARY ELLEN LCSW	7/26/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
252756	Fee-for-Service	1700844362	1700844362	1	1	PEREZ, MONA L	5/31/2006	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	121-A BOATYARD DR	None	FORT BRAGG	CA	95437	5751	23	06045	39.42167151	-123.8057535	Mendocino County
252758	Fee-for-Service	1417639675	1417639675	1	1	PROCARE MED TRANS LLC	11/7/2023	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	829 S LEMON AVE	STE A11B	DIAMOND BAR	CA	91789	2901	19	06037	34.00224193	-117.855401	Los Angeles County
252762	Fee-for-Service	1548343510	1548343510	1	8	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C B O SACRAMENTO	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252767	Fee-for-Service	1619607488	1619607488	1	1	PAJARO VALLEY HEALTH CARE	9/1/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT HOSPITAL CORP	75 NIELSON STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
252777	Fee-for-Service	1952863805	1952863805	1	1	PHAN, ALLAN Q MD	12/2/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	181207	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
252793	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252811	Fee-for-Service	1215078647	1215078647	1	1	POPE, JASON MD	2/26/2018	207LP2900X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	416 AVIATION BLVD STE B	None	SANTA ROSA	CA	95403	1032	49	06097	38.51406287	-122.7847603	Sonoma County
252828	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	4/22/2020	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
252838	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	12/8/2018	111N00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
252839	Fee-for-Service	1124555388	1124555388	1	1	POLYAK, TATYANA S MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	164438	02	General Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
252861	Fee-for-Service	1154392116	1154392116	1	1	PARMAR, VIKRAM S MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71676	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
252873	Fee-for-Service	1194020743	1194020743	1	1	PATEL, RUPALEE V NP	7/14/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
252885	Fee-for-Service	1568593374	1568593374	1	1	PORTER, VALENCIA B MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77174	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
252893	Fee-for-Service	1285826669	1285826669	1	1	PACIFIC HORIZON MEDICAL	10/22/1999	207R00000X	NA	Other	026	PHYSICIANS	70119	None	None	0	In state provider	CENTER INC	316 E LAS TUNAS DR	STE 102	SAN GABRIEL	CA	91776	1535	19	06037	34.10314065	-118.096387	Los Angeles County
252905	Fee-for-Service	1154420933	1154420933	2	1	PERRIS VALLEY PHYSICIANS	7/17/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ASSOCIATES, AMC	735 SOUTH D ST	None	PERRIS	CA	92570	2419	33	06065	33.77857232	-117.2288086	Riverside County
252911	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	7/12/2019	207Q00000X	NA	Adult Primary Care	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
252940	Fee-for-Service	1598160947	1598160947	1	1	POLIHROM, KATHERINE M CRNA	9/24/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
252949	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2015	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
252963	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
252993	Fee-for-Service	1699374421	1699374421	1	1	PACIFICA SL BOYLE LLC	7/8/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	325 S BOYLE AVENUE	None	LOS ANGELES	CA	90033	3812	19	06037	34.04404176	-118.2197344	Los Angeles County
253001	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
253007	Fee-for-Service	1124088422	1124088422	1	1	PICKENS, TODD R OD	10/30/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16 BRYSON DR	None	SUTTER CREEK	CA	95685	4118	03	06005	38.38259683	-120.8048032	Amador County
253012	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
253076	Fee-for-Service	1548343510	1548343510	1	7	PERMANENTE MEDICAL GROUP INC	12/11/2015	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
253080	Fee-for-Service	1104345065	1104345065	1	1	PERKINS, ASHLEY N LCSW	3/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
253085	Fee-for-Service	1548326341	1548326341	1	1	PRODROMOU, ELLEN J	7/31/1994	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
253115	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	10/29/2018	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
253120	Fee-for-Service	1194809798	1194809798	1	1	PREGNANCY SPECIALISTS	3/26/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GROUP INC	7930 FROST ST	STE 203	SAN DIEGO	CA	92123	2763	37	06073	32.80027001	-117.1532893	San Diego County
253125	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	9/12/2018	111N00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
253131	Fee-for-Service	1124555388	1124555388	1	1	POLYAK, TATYANA S MD	7/1/2020	390200000X	NA	Other	026	PHYSICIANS	164438	24	Plastic Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
253132	Fee-for-Service	1497077283	1497077283	1	1	PADILLA, MELODY R DO	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10959	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
253166	Fee-for-Service	1811187875	1811187875	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	PEDIATRIC INFECTIOUS DSE	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
253189	Fee-for-Service	1205291705	1205291705	1	1	PROEN, NICHOLAS C PT	1/1/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 E BULLARD AVE	102	FRESNO	CA	93710	5866	10	06019	36.82318621	-119.7562623	Fresno County
253197	Fee-for-Service	1154420933	1154420933	2	1	PERRIS VALLEY PHYSICIANS	7/17/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ASSOCIATES, AMC	735 SOUTH D ST	None	PERRIS	CA	92570	2419	33	06065	33.77857232	-117.2288086	Riverside County
253199	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	2/19/2020	207Q00000X	NA	Adult Primary Care	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
253224	Fee-for-Service	1790739126	1790739126	1	1	PLANNED PRNTHD MAR MONTE	7/1/1997	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	650 N FULTON ST	None	FRESNO	CA	93728	3404	10	06019	36.75213	-119.800333	Fresno County
253236	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
253242	Fee-for-Service	1184151151	1184151151	1	1	PARKER, ALVIN MD	3/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
253252	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	11/17/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
253265	Fee-for-Service	1376567495	1376567495	1	1	PETIT, STEVEN J MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	29872	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	10 CONGRESS ST	STE 201	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
253288	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	6/12/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
253297	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	4/17/2017	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
253307	Fee-for-Service	1356439921	1356439921	1	1	PONI, ESTEBAN S MD	2/7/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	93185	None	None	0	In state provider	None	598 N F ST	None	SAN BERNARDINO	CA	92410	3110	36	06071	34.109865	-117.296439	San Bernardino County
253313	Fee-for-Service	1669603494	1669603494	1	1	PALMER, JENNIFER E LCSW	2/3/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
253369	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
253387	Fee-for-Service	1811972953	1811972953	1	1	PANOSIAN, SEROJ G OD	5/31/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	607 N CENTRAL AVE	STE 105	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
253404	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
253408	Fee-for-Service	1700801016	1700801016	1	1	PALMER, SHAWN MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66126	18	Ophthalmology	0	In state provider	None	2160 E BIDWELL ST	None	FOLSOM	CA	95630	0000	34	06067	38.667483	-121.143969	Sacramento County
253413	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	9/25/2018	111N00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
253417	Fee-for-Service	1952447476	1952447476	1	1	PATEL, MILAN D MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124160	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24022 CALLE DE LA PLATA	STE 500	LAGUNA HILLS	CA	92653	7612	30	06059	33.6104493	-117.7110924	Orange County
253444	Fee-for-Service	1720779127	1720779127	1	1	PANIAGUA, TRISHA NP	11/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
253454	Fee-for-Service	1811187875	1811187875	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC INFECTIOUS DSE	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
253476	Fee-for-Service	1972821320	1972821320	1	1	PROVUS, JASON D MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98838	20	Orthopedic Surgery	0	In state provider	None	7910 FROST ST	STE 200	SAN DIEGO	CA	92123	2776	37	06073	32.80027449	-117.153846	San Diego County
253484	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	12/30/2018	171100000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
253485	Fee-for-Service	1225635642	1225635642	1	1	PRISTINE HOME HEALTH CARE	4/27/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	9087 ARROW ROUTE	SUITE 248	RANCHO CUCAMONGA	CA	91730	4412	36	06071	34.09931154	-117.6069482	San Bernardino County
253506	Fee-for-Service	1346803996	1346803996	1	1	PEDERSON, THOMAS MD	6/21/2023	207P00000X	NA	Other	026	PHYSICIANS	181544	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
253516	Fee-for-Service	1194109348	1194109348	1	1	PABIN, DESIREE	7/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
253527	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
253539	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
253569	Fee-for-Service	1437417441	1437417441	1	1	PATEL, LEENA J DO	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12573	08	Family Practice	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
253572	Fee-for-Service	1386908721	1386908721	1	1	PULUSU, VINAY KRISHNA MD	8/12/2019	207R00000X	NA	Other	026	PHYSICIANS	162109	41	Internal Medicine	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
253578	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	7/5/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
253586	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
253623	Fee-for-Service	1699171090	1699171090	1	1	PIETRUSZEWSKI, LINDSAY A PT	9/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 VETERAN AVE	RM 2226	LOS ANGELES	CA	90024	2704	19	06037	34.0605595	-118.4499527	Los Angeles County
253644	Fee-for-Service	1447530696	1447530696	1	1	PICKETT, CHARLOTTE M	9/28/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179557	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
253653	Fee-for-Service	1023124054	1023124054	1	1	PAK, JAESOO MD	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77845	01	General Practice	0	In state provider	None	11841 SOUTH ST	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
253658	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	6/12/2017	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
253666	Fee-for-Service	1083471445	1083471445	1	1	PRECISION HEALTH CONSULTING	2/3/2025	261QP2300X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	& CLINIC	760 S WASHBURN AVE	STE 22	CORONA	CA	92882	3303	33	06065	33.87374611	-117.567875	Riverside County
253690	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	2/11/2013	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
253699	Fee-for-Service	1700801016	1700801016	1	1	PALMER, SHAWN MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66126	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	2160 E BIDWELL ST	None	FOLSOM	CA	95630	0000	34	06067	38.667483	-121.143969	Sacramento County
253700	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	5/3/2019	111N00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
253723	Fee-for-Service	1912416017	1912416017	1	1	PRATT, HEATHER PSYD	9/17/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
253733	Fee-for-Service	1558555862	1558555862	1	1	PATEL, SHIVANI G PHD	3/17/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
253755	Fee-for-Service	1801673314	1801673314	1	1	PUNT, STEPHANIE E PHD	5/22/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
253758	Fee-for-Service	1346426848	1346426848	1	1	PHILP, JULIE C MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102329	07	Dermatology	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
253772	Fee-for-Service	1902025398	1902025398	1	1	PREMIER MEDICAL TRANSPORT	5/6/2008	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	530 NORTH PUENTE STREET	None	BREA	CA	92821	2804	30	06059	33.926157	-117.915613	Orange County
253775	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	12/30/2018	207Q00000X	NA	Adult Primary Care	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
253776	Fee-for-Service	1063496651	1063496651	1	52	PACIFIC CENTRAL COAST HEALTH	9/6/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	116 S PALISADE DR	STE 103 & 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
253815	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
253828	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
253841	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	9/20/2018	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
253864	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
253875	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
253928	Fee-for-Service	1043213549	1043213549	1	1	PURTZER, DANIEL C MD	4/30/1991	207ZP0102X	NA	Other	026	PHYSICIANS	56103	22	Pathology (M.D. only)	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
253941	Fee-for-Service	1023124054	1023124054	1	1	PAK, JAESOO MD	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77845	41	Internal Medicine	0	In state provider	None	11841 SOUTH ST	None	CERRITOS	CA	90703	6825	19	06037	33.85850849	-118.080567	Los Angeles County
253945	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	12/19/2016	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
253950	Fee-for-Service	1790851921	1790851921	1	1	PATEL, SUDHIR B MD INC	7/1/1998	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	49606	40	Pediatrics	0	In state provider	None	1700 MT VERNON AVENUE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
253953	Fee-for-Service	1659750560	1659750560	1	1	POLAK, JONATHAN D MD	4/8/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
253966	Fee-for-Service	1689009995	1689009995	1	1	PURCELL, MAURA A NP	12/11/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
253979	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	2/24/2020	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
253986	Fee-for-Service	1407053663	1407053663	1	1	PAYROVI, SUSAN MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	89816	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2000	43	06085	37.43304542	-122.1759654	Santa Clara County
253988	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	2/5/2019	111N00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
253990	Fee-for-Service	1942226279	1942226279	1	1	PERKOWSKI, DAVID J MD	11/1/1979	174400000X	NA	Other	026	PHYSICIANS	38668	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	STE 600	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
254032	Fee-for-Service	1053440065	1053440065	1	1	PHAM, LOAN V NP	8/20/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
254044	Fee-for-Service	1346426848	1346426848	1	1	PHILP, JULIE C MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102329	40	Pediatrics	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
254061	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	10/29/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
254104	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
254114	Fee-for-Service	1073606299	1073606299	1	10	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
254129	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	12/30/2018	193400000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
254153	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
254163	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
254171	Fee-for-Service	1306924113	1306924113	1	1	PRAVOVEROV, LEONID MD	8/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77583	45	Nephrology (Renal-Kidney)	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
254191	Fee-for-Service	1124190954	1124190954	1	1	PATHAK, ANJALI MD	6/6/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62620	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254213	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
254217	Fee-for-Service	1285667378	1285667378	1	1	POPLACK, STEVEN P MD	6/30/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168451	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
254223	Fee-for-Service	1861432312	1861432312	1	1	POINDEXTER, JHON J MD	4/30/1989	207P00000X	NA	Other	026	PHYSICIANS	46370	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 E 4TH ST	None	NATIONAL CITY	CA	91950	1350	37	06073	32.68038513	-117.1040623	San Diego County
254233	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	8/28/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
254245	Fee-for-Service	1528080462	1528080462	1	2	PICO, ELAINE L MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1060 SOLANO AVE	STE 1001	ALBANY	CA	94706	1681	01	06001	37.89019109	-122.2992637	Alameda County
254255	Fee-for-Service	1073684049	1073684049	1	1	PFEFFER, THOMAS MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46917	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
254274	Fee-for-Service	1548343510	1548343510	1	6	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP, INC	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
254275	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	4/2/2009	111N00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
254276	Fee-for-Service	1932280591	1932280591	1	1	PERESS, LEO Y MD	1/10/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39492	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
254295	Fee-for-Service	1669670279	1669670279	1	1	PODIATRY INSTITUTE OF	8/5/2013	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	SOUTHERN CALIFORNIA INC	9808 VENICE BLVD	SUITE 600	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
254296	Fee-for-Service	1134842933	1134842933	1	1	PACIFIC CARDIOVASCULAR AND V	12/23/2022	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	N INSTITUTE	2000 OUTLET CENTER DR	SUITE 225	OXNARD	CA	93036	0607	56	06111	34.220935	-119.1483716	Ventura County
254323	Fee-for-Service	1184664443	1184664443	1	1	PATEL, SAYJAL J MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66648	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
254328	Fee-for-Service	1649546623	1649546623	1	1	PERUMPAIL, RYAN B MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128296	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
254351	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	12/30/2018	207Q00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
254352	Fee-for-Service	1972583300	1972583300	1	1	PHILLIPS, MARY K CNM	11/24/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
254362	Fee-for-Service	1750311924	1750311924	1	1	PATEL, RAMESH R MD INC	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42669	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9900 TALBERT AVENUE	#203	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
254377	Fee-for-Service	1225093131	1225093131	1	1	PAGE, AMY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97227	0000	00	None	45.54387841	-122.6696022	Multnomah County
254393	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	2/11/2013	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
254417	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	11/30/2018	193400000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
254438	Fee-for-Service	1952663114	1952663114	1	1	PHAN, NGO MD INC	3/23/2015	207R00000X	NA	Other	026	PHYSICIANS	64044	41	Internal Medicine	0	In state provider	None	330 S GARFIELD AVE	STE 268	ALHAMBRA	CA	91801	3896	19	06037	34.09137167	-118.1241735	Los Angeles County
254441	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
254444	Fee-for-Service	1790212850	1790212850	1	1	PATEL, CHIRAG H MD	12/11/2023	207R00000X	NA	Other	026	PHYSICIANS	172846	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
254445	Fee-for-Service	1225735327	1225735327	1	1	PALENTINO, VICTORIA PT	3/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29645 RANCHO CALIFORNIA	STE. 121	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
254449	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
254489	Fee-for-Service	1790836500	1790836500	1	1	PICKETT, ANTHONY C MD IN	8/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	76921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MATERNITY CENTER OF VERM	5859 S VERMONT AVE	None	LOS ANGELES	CA	90044	3741	19	06037	33.987933	-118.291498	Los Angeles County
254506	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
254522	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	1/1/1979	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
254544	Fee-for-Service	1073684049	1073684049	1	1	PFEFFER, THOMAS MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46917	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
254563	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	2/5/2019	111N00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
254594	Fee-for-Service	1720036080	1720036080	1	1	PARK, EDWARD J MD	5/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85265	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
254598	Fee-for-Service	1750738324	1750738324	1	1	PATEL, SAFAL N MD	3/30/2020	208M00000X	NA	Other	026	PHYSICIANS	165602	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
254638	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
254656	Fee-for-Service	1750311924	1750311924	1	1	PATEL, RAMESH R MD INC	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42669	41	Internal Medicine	0	In state provider	None	9900 TALBERT AVENUE	#203	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
254675	Fee-for-Service	1326302191	1326302191	1	1	PATEL, NIRAJ S MD	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123498	10	Gastroenterology (M.D. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
254678	Fee-for-Service	1548343510	1548343510	1	11	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
254681	Fee-for-Service	1427147073	1427147073	2	1	PALU, INC.	10/1/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HARMACY	850 ATLANTIC	SUITE 100	MONTEREY PARK	CA	91754	4730	19	06037	34.05097684	-118.1379979	Los Angeles County
254706	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	9/20/2018	193400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
254728	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	6/21/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
254737	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
254787	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	11/28/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
254788	Fee-for-Service	1720140270	1720140270	1	1	POSADAS, EDWIN M MD	4/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54501	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
254808	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
254852	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	11/30/2018	111N00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
254873	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
254886	Fee-for-Service	1700318292	1700318292	1	1	PATHAK, SAGAR J MD	8/1/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	170359	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
254915	Fee-for-Service	1093179517	1093179517	1	1	PARK, JINA MD	12/4/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	152646	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
254922	Fee-for-Service	1215909668	1215909668	1	1	PRESSER, DAVID Z MD	4/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75037	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
254924	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
254928	Fee-for-Service	1740346774	1740346774	1	1	PALUN, NICHOLAS A LCSW	4/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
254958	Fee-for-Service	1508812389	1508812389	1	1	PHILP, KAREN K CRNA	10/3/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
254993	Fee-for-Service	1295930451	1295930451	1	1	PARTNERS N CARE, LLC	10/24/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5873 BUD COURT	None	RIVERSIDE	CA	92506	4517	33	06065	33.94544438	-117.3687149	Riverside County
254994	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	4/22/2020	193400000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
255004	Fee-for-Service	1427180496	1427180496	1	1	PRADHAN, AMARISH D MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84245	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7601 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
255016	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	11/27/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
255019	Fee-for-Service	1083609853	1083609853	1	1	PRIORITY ONE HOME HEALTH	5/12/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	4959 PALO VERDE ST	SUITE 108C	MONTCLAIR	CA	91763	2331	36	06071	34.08129954	-117.6966135	San Bernardino County
255024	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	1/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
255050	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	9/23/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
255056	Fee-for-Service	1801351085	1801351085	1	2	PEACE FROM WITHIN THERAPY IN	5/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C	7901 MELROSE AVE	204	LOS ANGELES	CA	90046	7173	19	06037	34.08383059	-118.361684	Los Angeles County
255059	Fee-for-Service	1740752997	1740752997	1	1	PINE STREET HEALTHCARE	12/19/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PARTNERS LLC	15315 MAGNOLIA BLVD	STE 401	SHERMAN OAKS	CA	91403	1175	19	06037	34.16488161	-118.4666419	Los Angeles County
255065	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
255075	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
255083	Fee-for-Service	1023070430	1023070430	1	1	POON, TAK C MD INC	4/27/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37035	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 SNEATH LN	STE 215	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
255098	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	11/21/2016	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
255111	Fee-for-Service	1578597241	1578597241	1	1	PHAM, AN THI MD	4/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	37379	01	General Practice	0	In state provider	None	1693 FLANIGAN DR	STE 101	SAN JOSE	CA	95121	1683	43	06085	37.31874246	-121.8234636	Santa Clara County
255140	Fee-for-Service	1225343668	1225343668	1	1	PRECIADO, LUZ	1/20/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
255141	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
255152	Fee-for-Service	1194974220	1194974220	1	1	POTTER, ELIZABETH M CNM	2/2/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
255155	Fee-for-Service	1477654440	1477654440	1	1	PEREZ, ANGEL G MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79348	08	Family Practice	0	In state provider	SHALOM MEDICAL CLINIC	1721 N WILMINGTON BLVD	None	WILMINGTON	CA	90744	1261	19	06037	33.79755756	-118.2753059	Los Angeles County
255164	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
255173	Fee-for-Service	1831407923	1831407923	1	1	PILKINGTON, CARRINE S LMFT	2/22/2022	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
255192	Fee-for-Service	1457516510	1457516510	1	2	PATTERSON, JOANNE L CNP	7/24/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5150 HILL ROAD EAST	SUITE F	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
255212	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	9/20/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
255222	Fee-for-Service	1144277633	1144277633	1	12	PATHOLOGY ASSOCIATES	9/6/2024	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	869 CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
255232	Fee-for-Service	1437597788	1437597788	1	1	PELUSO, MICHAEL J MD	5/15/2019	207R00000X	NA	Other	026	PHYSICIANS	149683	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
255269	Fee-for-Service	1508850132	1508850132	1	1	POLTE, LOREN A OD	2/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2920 COLD SPRINGS RD	None	PLACERVILLE	CA	95667	4220	09	06017	38.73421419	-120.8252301	El Dorado County
255279	Fee-for-Service	1639336050	1639336050	1	1	PRIBYL, SHEA M DO	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14720	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
255280	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	12/30/2018	193400000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
255288	Fee-for-Service	1427180496	1427180496	1	1	PRADHAN, AMARISH D MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84245	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7601 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
255305	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/25/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
255314	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
255326	Fee-for-Service	1043274319	1043274319	1	1	PARDO, MANUEL MD	9/1/1994	207L00000X	NA	Other	026	PHYSICIANS	75091	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
255330	Fee-for-Service	1104993468	1104993468	1	1	PUVVADA, RAO V MD	8/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51901	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
255331	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	9/12/2018	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
255333	Fee-for-Service	1588627855	1588627855	1	1	PRIDE, MATTHEW B MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78085	08	Family Practice	0	In state provider	None	3317 CHANATE RD	STE 2C	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
255336	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	6/29/2019	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
255354	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	1/23/2017	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
255364	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
255365	Fee-for-Service	1326087727	1326087727	1	1	POURADIB, AMIR A MD	5/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80929	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
255384	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
255386	Fee-for-Service	1457418105	1457418105	1	1	PRINCE, JOHN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	21178	34	Urology and Urological Surgery	0	In state provider	None	1125 E 17TH ST	STE E222	SANTA ANA	CA	92701	2219	30	06059	33.76004145	-117.854838	Orange County
255402	Fee-for-Service	1114060522	1114060522	1	1	PUBLIC HEALTH LAB, SAN	6/25/1987	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	JOAQUIN CO PUB HLTH SVS	1601 E HAZELTON AVE	None	STOCKTON	CA	95205	6229	39	06077	37.9501034	-121.2684501	San Joaquin County
255407	Fee-for-Service	1932554045	1932554045	1	1	PATEL, GOPAL MD	7/20/2023	207ZP0102X	NA	Other	026	PHYSICIANS	167152	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
255428	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	11/24/2019	111N00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
255443	Fee-for-Service	1477654440	1477654440	1	1	PEREZ, ANGEL G MD	11/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79348	01	General Practice	0	In state provider	SHALOM MEDICAL CLINIC	1721 N WILMINGTON BLVD	None	WILMINGTON	CA	90744	1261	19	06037	33.79755756	-118.2753059	Los Angeles County
255452	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	11/7/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
255465	Fee-for-Service	1124550769	1124550769	1	1	PATEL, HENAL H MD	8/9/2022	111NR0200X	NA	Other	026	PHYSICIANS	172599	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
255493	Fee-for-Service	1306208418	1306208418	1	1	PRATYUS YADAVALLI	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
255503	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
255509	Fee-for-Service	1144277633	1144277633	1	12	PATHOLOGY ASSOCIATES	9/6/2024	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	869 CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
255513	Fee-for-Service	1346292778	1346292778	1	1	PATEL, NIRAJ J MD	12/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117084	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
255519	Fee-for-Service	1790443984	1790443984	1	1	POWELL, ADAM CRNA	6/19/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
255522	Fee-for-Service	1477843449	1477843449	1	1	PAN, LU MD	8/26/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
255569	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	12/20/2018	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
255578	Fee-for-Service	1427180496	1427180496	1	1	PRADHAN, AMARISH D MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84245	41	Internal Medicine	0	In state provider	None	7601 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
255593	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	6/21/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
255598	Fee-for-Service	1437136660	1437136660	1	1	PRATT, DONALD J MD	7/1/1984	207R00000X	NA	Other	026	PHYSICIANS	48502	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
255603	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
255620	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	6/5/2018	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
255623	Fee-for-Service	1588627855	1588627855	1	1	PRIDE, MATTHEW B MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78085	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3317 CHANATE RD	STE 2C	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
255625	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
255643	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
255651	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
255671	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
255683	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
255707	Fee-for-Service	1861021990	1861021990	1	1	PAYNE, ALEXANDER MD	11/4/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
255721	Fee-for-Service	1235226531	1235226531	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	111N00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	391 TAYLOR BLVD	None	PLEASANT HILL	CA	94523	2288	07	06013	37.96119614	-122.070409	Contra Costa County
255722	Fee-for-Service	1750605721	1750605721	1	1	PATEL, NARESH R	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111561	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
255726	Fee-for-Service	1588127153	1588127153	1	1	PATHAK, CHETNA M MD	1/13/2023	208M00000X	NA	Other	026	PHYSICIANS	179919	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
255737	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	10/29/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
255756	Fee-for-Service	1811550429	1811550429	1	1	PARKER, MARY E LMFT	4/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19 WILLIAMSBURG LN	None	CHICO	CA	95926	2225	04	06007	39.7525191	-121.8551479	Butte County
255788	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	11/30/2018	171100000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
255857	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	10/8/2018	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
255878	Fee-for-Service	1790238681	1790238681	1	1	PV DRUG STORE	12/26/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2325 PALOS VERDES DR W	STE 220	PALOS VERDES EST	CA	90274	2777	19	06037	33.77489474	-118.4172958	Los Angeles County
255882	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/18/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
255890	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
255898	Fee-for-Service	1306924022	1306924022	1	1	PHILLIPS, KENNETH O MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75725	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
255899	Fee-for-Service	1427342377	1427342377	1	1	PURDIE, DENISE R MD	6/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122742	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
255905	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
255914	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	10/18/2019	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
255926	Fee-for-Service	1679071088	1679071088	1	1	PARTNERS FOR CARE, INC	8/10/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5601 W SLAUSON	SUITE 276	CULVER CITY	CA	90230	6593	19	06037	33.98900447	-118.37979	Los Angeles County
255931	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	2/24/2020	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
255943	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
255949	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
255957	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	6/18/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
255959	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
255972	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
255979	Fee-for-Service	1861584229	1861584229	1	1	PARRISH, CRISSY	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
255994	Fee-for-Service	1720406762	1720406762	1	1	PARADISE CONGREGATE LIVING	4/13/2016	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14822 COHASSET ST	None	VAN NUYS	CA	91405	1803	19	06037	34.20661447	-118.456137	Los Angeles County
256009	Fee-for-Service	1194389007	1194389007	1	1	PRIME CARE HOSPICE, INC	9/18/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1540 W GLENOAKS BLVD	#203	GLENDALE	CA	91201	3162	19	06037	34.16921112	-118.2872586	Los Angeles County
256027	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	10/8/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
256033	Fee-for-Service	1952366700	1952366700	1	1	PHILIP D SEIDENBERG, M.D.	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
256050	Fee-for-Service	1457321317	1457321317	1	1	PALOMAR HEALTH	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
256079	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	2/11/2013	171100000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
256080	Fee-for-Service	1821586710	1821586710	1	1	PHAM, VICKY M MD	10/7/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
256081	Fee-for-Service	1265584825	1265584825	1	1	PAIK, WILLIAM N MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	74379	30	Radiology	0	In state provider	None	215 W JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
256089	Fee-for-Service	1215434543	1215434543	1	1	PORTOBANCO, JHEANETT PSYD	5/13/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
256092	Fee-for-Service	1407906910	1407906910	1	1	PELFINI, ANDREW LMFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31249	-	NOT APPLICABLE	0	In state provider	None	2166 HAYES STREET	SUITE 302	SAN FRANCISCO	CA	94117	1033	38	06075	37.77322359	-122.4519089	San Francisco County
256129	Fee-for-Service	1649539206	1649539206	1	1	PROHEALTH PARTNERS, MEDICAL	10/18/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
256132	Fee-for-Service	1861570806	1861570806	1	1	PEARSALL, ELDRIDGE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35490	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2790 S ELM STREET	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
256141	Fee-for-Service	1184660615	1184660615	1	1	POULSON,BO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
256145	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	9/12/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
256168	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
256178	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
256184	Fee-for-Service	1831448943	1831448943	1	1	PREMIER EMERGENCY PHYSICIANS	9/10/2012	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OF CA MEDICAL GROUP	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
256194	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	11/24/2019	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
256199	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	9/16/2019	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
256207	Fee-for-Service	1215044755	1215044755	1	1	POPKY, LEONARD M MD	7/30/1991	207P00000X	NA	Other	026	PHYSICIANS	65991	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
256218	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
256231	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
256236	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	4/24/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
256238	Fee-for-Service	1386659795	1386659795	1	1	PAUL J. CONOMOS MD	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	2369	00	None	33.486606	-112.071654	Maricopa County
256239	Fee-for-Service	1881681815	1881681815	1	1	PORTIS,ANDREW J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	360 SHERMAN STREET	STE # 400	ST PAUL	MN	55102	2564	00	None	44.94200174	-93.10681299	Ramsey County
256240	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
256247	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
256258	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
256273	Fee-for-Service	1043707128	1043707128	1	1	PATEL, DHARA DO	11/1/2021	207R00000X	NA	Other	026	PHYSICIANS	17868	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
256283	Fee-for-Service	1851300594	1851300594	1	1	PARKER, SUSAN C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
256298	Fee-for-Service	1194389007	1194389007	1	1	PRIME CARE HOSPICE, INC	9/18/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1540 W GLENOAKS BLVD	#203	GLENDALE	CA	91201	3162	19	06037	34.16921112	-118.2872586	Los Angeles County
256314	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	12/16/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
256316	Fee-for-Service	1407896699	1407896699	1	1	PATRICK J LAWLER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1100 E 26TH ST	None	SIOUX FALLS	SD	57105	0000	00	None	43.529724	-96.7122495	Minnehaha County
256320	Fee-for-Service	1265130025	1265130025	1	1	PREMIUM URGENT CARE INC	5/26/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1477 EAST SHAW AVENUE	STE 150	FRESNO	CA	93710	8022	10	06019	36.80832659	-119.7614085	Fresno County
256338	Fee-for-Service	1457321317	1457321317	1	1	PALOMAR HEALTH	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
256366	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	7/22/2019	207Q00000X	NA	Adult Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
256402	Fee-for-Service	1760489439	1760489439	1	1	PORTIA BELL HUME BEHAVORIAL	11/30/1992	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HEALTH AND TRAINING	1333 WILLOW PASS RD	STE 102	CONCORD	CA	94520	5225	07	06013	37.96924618	-122.051411	Contra Costa County
256414	Fee-for-Service	1598178873	1598178873	1	1	PHUNG, MICHAEL C MD	5/6/2019	208600000X	NA	General Surgery	026	PHYSICIANS	160823	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
256417	Fee-for-Service	1548725187	1548725187	1	1	PANES, ACE J CRNA	5/14/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
256421	Fee-for-Service	1861570806	1861570806	1	1	PEARSALL, ELDRIDGE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35490	01	General Practice	0	In state provider	None	2790 S ELM STREET	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
256433	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	7/20/2019	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
256457	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	7/5/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
256465	Fee-for-Service	1396057832	1396057832	1	1	PARSON, ALGENON M	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153603	05	Anesthesiology	0	In state provider	None	75 NEILSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.92823955	-121.792905	Santa Cruz County
256466	Fee-for-Service	1164495032	1164495032	1	1	PATEL, LISA B MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2551 W 84 TH AVE	None	WESTMINSTER	CO	80031	0000	00	None	39.84905501	-105.0182452	Adams County
256468	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
256478	Fee-for-Service	1982761201	1982761201	1	1	PRIMO MEDICAL SUPPLIES	5/27/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PRIMO MEDICAL SUPPLIES	17337 VENTURA BLVD	SUITE 220	ENCINO	CA	91316	4920	19	06037	34.16102943	-118.5108514	Los Angeles County
256485	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	2/11/2013	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
256490	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	3/25/2020	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
256496	Fee-for-Service	1467642421	1467642421	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	PEDIATRIC HEMATOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
256501	Fee-for-Service	1063416915	1063416915	1	1	PATRICK, TAMMY G	5/31/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PACIFIC PHYSICAL THERAPY	121 BOATYARD DR	STE A	FORT BRAGG	CA	95437	5751	23	06045	39.42167151	-123.8057535	Mendocino County
256505	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
256517	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
256527	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
256533	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	6/18/2019	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
256536	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
256546	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
256571	Fee-for-Service	1396162525	1396162525	1	1	PATEL, HARDIK MD	8/26/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	144831	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
256595	Fee-for-Service	1053810614	1053810614	1	1	PADILLA, JESSICA H	3/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	SUITE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
256601	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
256606	Fee-for-Service	1265130025	1265130025	1	1	PREMIUM URGENT CARE INC	5/26/2023	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1477 EAST SHAW AVENUE	STE 150	FRESNO	CA	93710	8022	10	06019	36.80832659	-119.7614085	Fresno County
256624	Fee-for-Service	1457321317	1457321317	1	1	PALOMAR HEALTH	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
256646	Fee-for-Service	1306895412	1306895412	1	1	PASCUAL, EDMUND MD	1/31/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42651	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
256656	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	3/23/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
256682	Fee-for-Service	1477509289	1477509289	1	1	PEREZ, RAUL A MD	1/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43082	08	Family Practice	0	In state provider	None	202 W WILLOW AVE	None	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
256706	Fee-for-Service	1528527181	1528527181	1	1	PARAGON CHICO MEDICAL GROUP,	1/8/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	INC	1700 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74457424	-121.8502997	Butte County
256715	Fee-for-Service	1154959740	1154959740	1	1	PREMIUM PALLIATIVE SERVICES	7/13/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	14525 VANOWEN ST	SUITE 6	VAN NUYS	CA	91405	3941	19	06037	34.19395146	-118.449756	Los Angeles County
256720	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
256743	Fee-for-Service	1548343510	1548343510	1	70	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
256752	Fee-for-Service	1548343510	1548343510	1	12	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
256770	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	6/23/2016	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
256776	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	3/31/2020	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
256782	Fee-for-Service	1467642421	1467642421	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDIATRIC HEMATOLOGY	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
256792	Fee-for-Service	1588128516	1588128516	1	1	PENAFLOR, ERIC RCP	7/19/2021	2279G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
256793	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	9/20/2018	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
256804	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
256811	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	3/31/2020	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
256821	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
256824	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	9/11/2012	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
256828	Fee-for-Service	1114239035	1114239035	1	1	PEBDANI, PARMIS DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12149	04	Otology, Laryngology, Rhinology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
256835	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
256842	Fee-for-Service	1962422709	1962422709	1	3	PACIFIC EYE INSTITUTE	3/5/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MED GROUP INC	14075 HESPERIA RD	None	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
256853	Fee-for-Service	1811198914	1811198914	1	1	PATEL, PREETI R MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105138	40	Pediatrics	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
256859	Fee-for-Service	1366808370	1366808370	1	1	PETERSON, AARON OD	5/3/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2867 AGOURA RD	None	WESTLAKE VILLAGE	CA	91361	3218	56	06111	34.1501976	-118.8244431	Ventura County
256889	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	9/20/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
256916	Fee-for-Service	1447630462	1447630462	1	1	PEACE, DEVAUGHN MD	11/1/2018	207P00000X	NA	Other	026	PHYSICIANS	158014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
256918	Fee-for-Service	1184677163	1184677163	1	1	PLANNED PARENTHOOD MAR MONTE	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	5700 WATT AVE	None	NORTH HIGHLANDS	CA	95660	4752	34	06067	38.670723	-121.3823745	Sacramento County
256929	Fee-for-Service	1568655272	1568655272	1	1	PARKS, KAREN E	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
256933	Fee-for-Service	1669508990	1669508990	2	1	P L GARDNER MD S D COHEN MD	10/19/2012	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	AND D P BUI MD	2241 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4430	01	06001	37.76537189	-122.2454213	Alameda County
256942	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	11/7/2018	171100000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
256958	Fee-for-Service	1023205747	1023205747	1	1	PALOMINO, ADRIAN P MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110667	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
256960	Fee-for-Service	1841704210	1841704210	1	1	PISTIS HOME HEALTH	8/1/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 204F	GLENDALE	CA	91205	3385	19	06037	34.13065269	-118.2524619	Los Angeles County
256997	Fee-for-Service	1104606722	1104606722	1	1	PRESENQUI, AXEL PT	5/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3167 RANCHO VISTA BLVD	SUITE D	PALMDALE	CA	93551	5517	19	06037	34.60343243	-118.1875714	Los Angeles County
257003	Fee-for-Service	1154959740	1154959740	1	1	PREMIUM PALLIATIVE SERVICES	7/13/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	14525 VANOWEN ST	SUITE 6	VAN NUYS	CA	91405	3941	19	06037	34.19395146	-118.449756	Los Angeles County
257011	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	11/7/2018	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
257014	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
257047	Fee-for-Service	1063826741	1063826741	1	1	PHAM, KATHRYN OD	10/28/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	130 S MAIN ST	STE F	ORANGE	CA	92868	2869	30	06059	33.787512	-117.8673275	Orange County
257058	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	12/8/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
257059	Fee-for-Service	1750424016	1750424016	1	1	PREHODA, KAMI J LMFT	4/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
257066	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	10/15/2020	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
257068	Fee-for-Service	1558757245	1558757245	1	1	PICKRELL, BRENT B MD	9/2/2022	2086S0105X	NA	General Surgery	026	PHYSICIANS	176983	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
257084	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
257095	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
257101	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	3/25/2020	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
257106	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	6/18/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
257113	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
257124	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
257132	Fee-for-Service	1962422709	1962422709	1	3	PACIFIC EYE INSTITUTE	7/25/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GROUP INC	14075 HESPERIA RD	None	VICTORVILLE	CA	92395	4500	36	06071	34.50679185	-117.296399	San Bernardino County
257162	Fee-for-Service	1861595845	1861595845	1	1	PONTON, MARCEL PHD	10/1/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
257172	Fee-for-Service	1154792570	1154792570	1	1	PRXP OF CA LLC	3/6/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4345 E LOWELL ST	SUITE C & D	ONTARIO	CA	91761	2222	36	06071	34.052238	-117.556533	San Bernardino County
257177	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	2/24/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
257227	Fee-for-Service	1508942996	1508942996	1	1	PHYSICIANS SURGERY SVS	7/25/2005	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ADVANCED SURGERY CENTER	235 OCONNOR DR	None	SAN JOSE	CA	95128	1624	43	06085	37.324998	-121.9398865	Santa Clara County
257230	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
257259	Fee-for-Service	1922242569	1922242569	1	1	PEZESHKIAN, STEPHANIE L DO	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	11487	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
257297	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	6/15/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
257298	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	10/3/2012	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
257301	Fee-for-Service	1407868565	1407868565	1	1	PANG, FRANCES J MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61279	40	Pediatrics	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
257303	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YP2500X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
257304	Fee-for-Service	1578590378	1578590378	1	1	PRESCOP, STEVEN A	4/30/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51747	08	Family Practice	0	In state provider	None	280 HOPE ST	None	MOUNTAIN VIEW	CA	94041	1308	43	06085	37.39234309	-122.0785697	Santa Clara County
257308	Fee-for-Service	1083165542	1083165542	1	1	PEREZ, JOSEPHINE M LMFT	2/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1881 COMMERCENTER DRIVE	SUITE 232	SAN BERNARDINO	CA	92408	3479	36	06071	34.06789529	-117.2822533	San Bernardino County
257328	Fee-for-Service	1619692480	1619692480	1	1	PANTHERS LIMITED LIABILITY C	4/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3538 MANTHEY RD STE D	None	STOCKTON	CA	95206	5304	39	06077	37.9101965	-121.2924357	San Joaquin County
257336	Fee-for-Service	1417050063	1417050063	1	1	PAZ, ISAAC BENJAMIN	6/4/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48296	02	General Surgery	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
257347	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	9/25/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
257352	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	10/11/2019	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
257370	Fee-for-Service	1679192272	1679192272	1	1	PATHAK, SUJAY R MD	9/20/2023	390200000X	NA	Other	026	PHYSICIANS	21217	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
257371	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	4/22/2020	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
257376	Fee-for-Service	1689904237	1689904237	1	1	PAWOO, NOGBA DO	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14132	22	Pathology (M.D. only)	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92392	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
257377	Fee-for-Service	1326395021	1326395021	1	1	PLATINUM WOMENS HEALTH AND	2/26/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	WELLNESS INC AMC	25495 MEDICAL CENTER DR	STE 300	MURRIETA	CA	92562	4902	33	06065	33.55804188	-117.1834064	Riverside County
257381	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
257390	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
257395	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
257401	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	2/11/2013	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
257411	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
257417	Fee-for-Service	1174064083	1174064083	1	1	POMERANZ, MARCELLA A	7/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2031 MCDANIEL ST	STE 210	N LAS VEGAS	NV	89030	0102	00	None	36.19740597	-115.1207123	Clark County
257430	Fee-for-Service	1134225519	1134225519	1	1	PACIFIC CLINICS	8/29/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	66 HURLBUT STREET	None	PASADENA	CA	91105	4025	19	06037	34.12993251	-118.1516625	Los Angeles County
257432	Fee-for-Service	1891117800	1891117800	1	1	PATOLO, SELENA TINA	1/30/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1804 EVERGREEN AVENUE	None	WEST SACRAMENTO	CA	95691	3108	57	06113	38.57687028	-121.5325785	Yolo County
257465	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	12/20/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
257492	Fee-for-Service	1720130784	1720130784	1	1	PEART, HAROLD T	8/31/1986	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40523	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6221 WILSHIRE BLVD	215	LOS ANGELES	CA	90048	5226	19	06037	34.06329534	-118.3640031	Los Angeles County
257518	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	4/17/2017	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
257533	Fee-for-Service	1861430977	1861430977	1	1	PATLAN, ORALIA B PSYD	6/29/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3815 ATLANTIC AVENUE	STE 2	LONG BEACH	CA	90807	3500	19	06037	33.827346	-118.1851085	Los Angeles County
257545	Fee-for-Service	1477694859	1477694859	1	1	PRECIADO, MARTH R MD INC	11/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51820	06	Cardiovascular Disease (M.D. only)	0	In state provider	PRECIADO CARDIOLOGY AMC	1701 CESAR CHAVEZ AVE	STE 355	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
257551	Fee-for-Service	1558703827	1558703827	1	1	PROVIDENT PLACE	12/20/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	20400 ITUMA ROAD	None	APPLE VALLEY	CA	92308	4445	36	06071	34.49076452	-117.218655	San Bernardino County
257573	Fee-for-Service	1487732269	1487732269	1	1	PATEL, RITU J MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74741	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
257584	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TB0200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
257586	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	2/24/2020	193400000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
257592	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
257602	Fee-for-Service	1255454633	1255454633	1	1	POSITIVE DIRECTIONS, INC	9/14/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1031 KALA LOOP	None	MC FARLAND	CA	93250	1062	15	06029	35.68807523	-119.2328752	Kern County
257634	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	11/30/2018	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
257641	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	12/7/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
257650	Fee-for-Service	1740553775	1740553775	1	3	PARKS, DAVID J MD INC	11/4/2013	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78517	18	Ophthalmology	0	In state provider	None	1409 NORTH NORMA STREET	None	RIDGECREST	CA	93555	2510	15	06029	35.64666576	-117.6787892	Kern County
257657	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
257665	Fee-for-Service	1922495076	1922495076	1	1	PROHEALTH PARTNERS A MEDICAL	6/9/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	7643 S ATLANTIC AVE	None	CUDAHY	CA	90201	5019	19	06037	33.96585232	-118.18712	Los Angeles County
257667	Fee-for-Service	1710943816	1710943816	1	1	PAUL, MATTHEW K MD INC	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94289	20	Orthopedic Surgery	0	In state provider	None	2662 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57071892	-122.3974077	Shasta County
257670	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
257679	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	11/8/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
257682	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/24/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
257689	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	6/12/2017	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
257693	Fee-for-Service	1720077423	1720077423	1	1	PATTANACHINDA, JUTHART	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	34191	40	Pediatrics	0	In state provider	None	2950 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
257701	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
257719	Fee-for-Service	1891117800	1891117800	1	1	PATOLO, SELENA TINA	1/30/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1804 EVERGREEN AVENUE	None	WEST SACRAMENTO	CA	95691	3108	57	06113	38.57687028	-121.5325785	Yolo County
257753	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
257755	Fee-for-Service	1861563413	1861563413	1	1	POOMMIPANIT-BAJON, LIDA B MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70122	01	General Practice	0	In state provider	None	2055 N PERRIS BLVD	STE E11	PERRIS	CA	92571	2518	33	06065	33.80930628	-117.2260719	Riverside County
257775	Fee-for-Service	1104452226	1104452226	1	1	PIRES-MENARD, ALEXANDRA P MD	9/27/2023	207R00000X	NA	Other	026	PHYSICIANS	183765	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
257786	Fee-for-Service	1932527686	1932527686	1	1	PHILLIPS, DARCI J MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137652	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
257792	Fee-for-Service	1386707388	1386707388	1	1	PRENDERGAST, STEPHANIE A PT	3/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	340 DARDANELLI LANE	23	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
257805	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	12/20/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
257831	Fee-for-Service	1477694859	1477694859	1	1	PRECIADO, MARTH R MD INC	11/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51820	41	Internal Medicine	0	In state provider	PRECIADO CARDIOLOGY AMC	1701 CESAR CHAVEZ AVE	STE 355	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
257840	Fee-for-Service	1366902769	1366902769	1	1	PATEL, ANITA DO	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	23854	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
257871	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	2/2/2017	103TB0200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
257874	Fee-for-Service	1548343510	1548343510	1	53	PERMANENTE MEDICAL GROUP INC	10/29/2018	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
257878	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
257916	Fee-for-Service	1457469074	1457469074	1	1	PHUPHANICH, SURASAK MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	36229	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
257917	Fee-for-Service	1114401106	1114401106	1	1	PREMIER WOMENS HEALTH	11/9/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152227	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ASSOCIATES	7230 MEDICAL CENTER DR	STE 204	WEST HILLS	CA	91307	4005	19	06037	34.20172814	-118.6294322	Los Angeles County
257922	Fee-for-Service	1053320234	1053320234	1	1	POIRIER, TOMMY J MD	7/1/1974	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	21635	10	Gastroenterology (M.D. only)	0	In state provider	None	3965 J ST	# 200	SACRAMENTO	CA	95819	3624	34	06067	38.56967099	-121.4533629	Sacramento County
257925	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	12/27/2016	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
257928	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	5/18/2020	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
257936	Fee-for-Service	1457029779	1457029779	1	1	POSADA SL LLC	12/23/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8120 PAINTER AVE	None	WHITTIER	CA	90602	3101	19	06037	33.966189	-118.032681	Los Angeles County
257943	Fee-for-Service	1760774491	1760774491	1	1	PATEL, ROSHAN M MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140023	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
257946	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
257952	Fee-for-Service	1922495076	1922495076	1	1	PROHEALTH PARTNERS A MEDICAL	6/9/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	7643 S ATLANTIC AVE	None	CUDAHY	CA	90201	5019	19	06037	33.96585232	-118.18712	Los Angeles County
257957	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	11/28/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
257965	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
257974	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/19/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
257977	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
257989	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
258024	Fee-for-Service	1477510410	1477510410	2	1	PATTERSON, ELIZABETH MD	1/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42349	40	Pediatrics	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
258035	Fee-for-Service	1386021301	1386021301	1	1	PETERSON, ALEXANDRA LCSW	4/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
258043	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
258081	Fee-for-Service	1396741518	1396741518	1	1	PARK, SUNG J MD	9/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	62508	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
258094	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	2/11/2013	171100000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
258137	Fee-for-Service	1427173723	1427173723	1	1	POWERS, ERIN	7/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
258159	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	2/26/2013	103TB0200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
258167	Fee-for-Service	1558423418	1558423418	1	1	PACIFICA ORTHOPEDICS MEDICAL	10/27/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	CORPORATION	18800 DELAWARE ST	STE 1100	HUNTINGTON BEACH	CA	92648	6021	30	06059	33.68911733	-117.9931535	Orange County
258169	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	7/20/2019	101YP2500X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
258180	Fee-for-Service	1306992896	1306992896	1	1	PAUL, GREGG M MD	10/31/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40539	-	NOT APPLICABLE	0	In state provider	None	8491 NORTH LAKE BLVD	None	KINGS BEACH	CA	96143	2099	31	06061	39.23638368	-120.0236105	Placer County
258183	Fee-for-Service	1013052935	1013052935	1	1	PON, CLINTON D OD	7/18/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7119 ELK GROVE BLVD	STE 213	ELK GROVE	CA	95758	9568	34	06067	38.409957	-121.4192385	Sacramento County
258205	Fee-for-Service	1457469074	1457469074	1	1	PHUPHANICH, SURASAK MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	36229	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
258212	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	6/25/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
258218	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	3/25/2020	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
258229	Fee-for-Service	1841345162	1841345162	1	1	PRAKASH, ANAND MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26623	13	Neurology (M.D. only)	0	In state provider	None	3975 JACKSON ST	STE 105	RIVERSIDE	CA	92503	3945	33	06065	33.92729721	-117.4413503	Riverside County
258235	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	7/20/2019	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
258238	Fee-for-Service	1922495076	1922495076	1	1	PROHEALTH PARTNERS A MEDICAL	6/9/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	GROUP INC	7643 S ATLANTIC AVE	None	CUDAHY	CA	90201	5019	19	06037	33.96585232	-118.18712	Los Angeles County
258245	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
258247	Fee-for-Service	1295051928	1295051928	1	1	PARIKH, RUSHI V MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118727	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258256	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
258260	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	3/31/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
258266	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	6/12/2017	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
258276	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
258285	Fee-for-Service	1396894762	1396894762	1	1	PETERSEN, JONI LYNN	8/24/2005	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8038 LAUREL PARK CIR	None	RIVERSIDE	CA	92509	4096	33	06065	33.99958197	-117.4589518	Riverside County
258288	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	5/3/2019	103TC0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
258299	Fee-for-Service	1770537185	1770537185	1	2	PASCUAL, LISA U MD	8/1/2006	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	STE 3A36	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
258310	Fee-for-Service	1477510410	1477510410	2	1	PATTERSON, ELIZABETH MD	1/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42349	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
258311	Fee-for-Service	1609405281	1609405281	1	1	PALAKURTY, SRI HARSHA	2/6/2024	1835E0208X	NA	None	026	PHYSICIANS	185746	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
258330	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	9/20/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
258347	Fee-for-Service	1932357936	1932357936	1	1	PARIKH, SARVESH J MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101270	41	Internal Medicine	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	2347	19	06037	33.94435533	-117.9931159	Los Angeles County
258372	Fee-for-Service	1245550458	1245550458	1	1	PHILLIP PARMET	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7026 OLD KATY RD	STE 276	HOUSTON	TX	77024	2133	00	None	29.78388299	-95.44503208	Harris County
258378	Fee-for-Service	1710283858	1710283858	1	1	PATTERSON, ROBERT J CO	4/1/1995	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	535 E ROMIE LN	SUITE 3	SALINAS	CA	93901	4026	27	06053	36.65969283	-121.6449044	Monterey County
258381	Fee-for-Service	1114123775	1114123775	1	1	PONSTEIN, NATHANIEL A MD	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108136	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
258383	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	2/24/2020	207Q00000X	NA	Adult Primary Care	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
258387	Fee-for-Service	1124082748	1124082748	1	1	POCKROS, PAUL J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39713	10	Gastroenterology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
258399	Fee-for-Service	1063496651	1063496651	1	42	PACIFIC CENTRAL COAST HEALTH	7/6/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	850 FAIR OAKS AVE	STE 220	ARROYO GRANDE	CA	93420	3929	40	06079	35.11274104	-120.588873	San Luis Obispo County
258405	Fee-for-Service	1376550731	1376550731	1	1	PEVOTO, PATRICK S MD	7/7/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166445	09	Gynecology (D.O. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
258410	Fee-for-Service	1023217759	1023217759	1	1	PARKS, BRANDON A LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51120	-	NOT APPLICABLE	0	In state provider	None	1303 W WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
258423	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
258451	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2016	103TB0200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
258457	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	11/27/2007	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
258460	Fee-for-Service	1780749390	1780749390	1	1	PAYNE JR, SLOANE WALLER PHD	8/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95414	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
258499	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
258505	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	7/12/2019	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
258523	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
258533	Fee-for-Service	1548343510	1548343510	1	61	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
258544	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
258547	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	6/18/2019	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
258551	Fee-for-Service	1225488364	1225488364	1	1	PRATHER, ARIC A PHD	9/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258554	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
258562	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
258568	Fee-for-Service	1073588521	1073588521	1	1	PITT, ALAN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
258577	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
258596	Fee-for-Service	1467419432	1467419432	1	1	PRADOS, MICHAEL	1/1/1995	2086S0105X	NA	General Surgery	026	PHYSICIANS	41871	14	Neurological Surgery	0	In state provider	UCSF MEDICAL CENTER	505 PARNASSUS AVE	# 787M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
258598	Fee-for-Service	1003983008	1003983008	1	1	PINDUR, JANA MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52226	22	Pathology (M.D. only)	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
258613	Fee-for-Service	1831191980	1831191980	1	1	PLANTE, DEBORAH K MD	9/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52025	67	Endocrinology	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
258618	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	1/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
258637	Fee-for-Service	1780080994	1780080994	1	1	PACIFIC VISION CARE, OPTOMET	11/23/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RIC SERVICES, INC.	5532 WOODRUFF AVE	None	LAKEWOOD	CA	90713	1535	19	06037	33.857928	-118.1170415	Los Angeles County
258669	Fee-for-Service	1548343510	1548343510	1	65	PERMANENTE MEDICAL GROUP INC	7/20/2019	207Q00000X	NA	Adult Primary Care	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
258693	Fee-for-Service	1376550731	1376550731	1	1	PEVOTO, PATRICK S MD	7/7/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166445	15	Obstetrics (D.O. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
258710	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	11/30/2018	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
258711	Fee-for-Service	1407496433	1407496433	1	1	PATONONA, RONAN B NP	8/9/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11735 FIRESTONE BLVD	None	NORWALK	CA	90650	2808	19	06037	33.91353706	-118.0831749	Los Angeles County
258734	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
258745	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YP2500X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
258767	Fee-for-Service	1366593725	1366593725	1	1	PROCARE PHYSICAL THERAPY, IN	7/28/2019	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C.	1780 ORANGE TREE LN	None	REDLANDS	CA	92374	2856	36	06071	34.06785047	-117.215478	San Bernardino County
258788	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
258791	Fee-for-Service	1013649623	1013649623	1	1	PRICE, ANDREW OD	12/12/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2755 CANYON SPRINGS PKWY	None	RIVERSIDE	CA	92507	0932	33	06065	33.938604	-117.282465	Riverside County
258793	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	3/31/2020	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
258803	Fee-for-Service	1144277633	1144277633	1	16	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
258810	Fee-for-Service	1649537150	1649537150	1	1	PROMISE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2140 W OLYMPIC BLVD	STE 326	LOS ANGELES	CA	90006	2279	19	06037	34.05206987	-118.2806804	Los Angeles County
258812	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	12/16/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
258814	Fee-for-Service	1215930250	1215930250	1	1	PAGE, KIMBERLY A MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64229	14	Neurological Surgery	0	In state provider	None	525 DOYLE PARK DRIVE	STE 102	SANTA ROSA	CA	95405	4562	49	06097	38.442636	-122.69889	Sonoma County
258829	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
258833	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
258841	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
258852	Fee-for-Service	1235226531	1235226531	1	7	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
258864	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	9/12/2018	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
258895	Fee-for-Service	1255336665	1255336665	1	1	PARK, CHAN H MD	5/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68509	08	Family Practice	0	In state provider	None	2101 7TH ST	None	WASCO	CA	93280	1502	15	06029	35.59426049	-119.3498955	Kern County
258901	Fee-for-Service	1831191980	1831191980	1	1	PLANTE, DEBORAH K MD	9/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52025	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
258905	Fee-for-Service	1548343510	1548343510	1	21	PERMANENTE MEDICAL GROUP INC	7/20/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2651 HIGHLAND	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
258959	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	4/22/2020	171100000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
258970	Fee-for-Service	1821256454	1821256454	1	1	PARK, JOONHEE MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140066	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
258975	Fee-for-Service	1235498437	1235498437	1	1	PREFERRED DIAGNOSTIC IMAGING	7/8/2016	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	LLC	10230 ARTESIA BLVD	STE 100	BELLFLOWER	CA	90706	6763	19	06037	33.8728276	-118.1160403	Los Angeles County
258992	Fee-for-Service	1235228453	1235228453	1	1	PICKERING, TERRI-DIANN E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60486	18	Ophthalmology	0	In state provider	None	55 STEVENSON ST	None	SAN FRANCISCO	CA	94105	2936	38	06075	37.78967198	-122.3997208	San Francisco County
258994	Fee-for-Service	1659896975	1659896975	1	1	PEREZ, KARIN LMFT	9/11/2023	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
258996	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	7/20/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
259001	Fee-for-Service	1922069087	1922069087	1	2	PACIFIC RIM PATHOLOGY MEDICA	5/10/2023	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9295 FARNHAM ST	SUITE 100	SAN DIEGO	CA	92123	1254	37	06073	32.83285255	-117.1299735	San Diego County
259006	Fee-for-Service	1487175238	1487175238	1	1	PATEL, AKASH DO	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	19002	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
259013	Fee-for-Service	1558520874	1558520874	1	1	PAL, JOSHUA S MD	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104765	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
259015	Fee-for-Service	1528125770	1528125770	1	1	PFIFFNER, LINDA J PHD	5/14/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259026	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	11/28/2016	103TB0200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
259031	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
259056	Fee-for-Service	1871549899	1871549899	1	20	PUEBLO RAD MED GRP INC	10/3/2012	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	315 CAMINO DEL REMEDIO	BLDG 3	SANTA BARBARA	CA	93110	1332	42	06083	34.444881	-119.7793725	Santa Barbara County
259068	Fee-for-Service	1093752446	1093752446	1	1	PRIME CHOICE HOME HEALTH INC	3/30/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	12611 HIDDENCREEK WAY	SUITE I	CERRITOS	CA	90703	2156	19	06037	33.88499597	-118.0628892	Los Angeles County
259073	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	5/3/2019	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
259080	Fee-for-Service	1073606299	1073606299	1	33	PERMANENTE MEDICAL GROUP INC	7/20/2019	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
259090	Fee-for-Service	1144277633	1144277633	1	16	PATHOLOGY ASSOCIATES	2/13/2017	207ZP0105X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
259095	Fee-for-Service	1649537150	1649537150	1	1	PROMISE HOSPICE INC	6/18/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2140 W OLYMPIC BLVD	STE 326	LOS ANGELES	CA	90006	2279	19	06037	34.05206987	-118.2806804	Los Angeles County
259099	Fee-for-Service	1548343510	1548343510	1	19	PERMANENTE MEDICAL GROUP INC	10/29/2018	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
259103	Fee-for-Service	1316323561	1316323561	1	1	PATCHEN, OONA D LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	534 B ST	None	SANTA ROSA	CA	95401	5211	49	06097	38.44296	-122.7177585	Sonoma County
259109	Fee-for-Service	1528398971	1528398971	1	1	PETTIES, CHAD LMFT	1/22/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
259112	Fee-for-Service	1609452069	1609452069	1	1	PADLIPSKY, JACQUELINE E MD	11/21/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
259119	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
259123	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/8/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
259125	Fee-for-Service	1881895316	1881895316	1	1	PARK, KENNETH K MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108380	None	None	0	In state provider	None	647 W AVE Q	None	PALMDALE	CA	93551	3893	19	06037	34.58715647	-118.1417372	Los Angeles County
259127	Fee-for-Service	1952729196	1952729196	1	1	PATEL, ARISHA MD	11/15/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	160792	None	None	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
259128	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
259133	Fee-for-Service	1104351261	1104351261	1	1	PFAFF, NORA MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146185	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
259152	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	9/12/2018	103TC0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
259157	Fee-for-Service	1235858960	1235858960	1	1	PODOS, MADDISON	1/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
259164	Fee-for-Service	1528039534	1528039534	1	1	PAKTER, ROBERT LOUIS MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	42885	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
259170	Fee-for-Service	1396373197	1396373197	1	1	POURNAMDARI, ASHLEY B MD	6/27/2024	208M00000X	NA	Other	026	PHYSICIANS	183456	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
259246	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	2/24/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
259255	Fee-for-Service	1861834897	1861834897	1	1	POTU, KALYAN C MD	6/26/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
259260	Fee-for-Service	1326338039	1326338039	1	1	PAGE, JONATHAN R LMFT	10/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	343 E MAIN ST	STE 701	STOCKTON	CA	95202	2977	39	06077	37.95334019	-121.2862084	San Joaquin County
259276	Fee-for-Service	1548340961	1548340961	1	1	PALAZZI,BEBRA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	0000	00	None	29.70724683	-95.4026169	Harris County
259278	Fee-for-Service	1144683913	1144683913	1	1	PARVINJAH, SHAUDEE MD	11/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153215	None	None	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
259284	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
259304	Fee-for-Service	1184720245	1184720245	1	1	PEVEC, ROSEANNE E MD	10/31/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	74507	04	Otology, Laryngology, Rhinology	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
259311	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	6/12/2017	103TB0200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
259320	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
259340	Fee-for-Service	1922058593	1922058593	1	1	PARSAPOUR, KOUROSH MD	2/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79856	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
259356	Fee-for-Service	1992266449	1992266449	1	1	PERPETUAL DAYS HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	STE 284	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
259364	Fee-for-Service	1235226531	1235226531	1	25	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
259390	Fee-for-Service	1467605709	1467605709	1	1	PALIWAL, YOGESH K MD INC	9/21/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35011	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 206	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
259398	Fee-for-Service	1982067062	1982067062	1	1	PATEL, SURENDRA MD INC	5/31/2016	261QP2300X	NA	Other	026	PHYSICIANS	50956	41	Internal Medicine	0	In state provider	None	5680 N FRESNO STREET	SUITE 101	FRESNO	CA	93710	8331	10	06019	36.820746	-119.7812905	Fresno County
259406	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	7/21/2017	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
259407	Fee-for-Service	1851681399	1851681399	1	1	PHILLIPS, JAMES E MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124786	05	Anesthesiology	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
259411	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	2/24/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
259412	Fee-for-Service	1114955705	1114955705	1	1	PULIYANDA, DECHU P MD	8/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72917	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
259415	Fee-for-Service	1538541339	1538541339	1	1	PACHON ROMERO, MARIA I MD	12/7/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169071	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
259417	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2015	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
259422	Fee-for-Service	1548767536	1548767536	1	1	PLACK, DANIEL MD	8/2/2024	207L00000X	NA	Other	026	PHYSICIANS	174784	05	Anesthesiology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
259433	Fee-for-Service	1881879864	1881879864	1	1	PHYSICAL THERAPY SOLUTIONS P	12/12/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	LLNESS CENTER	2595 W FLORIDA AVE	None	HEMET	CA	92545	4615	33	06065	33.7472787	-116.9990751	Riverside County
259441	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
259446	Fee-for-Service	1396800843	1396800843	1	1	PACE-ESTEP, DEANNA	8/19/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
259458	Fee-for-Service	1043417579	1043417579	1	1	PEIRCE, DAVID C PHD	3/22/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
259505	Fee-for-Service	1639241789	1639241789	1	1	PARISI, LEANNA M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	HSPLTY OPTRY CTR INC	164 W HOSPITALITY LN	STE 7	SAN BERNARDINO	CA	92408	3329	36	06071	34.06586648	-117.2866005	San Bernardino County
259510	Fee-for-Service	1114193992	1114193992	1	1	PARKER, DANIEL T MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109546	01	General Practice	0	In state provider	None	2805 J ST	STE 300	SACRAMENTO	CA	95816	4307	34	06067	38.573982	-121.468419	Sacramento County
259532	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	10/8/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
259550	Fee-for-Service	1275626897	1275626897	2	1	PHAM, RANDAL T MD	11/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71297	18	Ophthalmology	0	In state provider	None	455 O'CONNOR DR	STE 180	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
259569	Fee-for-Service	1265074447	1265074447	1	1	PROCARE TRANSPORTATION, INC	11/22/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	735 S GLENDALE AVE	A	GLENDALE	CA	91205	2317	19	06037	34.13735094	-118.2513947	Los Angeles County
259574	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	8/14/2017	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
259593	Fee-for-Service	1124446786	1124446786	1	1	PARIKH, PRANAY MD	5/15/2018	207R00000X	NA	Other	026	PHYSICIANS	145640	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
259595	Fee-for-Service	1477748598	1477748598	1	1	PERRY, MARIA JOSE	4/17/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
259600	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	11/7/2013	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
259607	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YP2500X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
259642	Fee-for-Service	1992266449	1992266449	1	1	PERPETUAL DAYS HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	STE 284	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
259645	Fee-for-Service	1255568366	1255568366	1	1	PAFFORD, BENNETT W MD	3/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114715	41	Internal Medicine	0	In state provider	None	670 COUNTY ROAD 83	None	CANBY	CA	96015	0322	25	06049	41.44344745	-120.8718025	Modoc County
259667	Fee-for-Service	1386999183	1386999183	1	1	PALOMARES, JULIA I LMFT	6/26/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	102499	-	NOT APPLICABLE	0	In state provider	None	2035 E BALL RD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
259674	Fee-for-Service	1083123483	1083123483	1	1	PANACEA HOSPICE INC	5/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2390 GARDENA AVE	None	SIGNAL HILL	CA	90755	1900	19	06037	33.80081687	-118.1686795	Los Angeles County
259691	Fee-for-Service	1720518798	1720518798	1	1	PROSTHETICS & ORTHOTICS	3/12/2018	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP ORANGE COUNTY LLC	26300 LA ALAMEDA	SUITE 120	MISSION VIEJO	CA	92691	6380	30	06059	33.56420663	-117.6703769	Orange County
259693	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	10/8/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
259696	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	3/31/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
259700	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
259703	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	3/16/2009	101YP2500X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
259728	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
259771	Fee-for-Service	1992894125	1992894125	1	1	PLANNED PARENTHOOD L A	12/1/1977	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	LAKEWOOD CENTER	5525 DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	19	06037	33.8471395	-118.1244195	Los Angeles County
259773	Fee-for-Service	1366620502	1366620502	1	1	PUN, PRITI DO	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10158	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
259821	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	9/20/2018	171100000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
259831	Fee-for-Service	1558380329	1558380329	1	1	PHAM, ROSALIE D MD	6/3/2021	207L00000X	NA	Other	026	PHYSICIANS	73515	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
259851	Fee-for-Service	1396062626	1396062626	1	1	PITSCH, ERICA A PT	12/17/2024	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
259861	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	10/8/2018	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
259878	Fee-for-Service	1750342499	1750342499	1	1	POPESCU, MARIA I MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75935	78	Neoplastic Diseases/Oncology	0	In state provider	PROFESSIONAL CORPORATION	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
259885	Fee-for-Service	1164777355	1164777355	1	1	PATEL, PURVI M MD	3/17/2017	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	132079	01	General Practice	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
259889	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	4/17/2017	103TB0200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
259892	Fee-for-Service	1306497995	1306497995	1	1	PATEL, SARITA A AU	7/5/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
259897	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	11/20/2013	101YP2500X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
259931	Fee-for-Service	1508837832	1508837832	1	1	PAN, GOLDEN MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51110	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
259938	Fee-for-Service	1962070987	1962070987	1	1	PHILIPPAS, ELENIE DO	10/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21468	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
259961	Fee-for-Service	1083123483	1083123483	1	1	PANACEA HOSPICE INC	5/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2390 GARDENA AVE	None	SIGNAL HILL	CA	90755	1900	19	06037	33.80081687	-118.1686795	Los Angeles County
259965	Fee-for-Service	1487603254	1487603254	1	2	PESTANA, DAMIAN R MD	9/30/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	27221	41	Internal Medicine	0	In state provider	None	153 PEARSON ROAD	None	PARADISE	CA	95969	5045	04	06007	39.75272738	-121.6254323	Butte County
259967	Fee-for-Service	1881056075	1881056075	1	1	PELEGRIN, GORDON MD	4/24/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	179605	None	None	0	In state provider	None	147 BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
259982	Fee-for-Service	1073606299	1073606299	1	11	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
259988	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	4/22/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
259991	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
259992	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
259998	Fee-for-Service	1366952020	1366952020	1	1	PAKAWONGSE, LILLY NP	5/8/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
260017	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
260029	Fee-for-Service	1124269543	1124269543	1	1	POWERS, MARTIN P MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111689	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
260042	Fee-for-Service	1609273234	1609273234	1	1	PROGRESS SPEECH & LANGUAGE	1/13/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	PATHOLOGY CENTER INC	304 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.809904	-117.908676	Orange County
260109	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	11/7/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
260111	Fee-for-Service	1053949438	1053949438	1	1	PIGNATO, MEGAN MD	11/27/2023	208M00000X	NA	Other	026	PHYSICIANS	191351	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
260117	Fee-for-Service	1386763506	1386763506	1	1	PASTORE, HUGO LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
260130	Fee-for-Service	1659391498	1659391498	1	1	PRIOR, MARILYN K PT	4/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24519 REDLANDS BLVD	SUITE B	LOMA LINDA	CA	92354	4016	36	06071	34.06303048	-117.269595	San Bernardino County
260149	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	8/14/2017	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
260160	Fee-for-Service	1750342499	1750342499	1	1	POPESCU, MARIA I MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75935	68	Hematology	0	In state provider	PROFESSIONAL CORPORATION	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
260174	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
260183	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
260210	Fee-for-Service	1881633485	1881633485	1	1	PORTER-PURSNANI, CARLA J DPM	4/9/2014	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4108 ADMIRALTY LN	None	FOSTER CITY	CA	94404	1678	41	06081	37.56096551	-122.2672519	San Mateo County
260212	Fee-for-Service	1134615115	1134615115	1	1	PATEL, NAVYA T DO	10/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18830	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
260234	Fee-for-Service	1487761227	1487761227	1	2	PETERSON TULSKY, JACQUELINE	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	71894	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	BLDG 80, 6TH FLOOR	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
260236	Fee-for-Service	1891995403	1891995403	1	1	PEREZ, FREDY OD APC	1/1/1979	261Q00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1509 W SUNSET BLVD	None	LOS ANGELES	CA	90026	3319	19	06037	34.07596752	-118.2554684	Los Angeles County
260250	Fee-for-Service	1639394117	1639394117	1	3	PINE RIVER INC.	2/3/2023	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	D	1700 PENNSYLVANIA AVE	STE B	FAIRFIELD	CA	94533	3510	48	06095	38.259945	-122.0498745	Solano County
260253	Fee-for-Service	1487603254	1487603254	1	2	PESTANA, DAMIAN R MD	9/30/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	27221	10	Gastroenterology (M.D. only)	0	In state provider	None	153 PEARSON ROAD	None	PARADISE	CA	95969	5045	04	06007	39.75272738	-121.6254323	Butte County
260257	Fee-for-Service	1609957844	1609957844	1	1	PALANIAPPAN, LATHA MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65904	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
260259	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
260268	Fee-for-Service	1740254366	1740254366	1	1	PITZER, JO ELLEN MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	75285	08	Family Practice	0	In state provider	None	2141 N HARBOR BLVD	SUITE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
260271	Fee-for-Service	1871549899	1871549899	1	17	PUEBLO RAD MED GRP INC	4/27/2010	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	921 OAK PARK BLVD	STE 102	PISMO BEACH	CA	93449	3289	40	06079	35.13600697	-120.6045995	San Luis Obispo County
260276	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	4/22/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
260279	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	12/26/2007	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
260280	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
260284	Fee-for-Service	1518079508	1518079508	1	2	PHARMACY SERVICE INC	5/5/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 103	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
260305	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	10/3/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
260328	Fee-for-Service	1609273234	1609273234	1	1	PROGRESS SPEECH & LANGUAGE	1/13/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PATHOLOGY CENTER INC	304 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.809904	-117.908676	Orange County
260340	Fee-for-Service	1710284229	1710284229	1	1	PRODIGY HEALTHCARE, INC	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	701 EAST MAIN STREET	104, 108, 201, 501, 701	FOWLER	CA	93625	2423	10	06019	36.63327878	-119.672445	Fresno County
260342	Fee-for-Service	1376876912	1376876912	1	5	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	34845 YUCAIPA BLVD	STE 105	YUCAIPA	CA	92399	4155	36	06071	34.0338525	-117.0443565	San Bernardino County
260347	Fee-for-Service	1356745616	1356745616	1	1	PUELS, SHANNA L LMFT	9/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
260352	Fee-for-Service	1992902670	1992902670	1	1	PANKHANIYA, RAVI R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86587	05	Anesthesiology	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
260399	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	12/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
260403	Fee-for-Service	1033426564	1033426564	1	1	PARK, CHUL-KYUN MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114434	05	Anesthesiology	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
260406	Fee-for-Service	1326692633	1326692633	1	1	PEARCE, KADI L	8/13/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	970 N LATHAM STREET	None	COLTON	CA	92324	1934	36	06071	34.07681442	-117.3391912	San Bernardino County
260428	Fee-for-Service	1306849807	1306849807	1	1	PHAN, THAO H MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90577	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
260430	Fee-for-Service	1972061273	1972061273	1	1	PORTER, LAURA J NP	5/5/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
260438	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	11/7/2018	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
260441	Fee-for-Service	1831263334	1831263334	1	1	PATEL, SUGNAYKUMAR P MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53352	36	Psychiatry	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
260446	Fee-for-Service	1750342499	1750342499	1	1	POPESCU, MARIA I MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75935	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
260447	Fee-for-Service	1205179850	1205179850	1	1	PANG, PATRICIA C MD	11/30/2022	207L00000X	NA	Other	026	PHYSICIANS	175735	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
260450	Fee-for-Service	1801425715	1801425715	1	1	PARK, SOPHIA A MD	7/14/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186190	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
260462	Fee-for-Service	1902105737	1902105737	1	1	PEASE, CHRISTOPHER R F MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127893	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
260464	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TB0200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
260471	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
260503	Fee-for-Service	1710177845	1710177845	1	1	PANOSSIAN, ANDRE A MD	10/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76052	24	Plastic Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
260516	Fee-for-Service	1932316510	1932316510	1	1	PAN, KWEI MIN P MD	1/31/1988	208600000X	NA	General Surgery	026	PHYSICIANS	43080	02	General Surgery	0	In state provider	None	2621 S BRISTOL ST	STE 208	SANTA ANA	CA	92704	5700	30	06059	33.711876	-117.885371	Orange County
260519	Fee-for-Service	1063496651	1063496651	1	25	PACIFIC CENTRAL COAST HEALTH	6/6/2016	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	877 OAK PARK BLVD	None	PISMO BEACH	CA	93449	3292	40	06079	35.13294806	-120.6057266	San Luis Obispo County
260528	Fee-for-Service	1306137856	1306137856	1	1	PATEL, ROSHAN D MD	9/11/2020	207R00000X	NA	Other	026	PHYSICIANS	136505	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
260541	Fee-for-Service	1487635546	1487635546	1	1	POURZIA, GHOLAMREZA F MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45667	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	815 COURT ST	STE 5	JACKSON	CA	95642	2154	03	06005	38.35293152	-120.7676346	Amador County
260545	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
260547	Fee-for-Service	1609957844	1609957844	1	1	PALANIAPPAN, LATHA MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65904	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
260563	Fee-for-Service	1548343510	1548343510	1	68	PERMANENTE MEDICAL GROUP INC	6/18/2019	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
260567	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
260568	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
260571	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
260594	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	12/8/2018	103TC0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
260597	Fee-for-Service	1134569106	1134569106	1	1	PALISPIS, WINNIE A MD	12/3/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	131811	20	Orthopedic Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
260612	Fee-for-Service	1952454035	1952454035	1	1	PORTILLO, BARBARA M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	608 E ORANGEBURG AVE	None	MODESTO	CA	95350	5513	50	06099	37.66359354	-120.985569	Stanislaus County
260617	Fee-for-Service	1609273234	1609273234	1	1	PROGRESS SPEECH & LANGUAGE	1/13/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	PATHOLOGY CENTER INC	304 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.809904	-117.908676	Orange County
260622	Fee-for-Service	1396377826	1396377826	1	1	PAYES, MARGARITA NP	5/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
260626	Fee-for-Service	1699761437	1699761437	1	1	PURUSH,AJITH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	0000	00	None	34.558992	-112.481901	Yavapai County
260630	Fee-for-Service	1376876912	1376876912	1	5	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	34845 YUCAIPA BLVD	STE 105	YUCAIPA	CA	92399	4155	36	06071	34.0338525	-117.0443565	San Bernardino County
260641	Fee-for-Service	1184288706	1184288706	1	1	PARK, HILLARY C DO	9/8/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21037	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
260646	Fee-for-Service	1114937554	1114937554	1	1	PACIFIC INTERNAL MED GRP	2/28/1986	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2777 PACIFIC AVE	STE E	LONG BEACH	CA	90806	2626	19	06037	33.80761478	-118.193744	Los Angeles County
260649	Fee-for-Service	1821191784	1821191784	1	1	PANDIPATI, SANTOSH MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54842	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 E HAMILTON AVE	STE 220	CAMPBELL	CA	95008	0665	43	06085	37.29428651	-121.934403	Santa Clara County
260657	Fee-for-Service	1053173559	1053173559	1	2	PERFECT PATHOLOGY MEDICAL PC	10/1/2024	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
260686	Fee-for-Service	1326227901	1326227901	1	1	PURCELL, JOSEPH P DO	12/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10323	25	Physical Medicine and Rehabilitation	0	In state provider	None	1255 EAST STREET	SUITE 201	REDDING	CA	96001	0800	45	06089	40.58763719	-122.3893695	Shasta County
260687	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
260694	Fee-for-Service	1326692633	1326692633	1	1	PEARCE, KADI L	8/13/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	970 N LATHAM STREET	None	COLTON	CA	92324	1934	36	06071	34.07681442	-117.3391912	San Bernardino County
260725	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
260728	Fee-for-Service	1497881247	1497881247	1	1	PETERS, KATHERINE NP	12/5/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260731	Fee-for-Service	1790844769	1790844769	1	2	PEDIATRIC CARE OF STOCKTON I	11/14/2022	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2800 N CALIFORNIA STREET	SUITE 14	STOCKTON	CA	95204	3759	39	06077	37.97782434	-121.2919633	San Joaquin County
260739	Fee-for-Service	1871064436	1871064436	1	1	PENA, CRYSTAL H NP	8/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
260748	Fee-for-Service	1477814820	1477814820	1	1	PINE GROVE HEALTHCARE	6/1/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	126 N SAN GABRIEL BLVD	None	SAN GABRIEL	CA	91775	2427	19	06037	34.10451803	-118.0910009	Los Angeles County
260753	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	10/19/2007	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
260761	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
260779	Fee-for-Service	1386732006	1386732006	1	1	PENINSULA CONVALESCENT	7/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES LLC	2140 CARLMONT DR	None	BELMONT	CA	94002	3417	41	06081	37.50951053	-122.2946728	San Mateo County
260803	Fee-for-Service	1932316510	1932316510	1	1	PAN, KWEI MIN P MD	1/31/1988	208600000X	NA	General Surgery	026	PHYSICIANS	43080	33	Thoracic Surgery	0	In state provider	None	2621 S BRISTOL ST	STE 208	SANTA ANA	CA	92704	5700	30	06059	33.711876	-117.885371	Orange County
260837	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
260841	Fee-for-Service	1669884490	1669884490	1	1	PHAM, NHUNG P MD	9/20/2020	208M00000X	NA	Other	026	PHYSICIANS	151290	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
260843	Fee-for-Service	1609540103	1609540103	1	1	POINDEXTER, OLENA CNP	1/20/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
260848	Fee-for-Service	1356961346	1356961346	1	1	POURESMAIL, POURYA OT	4/25/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
260856	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
260857	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	12/30/2015	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
260859	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
260866	Fee-for-Service	1952584526	1952584526	1	1	PATEL, BHAVIN N MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125713	34	Urology and Urological Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	3428	10	06019	36.84133078	-119.7824983	Fresno County
260873	Fee-for-Service	1871549899	1871549899	1	14	PUEBLO RAD MED GRP INC	2/26/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	350 CHAPALA ST	STE 104	SANTA BARBARA	CA	93101	3475	42	06083	34.41472235	-119.695187	Santa Barbara County
260877	Fee-for-Service	1700325248	1700325248	1	1	PACIFIC PSYCH SOLUTIONS INC	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	4300 LONG BEACH BLVD	STE 340	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
260880	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
260917	Fee-for-Service	1376876912	1376876912	1	5	PINNACLE MEDICAL GROUP INC	3/19/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	34845 YUCAIPA BLVD	STE 105	YUCAIPA	CA	92399	4155	36	06071	34.0338525	-117.0443565	San Bernardino County
260945	Fee-for-Service	1578762290	1578762290	1	1	PATEL, PAYAL A MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107507	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
260947	Fee-for-Service	1710215074	1710215074	1	1	POLOSS, ENJIL LMFT	4/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
260971	Fee-for-Service	1073642641	1073642641	1	1	PROMETHEUS LABORATORIES	6/7/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9410 CARROLL PARK DRIVE	None	SAN DIEGO	CA	92121	5201	37	06073	32.88801675	-117.1744702	San Diego County
260973	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
260990	Fee-for-Service	1154301224	1154301224	1	1	PELOT, MICHELE R MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92643	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK	None	BALDWIN PARK	CA	01706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
261011	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
261039	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	1/11/2017	103TB0200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
261049	Fee-for-Service	1548343510	1548343510	1	10	PERMANENTE MEDICAL GROUP INC	11/21/2016	101YP2500X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
261091	Fee-for-Service	1891157616	1891157616	1	1	POSADAS, EMERSON S MD	7/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
261092	Fee-for-Service	1598817728	1598817728	1	1	PASQUARIELLO, VINCENT MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43406	40	Pediatrics	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
261120	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	2/11/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
261144	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
261147	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
261148	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YP2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
261150	Fee-for-Service	1003990078	1003990078	1	1	PARAISO, MICHELLE S MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71895	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261156	Fee-for-Service	1700325248	1700325248	1	1	PACIFIC PSYCH SOLUTIONS INC	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4300 LONG BEACH BLVD	STE 340	LONG BEACH	CA	90807	2011	19	06037	33.83662572	-118.1900605	Los Angeles County
261160	Fee-for-Service	1386834349	1386834349	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	2080P0201X	NA	Neurology	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	PEDTRC ALLERGY/IMMUNOLOG	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
261169	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
261232	Fee-for-Service	1578762290	1578762290	1	1	PATEL, PAYAL A MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107507	40	Pediatrics	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
261254	Fee-for-Service	1326252743	1326252743	1	1	PHILLIPS, RAYLENE M MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92452	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
261260	Fee-for-Service	1548343510	1548343510	1	46	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
261295	Fee-for-Service	1720186786	1720186786	1	1	PEDRANO, GUADALUPE C MD INC	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	40246	01	General Practice	0	In state provider	None	2209 N SAN FERNANDO RD	None	LOS ANGELES	CA	90065	1231	19	06037	34.10340703	-118.2375875	Los Angeles County
261296	Fee-for-Service	1538247291	1538247291	1	1	PATEL, PANKAJ B MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58318	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
261299	Fee-for-Service	1356961882	1356961882	1	1	PALII, MAX	10/15/2023	208M00000X	NA	Other	026	PHYSICIANS	188762	None	None	0	In state provider	None	1020 29TH ST	#550	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
261302	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
261315	Fee-for-Service	1598946683	1598946683	1	1	PLAUT, ZACHARY A MD	4/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115703	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
261329	Fee-for-Service	1548343510	1548343510	1	4	PERMANENTE MEDICAL GROUP INC	12/16/2016	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
261341	Fee-for-Service	1417113002	1417113002	1	1	PARTHIBAN RAMACHANDRA	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10401 W THUNDERBIRD	None	SUN CITY	AZ	85351	0000	00	None	33.603885	-112.2831765	Maricopa County
261353	Fee-for-Service	1225024219	1225024219	1	1	PANJABI, RAVI S MD	6/20/2024	174400000X	NA	Other	026	PHYSICIANS	55600	05	Anesthesiology	0	In state provider	None	3160 CASTRO VALLEY BLVD	SUITE A	CASTRO VALLEY	CA	94546	5565	01	06001	37.69558946	-122.0802885	Alameda County
261386	Fee-for-Service	1790776623	1790776623	1	1	PORTER, MINTO MN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1406 6TH AVE N	None	SAINT CLOUD	MN	56303	1900	00	None	45.5746739	-94.17010435	Stearns County
261410	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
261429	Fee-for-Service	1376934679	1376934679	1	2	PIRRACCHIO, ROMAIN C MD	2/17/2022	207LC0200X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
261433	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
261434	Fee-for-Service	1548343510	1548343510	1	37	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
261435	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
261448	Fee-for-Service	1386834349	1386834349	1	1	PEDIATRIC SUBSPLTY FACUL	1/1/2002	2080P0201X	NA	Neurology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PEDTRC ALLERGY/IMMUNOLOG	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
261454	Fee-for-Service	1407683824	1407683824	1	1	PURE CURE PHARMACY	11/12/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2356 VENTURA BLVD	STE A	CAMARILLO	CA	93010	6644	56	06111	34.21642109	-119.0384379	Ventura County
261458	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	9/25/2018	103TC0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
261475	Fee-for-Service	1780725408	1780725408	2	1	PROKUPEK, DALE A MD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	71035	41	Internal Medicine	0	In state provider	None	8641 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
261512	Fee-for-Service	1104919539	1104919539	1	1	PETROVICH-GOOD, MARGARET	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54824	18	Ophthalmology	0	In state provider	None	2617 E CHAPMAN AVE	STE 301	ORANGE	CA	92869	3234	30	06059	33.7878445	-117.8254845	Orange County
261529	Fee-for-Service	1568994762	1568994762	1	1	PATEL, ERICA MD	12/13/2022	207R00000X	NA	Other	026	PHYSICIANS	157552	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
261541	Fee-for-Service	1326252743	1326252743	1	1	PHILLIPS, RAYLENE M MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92452	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
261550	Fee-for-Service	1548343510	1548343510	1	35	PERMANENTE MEDICAL GROUP INC	10/29/2018	171100000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
261589	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	11/10/2011	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
261615	Fee-for-Service	1548979685	1548979685	1	1	PRIORITY RESPONSE LLC	7/2/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1005 FITZUREN RD	B	ANTIOCH	CA	94509	4757	07	06013	37.99790049	-121.820535	Contra Costa County
261633	Fee-for-Service	1043401698	1043401698	1	1	PHAM, DAVID N MD	2/23/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	86094	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10900 WARNER AVE	STE 118	FOUNTAIN VALLEY	CA	92708	3846	30	06059	33.71628153	-117.9388215	Orange County
261652	Fee-for-Service	1659996528	1659996528	1	1	PARK, DOH JOON DO	7/27/2023	207R00000X	NA	Other	026	PHYSICIANS	21158	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
261664	Fee-for-Service	1114156254	1114156254	1	1	PUMAR, MARGO F MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131765	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
261670	Fee-for-Service	1639673064	1639673064	1	1	POORJAFAR, NASIM MD	12/6/2021	208M00000X	NA	Other	026	PHYSICIANS	174077	None	None	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
261697	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
261699	Fee-for-Service	1164464707	1164464707	1	1	PROMED, INC.	10/12/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1401 S BERETANIA ST	STE 620	HONOLULU	HI	96814	1873	00	None	21.30006825	-157.8391987	Honolulu County
261715	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	7/12/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
261720	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
261722	Fee-for-Service	1548343510	1548343510	1	3	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YP2500X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
261725	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
261750	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	11/24/2019	103TC0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
261754	Fee-for-Service	1326375213	1326375213	1	1	PAULINA T.Q. HAN O.D. INC.	5/7/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11028 LOWER AZUSA	SUITE B	EL MONTE	CA	91731	5406	19	06037	34.09193387	-118.0251713	Los Angeles County
261762	Fee-for-Service	1780725408	1780725408	2	1	PROKUPEK, DALE A MD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	71035	10	Gastroenterology (M.D. only)	0	In state provider	None	8641 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
261779	Fee-for-Service	1447261367	1447261367	1	1	PULIDO, MA CHRISTINA MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47855	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
261807	Fee-for-Service	1356712715	1356712715	1	1	PHILLIP, OMARI PT	7/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
261849	Fee-for-Service	1922462001	1922462001	1	1	PATEL-PADHIAR, PRIYANKA LMF	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	108105	-	NOT APPLICABLE	0	In state provider	T	1303 WEST WALNUT PKWY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
261859	Fee-for-Service	1992884738	1992884738	1	1	PUGACH, ROBERT G MD INC	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41822	34	Urology and Urological Surgery	0	In state provider	PACIFIC COAST UROLOGY	3801 KATELLA AVE	STE 110	LOS ALAMITOS	CA	90720	3371	30	06059	33.80318951	-118.066068	Orange County
261866	Fee-for-Service	1114007432	1114007432	1	3	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SPECIALISTS MED GROUP	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
261876	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
261895	Fee-for-Service	1083143390	1083143390	1	1	PERES-DA-SILVA, ASHWIN MD	3/28/2022	207R00000X	NA	Other	026	PHYSICIANS	166415	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
261947	Fee-for-Service	1760429252	1760429252	1	1	PAIN MANAGEMENT ASSOCIATES,	10/9/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	INC.	2888 LONG BEACH BLVD	SUITE 210	LONG BEACH	CA	90806	1530	19	06037	33.809706	-118.189343	Los Angeles County
261987	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	12/11/2015	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
262004	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
262007	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
262008	Fee-for-Service	1073557351	1073557351	1	1	PESHEVA, MARIA P MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88707	18	Ophthalmology	0	In state provider	None	801 S CHEVY CHASE DRIVE	SUITE 103	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
262012	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
262033	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	4/15/2019	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
262043	Fee-for-Service	1982622130	1982622130	1	1	PAUL BECK MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2775 MOSSIDE BLVD	None	MONROEVILLE	PA	15146	2760	00	None	40.436271	-79.76043	Allegheny County
262072	Fee-for-Service	1083870919	1083870919	1	1	PAULINE DANIELS DO	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
262073	Fee-for-Service	1558402610	1558402610	1	1	PINTOBENNETT, GAYNE A MFT	9/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8723	-	NOT APPLICABLE	0	In state provider	None	13715 EL CAMINO REAL	None	ATASCADERO	CA	93422	6334	40	06079	35.43641042	-120.6221242	San Luis Obispo County
262076	Fee-for-Service	1588665103	1588665103	1	1	PARK, JOHN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 SIXTH ST SW	None	CANTON	OH	44710	1702	00	None	40.79684788	-81.40409211	Stark County
262099	Fee-for-Service	1932618089	1932618089	1	1	PREIS, JACQUELYN M CRNA	5/24/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
262149	Fee-for-Service	1063496651	1063496651	1	43	PACIFIC CENTRAL COAST HEALTH	11/1/2021	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9500 STOCKDALE HWY	STE 109	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
262155	Fee-for-Service	1114007432	1114007432	1	3	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SPECIALISTS MED GROUP	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
262164	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	12/20/2018	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
262181	Fee-for-Service	1588680979	1588680979	1	1	PHONG, LAN PAO CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5110 WESTMINSTER AVE	STE K	SANTA ANA	CA	92703	1166	30	06059	33.75956711	-117.93704	Orange County
262197	Fee-for-Service	1033571195	1033571195	1	1	PHAMDUONG, ELLEN MD	10/8/2019	207L00000X	NA	Other	026	PHYSICIANS	138991	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
262231	Fee-for-Service	1467642421	1467642421	1	2	PEDIATRIC SUBSPLTY FACUL	2/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FACULTY INC	1201 W LA VETA AVE	STE 202	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
262234	Fee-for-Service	1790792844	1790792844	1	1	PHAN, CAN Q MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	62401	05	Anesthesiology	0	In state provider	None	26816 VISTA TER	None	LAKE FOREST	CA	92630	8115	30	06059	33.6649298	-117.6631024	Orange County
262270	Fee-for-Service	1588742050	1588742050	1	1	PLOTKIN, MINDY M DO	4/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	STE 3A	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
262273	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	12/8/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
262274	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
262290	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
262293	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
262299	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
262307	Fee-for-Service	1073640587	1073640587	1	1	POLANCO, MARIO PT	11/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5301 WHITTIER BLVD	ATRIUM SUITE	LOS ANGELES	CA	90022	4038	19	06037	34.02010603	-118.1557093	Los Angeles County
262309	Fee-for-Service	1467686790	1467686790	1	1	PARRILLA-ANDERSON, KARIN L L	10/2/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
262320	Fee-for-Service	1235226531	1235226531	1	40	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
262360	Fee-for-Service	1427137553	1427137553	1	1	PAREKH, HEMAL H MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84523	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
262362	Fee-for-Service	1386229896	1386229896	1	1	PREMIUM URGENT CARE, INC.	4/25/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	565 W SHAW AVE	None	CLOVIS	CA	93612	3229	10	06019	36.80858654	-119.7221713	Fresno County
262363	Fee-for-Service	1053387035	1053387035	1	1	PAUL, MICHAEK K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 PINE GROVE AVE	None	PORT HURON	MI	48060	3511	00	None	42.986844	-82.42983	St. Clair County
262378	Fee-for-Service	1992956379	1992956379	1	1	PETERSON, CANDICE D LCSW	2/8/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
262390	Fee-for-Service	1871549899	1871549899	1	21	PUEBLO RAD MED GRP INC	9/21/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	31 W GUTIERREZ STREET	None	SANTA BARBARA	CA	93101	3499	42	06083	34.41528766	-119.6947156	Santa Barbara County
262400	Fee-for-Service	1336227495	1336227495	1	1	PATEL, HANNON R MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78320	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
262409	Fee-for-Service	1114547114	1114547114	1	1	PRIME HEALTHCARE SERVICES	8/14/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ST FRANCIS LLC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
262442	Fee-for-Service	1114007432	1114007432	1	3	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	SPECIALISTS MED GROUP	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
262453	Fee-for-Service	1548343510	1548343510	1	48	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
262469	Fee-for-Service	1033368741	1033368741	1	1	PETROVICH, LAURA N MD PC	3/19/2009	207R00000X	NA	Other	026	PHYSICIANS	72085	41	Internal Medicine	0	In state provider	None	1224 10TH ST	STE 200	CORONADO	CA	92118	3416	37	06073	32.68506092	-117.1778906	San Diego County
262478	Fee-for-Service	1073574075	1073574075	1	1	PACIFIC RIM PATHOLOGY	10/7/1997	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
262520	Fee-for-Service	1467642421	1467642421	1	2	PEDIATRIC SUBSPLTY FACUL	2/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	FACULTY INC	1201 W LA VETA AVE	STE 202	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
262550	Fee-for-Service	1245897735	1245897735	1	1	PERSONIUS, JULIETTE MD	8/24/2023	390200000X	NA	Other	026	PHYSICIANS	180396	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
262560	Fee-for-Service	1902990302	1902990302	3	1	PACIFIC HEALTHCARE INC	12/31/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1907 SUNNYCREST DRIVE	None	FULLERTON	CA	92835	3626	30	06059	33.89261987	-117.9316747	Orange County
262561	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
262562	Fee-for-Service	1730492240	1730492240	1	1	PRONTO MEDICAL SUPPLY INC	5/11/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1117 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2528	19	06037	34.17006439	-118.3481038	Los Angeles County
262563	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	3/16/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
262577	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
262581	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
262583	Fee-for-Service	1699751255	1699751255	1	1	PITTS, BRIAN MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82816	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
262585	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/8/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
262637	Fee-for-Service	1689030173	1689030173	1	1	PON, GREGORY J PT	8/14/2022	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
262644	Fee-for-Service	1427137553	1427137553	1	1	PAREKH, HEMAL H MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84523	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
262667	Fee-for-Service	1609074806	1609074806	1	1	PACIFIC GYNECOLOGIC	12/1/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	SPECIALISTS	181 SOUTH BUENA VISTA ST	3RD FLOOR	BURBANK	CA	91505	1204	19	06037	34.15958049	-118.328816	Los Angeles County
262673	Fee-for-Service	1114547114	1114547114	1	2	PRIME HEALTHCARE SERVICES	4/5/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3663 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3506	19	06037	33.92934746	-118.2012154	Los Angeles County
262694	Fee-for-Service	1114547114	1114547114	1	1	PRIME HEALTHCARE SERVICES	8/13/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ST FRANCIS LLC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
262696	Fee-for-Service	1508810367	1508810367	1	1	PECK, WALLACE W MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52810	30	Radiology	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
262706	Fee-for-Service	1316566060	1316566060	1	1	PHILLIPS, ELIZABETH MD	7/8/2024	207R00000X	NA	Other	026	PHYSICIANS	186065	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
262753	Fee-for-Service	1033368741	1033368741	1	1	PETROVICH, LAURA N MD PC	3/19/2009	207R00000X	NA	Other	026	PHYSICIANS	72085	40	Pediatrics	0	In state provider	None	1224 10TH ST	STE 200	CORONADO	CA	92118	3416	37	06073	32.68506092	-117.1778906	San Diego County
262757	Fee-for-Service	1295788016	1295788016	1	1	PARK, CATHERINE Y MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85473	None	None	0	In state provider	EMERGENCY DEPT.	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
262767	Fee-for-Service	1629034558	1629034558	1	1	PU, LEE MD	6/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55357	24	Plastic Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
262768	Fee-for-Service	1427394410	1427394410	1	1	PALLAPATI, ARUNA MD INC	1/1/2013	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98165	40	Pediatrics	0	In state provider	None	760 S WASHBURN AVE	SUITE 20	CORONA	CA	92882	3303	33	06065	33.87374611	-117.567875	Riverside County
262849	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	1/30/2012	207RA0201X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
262850	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
262867	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
262871	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
262874	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
262892	Fee-for-Service	1053331710	1053331710	1	1	PEREZ, LEONARD MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52112	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2005 17TH STREET	None	BAKERSFIELD	CA	93301	4203	15	06029	35.37431347	-119.0249415	Kern County
262938	Fee-for-Service	1497863377	1497863377	1	1	PRINTS, ANDREW C MD	6/1/1994	207P00000X	NA	Other	026	PHYSICIANS	78945	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
262952	Fee-for-Service	1609074806	1609074806	1	1	PACIFIC GYNECOLOGIC	12/1/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SPECIALISTS	181 SOUTH BUENA VISTA ST	3RD FLOOR	BURBANK	CA	91505	1204	19	06037	34.15958049	-118.328816	Los Angeles County
262975	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	11/27/2007	103TC2200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
262985	Fee-for-Service	1114547114	1114547114	1	1	PRIME HEALTHCARE SERVICES	8/13/2020	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ST FRANCIS LLC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
263038	Fee-for-Service	1790787802	1790787802	1	1	PHAM, CUNG B MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81143	08	Family Practice	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
263050	Fee-for-Service	1679543250	1679543250	1	1	POKROY, MICHAEL V MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	33060	40	Pediatrics	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
263061	Fee-for-Service	1124096847	1124096847	1	1	PORCELLI, MARTIN J DO	1/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4403	08	Family Practice	0	In state provider	None	336 ERVILLA ST	None	POMONA	CA	91767	3016	19	06037	34.07795671	-117.7476969	Los Angeles County
263082	Fee-for-Service	1780898858	1780898858	1	1	PINTO, JAMES L MD	4/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53971	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91672	2918	19	06037	34.076894	-117.7522688	Los Angeles County
263107	Fee-for-Service	1700098282	1700098282	1	1	PARK, PATRICIA MD	8/30/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	83264	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
263111	Fee-for-Service	1154788560	1154788560	1	1	POMONA COMMUNITY HEALTH	8/16/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4241	36	06071	34.045119	-117.6464565	San Bernardino County
263135	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	1/30/2012	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
263139	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
263151	Fee-for-Service	1457030074	1457030074	1	1	PADEN, NICOLE G NP	9/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
263154	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
263158	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
263161	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
263201	Fee-for-Service	1790541993	1790541993	1	1	POPAT, SOFIA OT	3/31/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
263228	Fee-for-Service	1447383310	1447383310	1	1	PROHEALTH PARTNERS A MEDICAL	6/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP INC	3650 E SOUTH ST	SUITE 310	LAKEWOOD	CA	90712	1519	19	06037	33.8601747	-118.1494013	Los Angeles County
263249	Fee-for-Service	1053511634	1053511634	1	1	PATEL, JITESH K MD	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79857	10	Gastroenterology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
263265	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	6/15/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
263272	Fee-for-Service	1114547114	1114547114	1	1	PRIME HEALTHCARE SERVICES	8/13/2020	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	ST FRANCIS LLC	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
263282	Fee-for-Service	1063496651	1063496651	1	58	PACIFIC CENTRAL COAST HEALTH	2/27/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1555 HIGUERA STREET	None	SAN LUIS OBISPO	CA	93401	2917	40	06079	35.28600339	-120.6530238	San Luis Obispo County
263338	Fee-for-Service	1679543250	1679543250	1	1	POKROY, MICHAEL V MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	33060	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
263341	Fee-for-Service	1992883896	1992883896	1	1	PAYNE, ROBERT D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	36089	40	Pediatrics	0	In state provider	None	50 S SAN MATEO DR	STE 260	SAN MATEO	CA	94401	3859	41	06081	37.56634141	-122.3261145	San Mateo County
263362	Fee-for-Service	1255515672	1255515672	1	1	PANKAJ K BHATNAGAR MD PC	6/1/2014	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	None	6850 N DURANGO DR	SUITE 204	LAS VEGAS	NV	89149	4596	00	None	36.285876	-115.285266	Clark County
263400	Fee-for-Service	1154788560	1154788560	1	1	POMONA COMMUNITY HEALTH	8/16/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4241	36	06071	34.045119	-117.6464565	San Bernardino County
263422	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	9/12/2018	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
263428	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
263442	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
263445	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
263449	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
263478	Fee-for-Service	1720139355	1720139355	1	1	POSITIVE AND VIGILANT HLTH	12/8/1987	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	331 ILENE ST	None	MARTINEZ	CA	94553	2631	07	06013	38.00820807	-122.1335048	Contra Costa County
263520	Fee-for-Service	1447383310	1447383310	1	1	PROHEALTH PARTNERS A MEDICAL	6/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	GROUP INC	3650 E SOUTH ST	SUITE 310	LAKEWOOD	CA	90712	1519	19	06037	33.8601747	-118.1494013	Los Angeles County
263524	Fee-for-Service	1295152379	1295152379	1	1	POWERS, MATTHEW A MD	3/1/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	139016	None	None	0	In state provider	None	3536 MENDOCINO AVE	STE 380	SANTA ROSA	CA	95403	3612	49	06097	38.473326	-122.725935	Sonoma County
263534	Fee-for-Service	1053511634	1053511634	1	1	PATEL, JITESH K MD	1/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79857	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
263538	Fee-for-Service	1922191352	1922191352	1	1	PATHEJA, PRITAM S MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94037	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
263541	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
263545	Fee-for-Service	1023302346	1023302346	1	1	PAREKH, SURAJ V MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160018	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
263554	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	2/26/2013	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
263559	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
263564	Fee-for-Service	1134673478	1134673478	1	1	PANACEA HOME HEALTH SERVICES	3/5/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4629 VAN NUYS BLVD	STE A	SHERMAN OAKS	CA	91403	5789	19	06037	34.15567998	-118.448716	Los Angeles County
263576	Fee-for-Service	1720316805	1720316805	3	1	PRUDENTIAL HOSPICE CARE, INC	6/29/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13047 ARTESIA BLVD	SUITE C200	CERRITOS	CA	90703	5700	19	06037	33.87328747	-118.0544355	Los Angeles County
263587	Fee-for-Service	1598813156	1598813156	1	1	PRAVDIN, MARY MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	93940	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
263613	Fee-for-Service	1013961408	1013961408	1	1	PALI MOMI MEDICAL CENTER	9/3/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	98-1079 MOANALUA RD	None	AIEA	HI	96701	4713	00	None	21.38373524	-157.937629	Honolulu County
263657	Fee-for-Service	1184910960	1184910960	1	1	PARK, HYO K MD	8/21/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160736	09	Gynecology (D.O. only)	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
263710	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	11/24/2019	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
263716	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
263718	Fee-for-Service	1083828594	1083828594	1	1	PARK, HYUNG HO LAC	2/8/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3000 WILSHIRE BLVD	STE 210	LOS ANGELES	CA	90010	1139	19	06037	34.06177848	-118.286694	Los Angeles County
263730	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	5/18/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
263734	Fee-for-Service	1073606299	1073606299	1	4	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
263740	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
263755	Fee-for-Service	1417974247	1417974247	1	1	PEDDI, VENKAT MD	10/24/2003	207RN0300X	NA	Nephrology	026	PHYSICIANS	51237	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
263793	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
263803	Fee-for-Service	1447383310	1447383310	1	1	PROHEALTH PARTNERS A MEDICAL	6/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3650 E SOUTH ST	SUITE 310	LAKEWOOD	CA	90712	1519	19	06037	33.8601747	-118.1494013	Los Angeles County
263807	Fee-for-Service	1215167531	1215167531	1	1	PURKEY, NEHA J MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129352	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
263825	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
263840	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	1/6/2017	103TC2200X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
263843	Fee-for-Service	1336192301	1336192301	1	1	PARK, ROYAL SON MD	4/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79808	34	Urology and Urological Surgery	0	In state provider	None	3445 PACIFIC COAST HWY	STE 310	TORRANCE	CA	90505	6660	19	06037	33.80164353	-118.3452355	Los Angeles County
263847	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2016	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
263864	Fee-for-Service	1720316805	1720316805	3	1	PRUDENTIAL HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13047 ARTESIA BLVD	SUITE C200	CERRITOS	CA	90703	5700	19	06037	33.87328747	-118.0544355	Los Angeles County
263865	Fee-for-Service	1205968138	1205968138	1	1	PARKER TRAUTMANN, AMANDA B L	5/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
263884	Fee-for-Service	1881437796	1881437796	1	1	PINNACLE ACUPUNCTURE, INC.	9/20/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5265 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2202	37	06073	32.74906069	-117.0820977	San Diego County
263887	Fee-for-Service	1831137223	1831137223	1	1	PACIFIC HEARING AND	12/1/2002	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	BALANCE INC	11645 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90025	6807	19	06037	34.05005135	-118.4602303	Los Angeles County
263889	Fee-for-Service	1659550986	1659550986	1	1	PORTERVILLE UNIFIED SD	6/26/2006	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	600 W GRAND AVE	None	PORTERVILLE	CA	93257	2029	54	06107	36.0768899	-119.0306019	Tulare County
263893	Fee-for-Service	1942210570	1942210570	2	1	PARK, KYUNG I MD	7/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50980	None	None	0	In state provider	None	12362 BEACH BLVD	SUITE 10	STANTON	CA	90680	3944	30	06059	33.78298855	-117.9927453	Orange County
263900	Fee-for-Service	1013961408	1013961408	1	1	PALI MOMI MEDICAL CENTER	8/27/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	98-1079 MOANALUA RD	None	AIEA	HI	96701	4713	00	None	21.38373524	-157.937629	Honolulu County
263922	Fee-for-Service	1619390390	1619390390	1	1	PROHEALTH PARTNERS A MEDICAL	12/19/2018	207RX0202X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	3650 S ST	STE 212	LAKEWOOD	CA	90712	1528	19	06037	0	0	None
263999	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	11/30/2018	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
264002	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
264005	Fee-for-Service	1063020717	1063020717	1	1	PHILLIP TARDANICO, LICENSED	3/17/2021	101YA0400X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER A	15000 7TH ST	STES 201 & 209	VICTORVILLE	CA	92395	3853	36	06071	34.52357581	-117.3058419	San Bernardino County
264020	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	3/25/2020	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
264027	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
264036	Fee-for-Service	1457321317	1457321317	1	7	PALOMAR HEALTH	8/15/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92025	4159	37	06073	33.12123297	-117.1199417	San Diego County
264038	Fee-for-Service	1104860865	1104860865	1	1	PARDO, FRANCISCO S MD	3/30/2007	2085R0001X	NA	Other	026	PHYSICIANS	57474	78	Neoplastic Diseases/Oncology	0	In state provider	INC	1855 1ST AVE	STE. 200B	SAN DIEGO	CA	92101	2685	37	06073	32.7247631	-117.1638834	San Diego County
264041	Fee-for-Service	1417974247	1417974247	1	1	PEDDI, VENKAT MD	10/24/2003	207RN0300X	NA	Nephrology	026	PHYSICIANS	51237	45	Nephrology (Renal-Kidney)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
264080	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	5/24/2017	101YM0800X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
264088	Fee-for-Service	1215167531	1215167531	1	1	PURKEY, NEHA J MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129352	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
264113	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
264123	Fee-for-Service	1811015241	1811015241	1	1	PIRNAZAR, MATTHEW R MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86494	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
264127	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC2200X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
264136	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
264149	Fee-for-Service	1740699180	1740699180	1	1	PARENTIS HOME HEALTH CARE	9/21/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	24012 CALLE DE LA PLATA	SUITE 405	LAGUNA HILLS	CA	92653	3621	30	06059	33.61012113	-117.7115908	Orange County
264169	Fee-for-Service	1124196886	1124196886	1	1	PERRELLI, KARA MD	5/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	155337	30	Radiology	0	In state provider	None	301 W. HUNTINGTON DR.	SUITE 617	ARCADIA	CA	91007	1519	19	06037	34.13481053	-118.0425638	Los Angeles County
264181	Fee-for-Service	1780789222	1780789222	1	1	PATEL, DILIP S MD INC	4/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	611 S 1ST AVE	None	ARCADIA	CA	91006	6152	19	06037	34.133058	-118.0282375	Los Angeles County
264237	Fee-for-Service	1730123381	1730123381	1	1	PARKER, DENISE D MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71183	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
264250	Fee-for-Service	1639480064	1639480064	1	1	PENMAN, PERI L DO	7/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12766	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
264252	Fee-for-Service	1467159111	1467159111	1	1	PHAM, JEFFREY NP	6/4/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
264275	Fee-for-Service	1528202363	1528202363	1	2	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	None	11100 WARNER AVE	STE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
264287	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	11/30/2018	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
264290	Fee-for-Service	1548343510	1548343510	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
264291	Fee-for-Service	1063020717	1063020717	1	1	PHILLIP TARDANICO, LICENSED	3/17/2021	101YA0400X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER A	15000 7TH ST	STES 201 & 209	VICTORVILLE	CA	92395	3853	36	06071	34.52357581	-117.3058419	San Bernardino County
264306	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	12/29/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
264313	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
264321	Fee-for-Service	1457321317	1457321317	1	7	PALOMAR HEALTH	8/15/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92025	4159	37	06073	33.12123297	-117.1199417	San Diego County
264326	Fee-for-Service	1104860865	1104860865	1	1	PARDO, FRANCISCO S MD	3/30/2007	2085R0001X	NA	Other	026	PHYSICIANS	57474	30	Radiology	0	In state provider	INC	1855 1ST AVE	STE. 200B	SAN DIEGO	CA	92101	2685	37	06073	32.7247631	-117.1638834	San Diego County
264331	Fee-for-Service	1669492252	1669492252	1	1	PINTER-BROWN, LAUREN C	1/1/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	46124	68	Hematology	0	In state provider	None	2250 ALCAZAR ST	STE 126	LOS ANGELES	CA	90089	0274	19	06037	34.06313563	-118.1997071	Los Angeles County
264367	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	2/9/2010	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
264378	Fee-for-Service	1922259498	1922259498	1	1	PARIKH, KINNARI R MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105021	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
264394	Fee-for-Service	1043399561	1043399561	1	1	PATEL, PARESH MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41512	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10155 COLIMA RD	None	WHITTIER	CA	90603	2063	19	06037	33.94349601	-118.0106968	Los Angeles County
264400	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
264401	Fee-for-Service	1699752832	1699752832	1	1	PRATT, JANEY S A MD	12/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140606	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
264419	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	11/21/2016	103TC2200X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
264421	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
264453	Fee-for-Service	1841412913	1841412913	1	1	PEREZ, GLENN MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46494	40	Pediatrics	0	In state provider	None	630 N 13TH AVE	STE A	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
264512	Fee-for-Service	1922260561	1922260561	1	1	PEER, LORNA K PSYD	8/17/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
264520	Fee-for-Service	1588854723	1588854723	1	1	PANDYA, SIMA DPM	2/6/2025	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
264553	Fee-for-Service	1619217593	1619217593	2	2	PUMPING ESSENTIALS, LLC	11/29/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1660 SCHOOL STREET	SUITE 105A	MORAGA	CA	94556	1124	07	06013	37.83335306	-122.1323053	Contra Costa County
264556	Fee-for-Service	1194974626	1194974626	1	1	PARISE, CHARLES M MD	5/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104011	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24022 CALLE DE LA PLATA	STE 500	LAGUNA HILLS	CA	92653	7612	30	06059	33.6104493	-117.7110924	Orange County
264564	Fee-for-Service	1528202363	1528202363	1	2	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	STE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
264575	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
264579	Fee-for-Service	1225079502	1225079502	1	1	PHILLIPS, JOHN P MD	1/31/1983	207P00000X	NA	Other	026	PHYSICIANS	46208	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
264594	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	3/25/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
264607	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
264620	Fee-for-Service	1952317745	1952317745	1	1	PANAGIOTIDES, GEORGE P	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73503	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	2865 ATLANTIC AVE	STE 205	LONG BEACH	CA	90806	1745	19	06037	33.809418	-118.185058	Los Angeles County
264625	Fee-for-Service	1548318595	1548318595	1	1	PARK, IL W MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40616	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
264637	Fee-for-Service	1326242397	1326242397	1	1	PESANTE, MAISHA MD	6/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168618	08	Family Practice	0	In state provider	None	6939 SUNRISE BLVD	STE 106	CITRUS HEIGHTS	CA	95610	3153	34	06067	38.692602	-121.2731145	Sacramento County
264654	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	9/20/2018	101YM0800X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
264662	Fee-for-Service	1619086105	1619086105	1	1	PERRY, JEANETTE B MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86421	08	Family Practice	0	In state provider	None	400 CANAL ST	STE A	KING CITY	CA	93930	3458	27	06053	36.20592899	-121.1314287	Monterey County
264663	Fee-for-Service	1174057871	1174057871	1	1	PHOTIADIS, SARA MD	3/18/2024	208600000X	NA	General Surgery	026	PHYSICIANS	163246	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
264669	Fee-for-Service	1669407656	1669407656	1	1	PLANNED PARENTHOOD -	7/14/1995	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	OF THE PACIFIC SOUTHWEST	71777 SAN JACINTO DR	STE 202&203	RANCHO MIRAGE	CA	92270	4457	33	06065	33.74394755	-116.4124572	Riverside County
264690	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
264704	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	1/6/2017	103TC2200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
264708	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
264727	Fee-for-Service	1568452845	1568452845	1	1	PIERCE, JEROME C MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77686	30	Radiology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
264734	Fee-for-Service	1801862420	1801862420	1	1	PALUSKA,THOMAS R MD	5/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT ER PHYSICIANS	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
264743	Fee-for-Service	1295010023	1295010023	1	1	PETRONI, JOSEPH L II LMFT	8/15/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99187	-	NOT APPLICABLE	0	In state provider	None	801 11TH STREET	None	MODESTO	CA	95354	2324	50	06099	37.63952026	-120.9974274	Stanislaus County
264753	Fee-for-Service	1508982554	1508982554	1	2	PONEC, CHRISTINE LMFT	9/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
264799	Fee-for-Service	1003984063	1003984063	1	1	PIECZENIK, EDWARD H LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
264816	Fee-for-Service	1841533221	1841533221	1	1	PATEL, NIRAL M MD	11/2/2020	207RC0200X	NA	Other	026	PHYSICIANS	169997	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
264817	Fee-for-Service	1316021942	1316021942	1	11	PILAR M DE CASTRO & CO	1/15/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	11451 TRUE WAY	None	GARDEN GROVE	CA	92840	2330	30	06059	33.79043118	-117.9331358	Orange County
264846	Fee-for-Service	1194974626	1194974626	1	1	PARISE, CHARLES M MD	5/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104011	41	Internal Medicine	0	In state provider	None	24022 CALLE DE LA PLATA	STE 500	LAGUNA HILLS	CA	92653	7612	30	06059	33.6104493	-117.7110924	Orange County
264852	Fee-for-Service	1528202363	1528202363	1	2	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
264857	Fee-for-Service	1790759678	1790759678	1	1	PARTI, RAJIV MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42362	40	Pediatrics	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
264859	Fee-for-Service	1104337393	1104337393	1	1	PALECEK, DAVID T NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2339 W CLEVELAND AVE	None	MADERA	CA	93637	8765	20	06039	36.97466548	-120.085749	Madera County
264862	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	12/11/2015	207RA0201X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
264878	Fee-for-Service	1487187779	1487187779	1	1	PATEL, ARMANI	10/28/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	20911 EARL ST	SUITE 220	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
264883	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	3/31/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
264889	Fee-for-Service	1548343510	1548343510	1	13	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1789 W YOSEMITE AVE	None	MANTECA	CA	95337	5160	39	06077	37.79964	-121.246425	San Joaquin County
264899	Fee-for-Service	1760911226	1760911226	1	1	PATEL, RADHIKA LPT	2/26/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
264904	Fee-for-Service	1093946238	1093946238	1	1	PREMIER HEALTHCARE SERVICES	2/28/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	25129 THE OLD RD	SUITE 320	STEVENSON RANCH	CA	91381	2244	19	06037	34.3752041	-118.5639379	Los Angeles County
264907	Fee-for-Service	1952317745	1952317745	1	1	PANAGIOTIDES, GEORGE P	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73503	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	2865 ATLANTIC AVE	STE 205	LONG BEACH	CA	90806	1745	19	06037	33.809418	-118.185058	Los Angeles County
264914	Fee-for-Service	1548318595	1548318595	1	1	PARK, IL W MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40616	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
264922	Fee-for-Service	1326242397	1326242397	1	1	PESANTE, MAISHA MD	6/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168618	38	Geriatrics	0	In state provider	None	6939 SUNRISE BLVD	STE 106	CITRUS HEIGHTS	CA	95610	3153	34	06067	38.692602	-121.2731145	Sacramento County
264936	Fee-for-Service	1376876912	1376876912	1	6	PINNACLE MEDICAL GROUP INC	3/19/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
264942	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	10/28/2013	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
264955	Fee-for-Service	1801963749	1801963749	1	1	PATAIL, SHOAIB C MD	3/4/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49190	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
264962	Fee-for-Service	1447668926	1447668926	1	1	PATEL, ARPIT A MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120433	05	Anesthesiology	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3462	27	06053	36.20731142	-121.1325532	Monterey County
264969	Fee-for-Service	1811086994	1811086994	1	1	PHC - FORT MOHAVE INC	12/12/2005	282NR1301X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
264974	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
264990	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	1/6/2017	103TC2200X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
264993	Fee-for-Service	1962451138	1962451138	1	1	POINIER ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
264996	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
265037	Fee-for-Service	1518304245	1518304245	1	1	PLAZA PHARMACY LLC	8/9/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	430 E AVENIDA DE LOS	ARBOLES, STE 103	THOUSAND OAKS	CA	91360	3017	56	06111	34.21786948	-118.8693896	Ventura County
265043	Fee-for-Service	1134254584	1134254584	1	1	PAJARO VALLEY UNIFIED SCHOOL	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	294 GREEN VALLEY RD	None	WATSONVILLE	CA	95076	1300	44	06087	36.93991665	-121.7699818	Santa Cruz County
265054	Fee-for-Service	1922462001	1922462001	1	2	PATEL-PADHIAR, PRIYANKA LMF	7/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
265065	Fee-for-Service	1730230830	1730230830	1	1	PEREZ, RICARDO J MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38927	08	Family Practice	0	In state provider	None	17600 MONTEREY ST	STE A	MORGAN HILL	CA	95037	3669	43	06085	37.13058303	-121.6545648	Santa Clara County
265141	Fee-for-Service	1760582738	1760582738	1	1	PRUM, KUNTHY MD	11/30/1984	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	39667	01	General Practice	0	In state provider	PHNOM PENH MED CLINIC	1082 REDONDO AVE	None	LONG BEACH	CA	90804	3927	19	06037	33.78049748	-118.1523882	Los Angeles County
265144	Fee-for-Service	1790759678	1790759678	1	1	PARTI, RAJIV MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42362	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
265147	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	12/11/2015	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
265169	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
265171	Fee-for-Service	1679174577	1679174577	1	1	PAYNE, CAITLIN H LMFT	6/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
265193	Fee-for-Service	1952317745	1952317745	1	1	PANAGIOTIDES, GEORGE P	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	73503	33	Thoracic Surgery	0	In state provider	MD	2865 ATLANTIC AVE	STE 205	LONG BEACH	CA	90806	1745	19	06037	33.809418	-118.185058	Los Angeles County
265200	Fee-for-Service	1598810475	1598810475	1	1	PASTRANO, ELLEN CHARMAINE MD	6/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119784	08	Family Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
265205	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	4/22/2020	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
265207	Fee-for-Service	1629047881	1629047881	1	1	PENA, LEINI-LUCK C MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
265211	Fee-for-Service	1982993531	1982993531	1	1	PAYNE, LAURA A PHD	8/2/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	0001	19	06037	34.07067	-118.4432445	Los Angeles County
265230	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	2/9/2010	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
265236	Fee-for-Service	1336618495	1336618495	1	1	PEDROZA, MARCUS A PT	1/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1019 S MAIN ST	None	MANTECA	CA	95337	5703	39	06077	37.78880388	-121.2161899	San Joaquin County
265253	Fee-for-Service	1063473023	1063473023	1	1	PETERSON, DREW A MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	65990	20	Orthopedic Surgery	0	In state provider	None	301 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3008	37	06073	32.74824655	-117.162423	San Diego County
265261	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
265263	Fee-for-Service	1265435416	1265435416	1	1	PAIN MANAGEMENT SPECIALISTS	9/14/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MANAGEMENT CENTERS	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	40	06079	35.29325417	-120.667547	San Luis Obispo County
265265	Fee-for-Service	1811086994	1811086994	1	1	PHC - FORT MOHAVE INC	12/12/2005	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
265271	Fee-for-Service	1023304573	1023304573	1	2	POLLOCK, ALLISON GANNON MD	5/4/2017	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	122922	25	Physical Medicine and Rehabilitation	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
265278	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
265280	Fee-for-Service	1275692873	1275692873	1	1	PRIETO, VICTOR A MD	1/1/1984	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	43097	20	Orthopedic Surgery	0	In state provider	None	909 HYDE ST	STE 423	SAN FRANCISCO	CA	94109	4846	38	06075	37.78939387	-122.4170945	San Francisco County
265283	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	11/8/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
265294	Fee-for-Service	1356753800	1356753800	1	1	PATEL, PRIYA MD	10/14/2022	390200000X	NA	Other	026	PHYSICIANS	181619	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
265310	Fee-for-Service	1891813085	1891813085	1	3	PALATNIK MEDICAL CORP	5/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5255 ELKHORN BLVD	None	SACRAMENTO	CA	95840	2506	34	06067	38.687364	-121.3417035	Sacramento County
265317	Fee-for-Service	1831557685	1831557685	1	1	PHO, WILLIAM MD	10/15/2017	207P00000X	NA	Other	026	PHYSICIANS	141915	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
265321	Fee-for-Service	1841207289	1841207289	1	1	PARADOWSKI, PAMELA A PHD	12/11/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19830 LANE CHABOT RD	STE C	CASTRO VALLEY	CA	94546	0000	01	06001	37.70011045	-122.0877799	Alameda County
265327	Fee-for-Service	1134254584	1134254584	1	1	PAJARO VALLEY UNIFIED SCHOOL	3/28/1995	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	294 GREEN VALLEY RD	None	WATSONVILLE	CA	95076	1300	44	06087	36.93991665	-121.7699818	Santa Cruz County
265332	Fee-for-Service	1386937191	1386937191	1	1	PLEASANTON DIAGNOSTICS	12/26/2018	2085R0202X	NA	Mammography/MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	IMAGING INC	5860 OWENS DRIVE	SUITE 150	PLEASANTON	CA	94588	3900	01	06001	37.69979047	-121.8991292	Alameda County
265343	Fee-for-Service	1194727321	1194727321	1	1	PARSA, KHOSROW P MD	2/1/1983	207RN0300X	NA	Nephrology	026	PHYSICIANS	12664	41	Internal Medicine	0	In state provider	None	1123 W CARSON ST	None	TORRANCE	CA	90502	2018	19	06037	33.83159545	-118.295496	Los Angeles County
265346	Fee-for-Service	1922344654	1922344654	1	1	PATEL, ZUHAIB R DO	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12552	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
265378	Fee-for-Service	1457389850	1457389850	1	1	PRICHARD, JOHN S MD	8/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41178	08	Family Practice	0	In state provider	None	86 DAILY DR	None	CAMARILLO	CA	93010	5803	56	06111	34.22174543	-119.0683503	Ventura County
265386	Fee-for-Service	1497409940	1497409940	1	1	PEACEFUL HEART FAMILY COUNSE	6/13/2022	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	LING, A PROFESSIONAL COR	1501 CORPORATE WAY	200	SACRAMENTO	CA	95831	3887	34	06067	38.492604	-121.5201645	Sacramento County
265401	Fee-for-Service	1629040480	1629040480	1	1	PHILIPS, DAVID A MD	1/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	116515	41	Internal Medicine	0	In state provider	None	168 N BRENT ST	STE 503	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
265429	Fee-for-Service	1790759678	1790759678	1	1	PARTI, RAJIV MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42362	01	General Practice	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
265431	Fee-for-Service	1427440304	1427440304	1	1	PULMONARY CONSULTANTS AND	12/4/2015	207PE0004X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	WELLNESS CENTER INC PC	555 E HARDY ST	IRA KAUFMAN PAVILION	INGLEWOOD	CA	90301	4106	19	06037	33.94909549	-118.3481595	Los Angeles County
265435	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	9/25/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
265453	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	10/18/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
265467	Fee-for-Service	1609894385	1609894385	1	1	PRAKALAPAKORN, SIPONG G	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95132	05	Anesthesiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
265489	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	9/25/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
265502	Fee-for-Service	1790734572	1790734572	1	1	PARK, JOE W DC	3/15/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	801 N TUSTIN AVE	SUITE 302	SANTA ANA	CA	92705	3612	30	06059	33.752286	-117.8341735	Orange County
265514	Fee-for-Service	1528592854	1528592854	1	1	PAYAN, ARYA DO	8/19/2023	2080P0203X	NA	Other	026	PHYSICIANS	21317	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
265519	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	2/9/2010	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
265539	Fee-for-Service	1063473023	1063473023	1	1	PETERSON, DREW A MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	65990	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3008	37	06073	32.74824655	-117.162423	San Diego County
265549	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
265551	Fee-for-Service	1265435416	1265435416	1	1	PAIN MANAGEMENT SPECIALISTS	7/10/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	MANAGEMENT CENTERS	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	40	06079	35.29325417	-120.667547	San Luis Obispo County
265563	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2015	103TC2200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
265567	Fee-for-Service	1851354823	1851354823	1	1	PAISLEY,JOHN W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
265570	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
265585	Fee-for-Service	1629605928	1629605928	1	1	PICART, ENID	10/1/2023	390200000X	NA	Other	026	PHYSICIANS	191118	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
265589	Fee-for-Service	1225275233	1225275233	2	1	PUTHILLATH, AJITHKUMAR A MD	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107213	68	Hematology	0	In state provider	None	2626 N CALIFORNIA ST	#B	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
265609	Fee-for-Service	1982281671	1982281671	1	1	PENNINGTON, KAYLIN MD MPH	9/9/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
265615	Fee-for-Service	1083895627	1083895627	1	1	PIH HEALTH GOOD SAMARITAN	12/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
265629	Fee-for-Service	1194727321	1194727321	1	1	PARSA, KHOSROW P MD	2/1/1983	207RN0300X	NA	Nephrology	026	PHYSICIANS	12664	45	Nephrology (Renal-Kidney)	0	In state provider	None	1123 W CARSON ST	None	TORRANCE	CA	90502	2018	19	06037	33.83159545	-118.295496	Los Angeles County
265633	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
265641	Fee-for-Service	1659476174	1659476174	1	1	PHAM, LIEN MD	2/28/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2323 MONTPELIER DR	None	SAN JOSE	CA	95116	1611	43	06085	37.36477892	-121.84828	Santa Clara County
265647	Fee-for-Service	1942488291	1942488291	1	1	PRIMARY CARE NURSES 2000 FAM	1/2/2020	251E00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ILY PRACTICE PROFESSIONA	1038 LEIGH	SUITE 216	SAN JOSE	CA	95126	4129	43	06085	37.30588367	-121.9214449	Santa Clara County
265662	Fee-for-Service	1578567244	1578567244	1	1	PELSON,JEFFREY S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	335 CAVES HWY	None	CAVE JUNCTION	OR	97523	0000	00	None	42.16151603	-123.6425882	Josephine County
265684	Fee-for-Service	1093134009	1093134009	1	1	PATEL, MEHA J MD	10/5/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156058	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
265685	Fee-for-Service	1306872726	1306872726	1	1	PARK, CHARLES J MD INC	7/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51947	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
265689	Fee-for-Service	1629040480	1629040480	1	1	PHILIPS, DAVID A MD	1/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	116515	01	General Practice	0	In state provider	None	168 N BRENT ST	STE 503	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
265702	Fee-for-Service	1861627242	1861627242	1	4	PLATINUM HOSPITALISTS LLP	1/24/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
265722	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	5/3/2019	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
265737	Fee-for-Service	1649699885	1649699885	1	1	PASEK, TIMOTHY M MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139556	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5139	37	06073	33.03623896	-117.2837308	San Diego County
265740	Fee-for-Service	1073606299	1073606299	1	32	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1721 TECHNOLOGY DR	None	SAN JOSE	CA	95110	1305	43	06085	37.36464282	-121.9163895	Santa Clara County
265746	Fee-for-Service	1790759629	1790759629	1	1	PROW, HAROLD MD	2/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172735	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
265751	Fee-for-Service	1154307593	1154307593	1	1	PRESBYTERIAN HEALTHCARE	11/11/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1010 SPRUCE ST	None	ESPANOLA	NM	87532	2724	00	None	35.99798685	-106.0888669	Rio Arriba County
265775	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
265793	Fee-for-Service	1790217750	1790217750	1	1	PHAM, BETTY N MD	5/11/2020	390200000X	NA	Other	026	PHYSICIANS	158911	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
265802	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	12/20/2018	101YM0800X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
265803	Fee-for-Service	1255766267	1255766267	1	1	PRO CARE MEDICAL GROUP INC	7/1/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16 CATHY LN	None	DANVILLE	CA	94526	1114	07	06013	37.82702515	-122.0007492	Contra Costa County
265808	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	12/20/2018	103T00000X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
265827	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	11/21/2016	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
265834	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
265841	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
265846	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC2200X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
265853	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
265869	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	10/8/2018	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
265870	Fee-for-Service	1427522911	1427522911	1	1	PAYNE, SAVANNAH LMFT	6/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
265876	Fee-for-Service	1558396069	1558396069	1	1	PRAJAPATI, DEVANG N MD	6/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78056	10	Gastroenterology (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
265910	Fee-for-Service	1871795195	1871795195	1	1	PERNOT, TARA L MD	1/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83761	41	Internal Medicine	0	In state provider	None	12395 EL CAMINO REAL	STE 317	SAN DIEGO	CA	92130	3085	37	06073	32.94324259	-117.2396525	San Diego County
265920	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
265939	Fee-for-Service	1346455524	1346455524	1	1	PATTISON MARGARET MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
265948	Fee-for-Service	1861442154	1861442154	1	1	PHAKLIDES, WILLIAM J MD	9/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	44825	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
265951	Fee-for-Service	1942301098	1942301098	2	1	PAI AND CHAN PHARMACY	11/19/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CORP II	770 S VERMONT AVE	None	LOS ANGELES	CA	90005	1520	19	06037	34.058016	-118.2916205	Los Angeles County
265972	Fee-for-Service	1558717579	1558717579	1	1	PLEASANT HILLIDENCE OPCO	6/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1625 OAK PARK BLVD	None	PLEASANT HILL	CA	94523	4487	07	06013	37.9332128	-122.0634088	Contra Costa County
265991	Fee-for-Service	1861627242	1861627242	1	4	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
266001	Fee-for-Service	1720179591	1720179591	1	1	PEARSON-CODY, MEGAN DO	10/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8946	18	Ophthalmology	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
266006	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
266011	Fee-for-Service	1649375189	1649375189	1	1	PHENOPATH LABORATORIES PLLC	11/18/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1737 AIRPORT WAY SOUTH	SUITE 201	SEATTLE	WA	98134	1636	00	None	47.58711915	-122.3214353	King County
266018	Fee-for-Service	1427237163	1427237163	1	2	PREMIER EMERGENCY	8/25/2017	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
266027	Fee-for-Service	1235126079	1235126079	1	1	POWER, WILLIAM D MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74368	22	Pathology (M.D. only)	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
266038	Fee-for-Service	1154307593	1154307593	1	1	PRESBYTERIAN HEALTHCARE	11/11/2012	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SERVICES	1010 SPRUCE ST	None	ESPANOLA	NM	87532	2724	00	None	35.99798685	-106.0888669	Rio Arriba County
266061	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	9/20/2018	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
266087	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
266094	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	9/12/2018	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
266114	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
266121	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
266126	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
266135	Fee-for-Service	1487064861	1487064861	1	1	PETERSON, SARAH C MD	7/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139249	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
266137	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	8/11/2017	103TC2200X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
266139	Fee-for-Service	1982783940	1982783940	1	1	PEARLE, JAMES L MD	4/1/1985	207RP1001X	NA	Pulmonology	026	PHYSICIANS	27073	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 W ROMNEYA DR	STE 308	ANAHEIM	CA	92801	1826	30	06059	33.8506615	-117.946413	Orange County
266142	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
266154	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266161	Fee-for-Service	1841579455	1841579455	1	1	PITIS, VARINTHREJ MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122811	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
266163	Fee-for-Service	1558396069	1558396069	1	1	PRAJAPATI, DEVANG N MD	6/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78056	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
266175	Fee-for-Service	1235455262	1235455262	1	1	PALLAS, ALEX P DO	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14311	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
266178	Fee-for-Service	1700844370	1700844370	1	1	PHAM, TONY H MD	11/13/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	87039	18	Ophthalmology	0	In state provider	None	2020 CAMINO DEL RIO N	STE 808	SAN DIEGO	CA	92108	6589	37	06073	32.77020579	-117.1423463	San Diego County
266195	Fee-for-Service	1003804089	1003804089	1	1	PETRONIJEVIC, CATHERINE	8/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5536	None	None	0	In state provider	None	17615 MORO RD	None	SALINAS	CA	93907	8541	27	06053	36.80320219	-121.663727	Monterey County
266200	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	5/29/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
266206	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
266234	Fee-for-Service	1861442154	1861442154	1	1	PHAKLIDES, WILLIAM J MD	9/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	44825	40	Pediatrics	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
266270	Fee-for-Service	1376961896	1376961896	1	1	PARK, BRIAN	2/28/2024	2085R0204X	NA	Other	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
266276	Fee-for-Service	1497795496	1497795496	1	1	PETTY, ROBERT T DO	12/1/2003	207P00000X	NA	Other	026	PHYSICIANS	4256	08	Family Practice	0	In state provider	None	2210 ARRANTS ST	None	SELMA	CA	93662	3006	10	06019	36.57076953	-119.6141985	Fresno County
266277	Fee-for-Service	1861627242	1861627242	1	4	PLATINUM HOSPITALISTS LLP	12/21/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
266295	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
266296	Fee-for-Service	1982384327	1982384327	1	1	PANJAITAN, GABRIELLA J LMFT	8/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
266302	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266304	Fee-for-Service	1518546712	1518546712	1	1	PARANIAL, MATTHEW C MD	2/24/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
266346	Fee-for-Service	1467879452	1467879452	1	1	PIRAN, PIROUZ	5/11/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	170109	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
266348	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
266376	Fee-for-Service	1316544992	1316544992	1	1	PERFECTCARE LLC	5/29/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	17510 PIONEER BLVD	STE 205	ARTESIA	CA	90701	4075	19	06037	33.871527	-118.0821805	Los Angeles County
266378	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	12/30/2018	101YM0800X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
266380	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
266381	Fee-for-Service	1215428610	1215428610	1	1	PETERMAN, CAITLIN M MD	10/22/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	165168	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
266397	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
266399	Fee-for-Service	1780866319	1780866319	1	1	PRAGER, ALLEN B DPM PC	3/2/2010	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3771 S WESTERN AVE	None	LOS ANGELES	CA	90018	4436	19	06037	34.01862065	-118.3089466	Los Angeles County
266411	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
266412	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
266419	Fee-for-Service	1427180694	1427180694	1	1	PALM SPRINGS UNIFIED SCHOOL	6/24/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	33	06065	33.82485354	-116.4955129	Riverside County
266421	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	12/20/2018	103TC2200X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
266425	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
266435	Fee-for-Service	1518303338	1518303338	1	1	PASH, JOEL S DO	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12100	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266437	Fee-for-Service	1528835451	1528835451	1	1	PANXPRESS HEALTH INC	3/12/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40924A FREMONT BLVD	A	FREMONT	CA	94538	4375	01	06001	37.53379853	-121.9605788	Alameda County
266442	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266480	Fee-for-Service	1073192100	1073192100	1	1	PAK, JOSEPH S OD	7/7/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12234 PALMDALE RD	None	VICTORVILLE	CA	92392	9418	19	06037	34.509285	-117.396792	San Bernardino County
266486	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
266492	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
266498	Fee-for-Service	1770670200	1770670200	1	1	PEREZ RAMIREZ, LUIS A PSYD	4/23/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	870 MARKET STREET	SUITE 1150A	SAN FRANCISCO	CA	94102	3001	38	06075	37.7848184	-122.4070488	San Francisco County
266544	Fee-for-Service	1528202363	1528202363	1	1	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	0	In state provider	None	520 SUPERIOR AVE	STE 330	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
266551	Fee-for-Service	1215659909	1215659909	1	1	POZUN, CARA LMFT	8/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
266578	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	2/5/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
266586	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266593	Fee-for-Service	1518313659	1518313659	1	1	PHAM, DAN V MD	7/3/2019	208M00000X	NA	Other	026	PHYSICIANS	155606	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
266631	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
266633	Fee-for-Service	1578729851	1578729851	1	1	PATEL, HEENA R MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132444	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
266657	Fee-for-Service	1619971538	1619971538	1	1	PATEL, SHIRISH T MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90923	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	168 N BRENT ST	STE 503	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
266661	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
266665	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	4/22/2020	103T00000X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
266670	Fee-for-Service	1114028040	1114028040	1	1	PARIS, MARC D MD	12/1/2003	207PE0004X	NA	Other	026	PHYSICIANS	36070	66	Emergency Medicine (Urgent Care)	0	In state provider	HEALDSBURG GENERAL HOSP	1375 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3382	49	06097	38.627145	-122.863779	Sonoma County
266679	Fee-for-Service	1336107580	1336107580	1	1	POMERADO OUTPATIENT	3/1/2001	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGICAL CENTER LP	17190 BERNARDO CENTER DR	STE 100	SAN DIEGO	CA	92128	7031	37	06073	33.02473938	-117.0778645	San Diego County
266684	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
266691	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
266696	Fee-for-Service	1427180694	1427180694	1	1	PALM SPRINGS UNIFIED SCHOOL	12/18/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	33	06065	33.82485354	-116.4955129	Riverside County
266697	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
266705	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC2200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
266708	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	3/25/2020	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
266725	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266769	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	5/18/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
266784	Fee-for-Service	1104897495	1104897495	1	1	PARK, STEVEN K MD	8/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101465	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
266785	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
266809	Fee-for-Service	1740711449	1740711449	1	1	PURE BIRTHS INC	3/13/2018	261QB0400X	NA	Freestanding Birth Center	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	25880 TOURNAMENT RD	SUITE 109	VALENCIA	CA	91355	2349	19	06037	34.39184204	-118.5626441	Los Angeles County
266825	Fee-for-Service	1457321317	1457321317	1	6	PALOMAR HEALTH	9/11/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1509 E VALLEY PARKWAY	None	ESCONDIDO	CA	92027	2315	37	06073	33.131502	-117.059544	San Diego County
266830	Fee-for-Service	1528202363	1528202363	1	1	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	520 SUPERIOR AVE	STE 330	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
266859	Fee-for-Service	1255579272	1255579272	1	1	PATEL, ANITA MD INC	4/21/2009	2086S0122X	NA	General Surgery	026	PHYSICIANS	92098	24	Plastic Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 601	LOS ANGELES	CA	90017	4810	19	06037	34.05362775	-118.2661889	Los Angeles County
266863	Fee-for-Service	1235226531	1235226531	1	36	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
266867	Fee-for-Service	1154770543	1154770543	1	1	PARIKH, RUPAL MD	8/3/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	178110	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
266871	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
266887	Fee-for-Service	1750596326	1750596326	1	1	PURCHASE, ROBERT J MD	6/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97653	20	Orthopedic Surgery	0	In state provider	None	1801 COLORADO AVE	STE 250	TURLOCK	CA	95832	2710	50	06099	37.50941613	-120.8353105	Stanislaus County
266894	Fee-for-Service	1760879662	1760879662	1	1	PARIKH, DIVYA A MD	6/7/2021	207R00000X	NA	Other	026	PHYSICIANS	144695	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266898	Fee-for-Service	1720018237	1720018237	1	1	PENGSON, JOEL A MD	9/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72774	41	Internal Medicine	0	In state provider	None	13050 HEACOCK ST	None	MORENO VALLEY	CA	92553	3122	33	06065	33.931386	-117.243772	Riverside County
266903	Fee-for-Service	1023137304	1023137304	1	1	PEREZ, BENZION I LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
266917	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	12/16/2008	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
266925	Fee-for-Service	1265621791	1265621791	1	1	PASCHALL, ERIK S MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103383	41	Internal Medicine	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
266941	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	4/22/2020	101YM0800X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
266949	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	11/7/2018	103T00000X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
266972	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
266974	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
266981	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
266990	Fee-for-Service	1548343510	1548343510	1	9	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC2200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
266992	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	9/12/2018	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
267010	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	4/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267029	Fee-for-Service	1003885518	1003885518	1	1	PLANNED PARENTHOOD	9/14/2000	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERN CO	1873 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3303	36	06071	34.067781	-117.286122	San Bernardino County
267055	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
267056	Fee-for-Service	1740673748	1740673748	1	1	PERROTTI, ALEXANDER E LMFT	1/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3662 LICHAU RD	None	PENNGROVE	CA	94951	8720	49	06097	38.333241	-122.641434	Sonoma County
267061	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
267088	Fee-for-Service	1477962595	1477962595	1	1	PHILLIPS, LASHUNDA K NP	5/13/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2919 FRUITVALE AVE	None	OAKLAND	CA	94602	2108	01	06001	37.79351912	-122.2188931	Alameda County
267113	Fee-for-Service	1528202363	1528202363	1	1	PREMIER CARDIOLOGY INC	3/17/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	520 SUPERIOR AVE	STE 330	NEWPORT BEACH	CA	92663	3637	30	06059	33.628914	-117.9276525	Orange County
267157	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267190	Fee-for-Service	1801222120	1801222120	1	1	PHILLIPS MEDSTONE APC	10/28/2014	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5333 MISSION CENTER RD	SUITE 100	SAN DIEGO	CA	92108	1347	37	06073	32.77178608	-117.1547851	San Diego County
267194	Fee-for-Service	1013448125	1013448125	1	1	PARIKH, AMAR MD	8/16/2023	207R00000X	NA	Other	026	PHYSICIANS	185296	None	None	0	In state provider	None	9808 VENICE BLVD	SUITE 603	CULVER CITY	CA	90232	6819	19	06037	34.0236396	-118.3980847	Los Angeles County
267199	Fee-for-Service	1851454037	1851454037	1	1	PLUMAS COUNTY HEALTH SVS	9/15/1997	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	270 COUNTY HOSPITAL RD	None	QUINCY	CA	95971	9126	32	06063	39.95246516	-120.9635967	Plumas County
267201	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	11/7/2018	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
267216	Fee-for-Service	1821635319	1821635319	1	1	PEREZ, JOSE R	7/6/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
267224	Fee-for-Service	1063587152	1063587152	1	1	POSERIA, NUTAN MD	8/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52289	41	Internal Medicine	0	In state provider	None	770 EAST CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
267228	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	10/8/2018	101YM0800X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
267233	Fee-for-Service	1922174085	1922174085	1	1	PENKALA, MICHELE M MD	7/31/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	75202	66	Emergency Medicine (Urgent Care)	0	In state provider	PERMANENTE MEDICAL GROUP	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
267234	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	11/30/2018	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
267250	Fee-for-Service	1558460634	1558460634	1	1	PARDAVE, RAUL A MD	7/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45243	08	Family Practice	0	In state provider	None	1530 E CHEVY CHASE DR	207	GLENDALE	CA	91206	4163	19	06037	34.150689	-118.2303855	Los Angeles County
267252	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
267260	Fee-for-Service	1871752956	1871752956	1	1	POLLEMA, TRAVIS L DO	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12742	01	General Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
267261	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	12/9/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
267265	Fee-for-Service	1477540599	1477540599	1	1	PENG, JIUN-RONG MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34348	02	General Surgery	0	In state provider	None	280 SOUTH MAIN STREET	STE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
267266	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
267278	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	3/31/2020	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
267283	Fee-for-Service	1326401621	1326401621	1	1	PIZULA, JENA R MD	8/28/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	152361	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
267286	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
267292	Fee-for-Service	1457664427	1457664427	1	1	PLETT, SARA K MD	2/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	119969	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
267293	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	3/31/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267331	Fee-for-Service	1033539150	1033539150	1	1	PHAN, KEVIN H MD	2/26/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171292	None	None	0	In state provider	None	8805 HAVEN AVE	SUITE 200	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
267336	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	11/14/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
267345	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
267374	Fee-for-Service	1871824037	1871824037	1	1	PATHCENTRAL INC	2/14/2011	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	213 TECHNOLOGY DRIVE	SUITE 200	IRVINE	CA	92618	2439	30	06059	33.66691335	-117.7501851	Orange County
267380	Fee-for-Service	1407359458	1407359458	1	1	PERSON 2 PERSON TRANSPORTATI	10/31/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON LLC	2830 BRAVADO	F	RANCHO CORDOVA	CA	95670	1936	34	06067	38.58345	-121.317021	Sacramento County
267388	Fee-for-Service	1184131948	1184131948	1	1	PYO, STELLA CNP	4/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
267390	Fee-for-Service	1801950498	1801950498	1	1	PESHIMAM, MAHMOOD MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36540	08	Family Practice	0	In state provider	None	10900 WARNER AVE	STE 115	FOUNTAIN VALLEY	CA	92708	3846	30	06059	33.71628153	-117.9388215	Orange County
267402	Fee-for-Service	1427067537	1427067537	1	1	PHAM, PHUONG-ANH T MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62741	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
267430	Fee-for-Service	1295977601	1295977601	1	1	PIERCE, TIFFANY M MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105539	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
267438	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267463	Fee-for-Service	1518143924	1518143924	1	1	PANIAGUA, ROSE M LMFT	9/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
267473	Fee-for-Service	1477623635	1477623635	1	1	PHAM, KEVIN MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67209	41	Internal Medicine	0	In state provider	None	500 S MAIN ST	STE 101	ORANGE	CA	92868	4535	30	06059	33.77991974	-117.8674745	Orange County
267483	Fee-for-Service	1447251145	1447251145	1	1	PAVIA, JOSE M MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43068	08	Family Practice	0	In state provider	None	13768 ROSWELL AVE	STE 101	CHINO	CA	91710	1401	36	06071	34.0038	-117.7218555	San Bernardino County
267484	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	12/20/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
267511	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	2/24/2020	101YM0800X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
267519	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	10/8/2018	103T00000X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
267535	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
267541	Fee-for-Service	1548343510	1548343510	1	14	PERMANENTE MEDICAL GROUP INC	2/11/2013	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
267542	Fee-for-Service	1730300070	1730300070	1	1	PASILLAS, JOE N LMFT	7/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
267548	Fee-for-Service	1477540599	1477540599	1	1	PENG, JIUN-RONG MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34348	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN STREET	STE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
267549	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
267554	Fee-for-Service	1427388362	1427388362	1	1	PEDTKE, ANDREW C MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110231	20	Orthopedic Surgery	0	In state provider	None	255 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.3639177	-121.8490241	Santa Clara County
267562	Fee-for-Service	1073606299	1073606299	1	28	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
267568	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
267575	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267592	Fee-for-Service	1386802056	1386802056	1	1	PRIMARY CRITICAL CARE	8/1/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	LIMITED PARTNERSHIP	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
267620	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	7/30/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
267631	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
267633	Fee-for-Service	1588656268	1588656268	1	6	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	900 HOPPER ST	None	PETALUMA	CA	94952	3388	49	06097	38.23409061	-122.6245587	Sonoma County
267635	Fee-for-Service	1902099146	1902099146	1	1	PATEL, KALPESH S MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101127	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
267636	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	9/25/2018	152W00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
267645	Fee-for-Service	1740875590	1740875590	1	1	PRIMARY AID HOME HEALTH INC	10/31/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 349	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
267681	Fee-for-Service	1427067537	1427067537	1	1	PHAM, PHUONG-ANH T MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62741	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
267689	Fee-for-Service	1144508201	1144508201	1	1	PRAKOBKIT, RITBUNE MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123959	41	Internal Medicine	0	In state provider	None	450 STANYON STREET	6TH FLOOR	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
267693	Fee-for-Service	1467847079	1467847079	1	1	PERSONAL HEARING SOLUTIONS	12/14/2023	332S00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
267696	Fee-for-Service	1144758467	1144758467	1	1	POWIERZA, THOMAS MD	9/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2874 N CARSON STREET,	SUITE 300	CARSON CITY	NV	89706	1683	00	None	39.185271	-119.7710595	Consolidated Municipality of Carson City
267709	Fee-for-Service	1174774905	1174774905	1	1	PANAHI, GHAROON MD INC	2/11/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34894	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 157	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
267722	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	10/26/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267744	Fee-for-Service	1699962688	1699962688	1	1	PEDIATRIC MEDICAL ASSOCIATES	2/11/2011	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	OF ORANGE COUNTY INC	1211 W LA PALMA AVE	STE 401	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
267753	Fee-for-Service	1477623635	1477623635	1	1	PHAM, KEVIN MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	67209	45	Nephrology (Renal-Kidney)	0	In state provider	None	500 S MAIN ST	STE 101	ORANGE	CA	92868	4535	30	06059	33.77991974	-117.8674745	Orange County
267754	Fee-for-Service	1639597081	1639597081	1	1	PATEL, ANIK DO	5/13/2019	390200000X	NA	Other	026	PHYSICIANS	14209	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
267766	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	7/20/2019	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
267793	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	4/27/2017	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
267794	Fee-for-Service	1942692777	1942692777	1	1	PACIFIC PERINATAL INSTITUTE	12/21/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
267800	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	10/29/2018	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
267804	Fee-for-Service	1669557930	1669557930	1	1	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1180 BROADWAY ST	None	KING CITY	CA	93930	3602	27	06053	36.20487971	-121.1387748	Monterey County
267816	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
267830	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
267838	Fee-for-Service	1144421082	1144421082	1	1	PATIL, SHILPA S. MD	12/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84592	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
267851	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
267858	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	3/25/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
267883	Fee-for-Service	1336730431	1336730431	1	1	PEDRO EVA, M.D. PSYCHIATRIC	2/12/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	CONSULTANT, INC.	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
267886	Fee-for-Service	1063533677	1063533677	1	1	PENAILILLO, CECILIA C LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
267894	Fee-for-Service	1881765790	1881765790	1	1	PRIETO, RAUL R	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62172	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
267904	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	3/25/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
267916	Fee-for-Service	1588656268	1588656268	1	6	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	900 HOPPER ST	None	PETALUMA	CA	94952	3388	49	06097	38.23409061	-122.6245587	Sonoma County
267918	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
267920	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	2/5/2019	152W00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
267966	Fee-for-Service	1427067537	1427067537	1	1	PHAM, PHUONG-ANH T MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62741	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
267976	Fee-for-Service	1467847079	1467847079	1	1	PERSONAL HEARING SOLUTIONS	12/14/2023	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
267978	Fee-for-Service	1184624363	1184624363	1	1	PEREZ, JOSE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4330 MEDICAL DR	STE 500	SAN ANTONIO	TX	78229	3318	00	None	29.51083557	-98.57095526	Bexar County
267981	Fee-for-Service	1821311804	1821311804	1	1	PARKER, ANDREA L NP	11/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
268006	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268040	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
268048	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	10/29/2018	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
268052	Fee-for-Service	1922069087	1922069087	1	1	PACIFIC RIM PATHOLOGY MEDICA	10/7/1997	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
268076	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	10/29/2018	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
268084	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	2/24/2020	103T00000X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
268086	Fee-for-Service	1669557930	1669557930	1	1	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1180 BROADWAY ST	None	KING CITY	CA	93930	3602	27	06053	36.20487971	-121.1387748	Monterey County
268100	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
268114	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
268122	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
268126	Fee-for-Service	1184721284	1184721284	1	2	PARKER, PETER J MD INC	6/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44924	03	Allergy	0	In state provider	None	414 N CAMDEN DR	STE 975	BEVERLY HILLS	CA	90210	4541	19	06037	34.06880486	-118.4042308	Los Angeles County
268133	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
268139	Fee-for-Service	1356366009	1356366009	1	1	PENNINGTON, TROY W DO	8/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7909	None	None	0	In state provider	None	3001 SILLECT AVE	STE D	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
268142	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268163	Fee-for-Service	1609839083	1609839083	1	1	PETTY, KENNETH G MD	5/19/2005	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	84641	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
268170	Fee-for-Service	1487959433	1487959433	1	1	PHAN, TIFFANY H MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133920	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
268183	Fee-for-Service	1043462971	1043462971	1	1	PELAYO, RAQUEL MD	10/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105985	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
268189	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	10/22/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
268197	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
268203	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
268224	Fee-for-Service	1629545348	1629545348	1	1	PEREZ, KEN H PSYD	7/26/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
268229	Fee-for-Service	1558687202	1558687202	1	1	PATANGAY, GUNJAN MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119036	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
268249	Fee-for-Service	1245242155	1245242155	1	1	PUSATERI, DAVID T MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81449	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
268273	Fee-for-Service	1376705517	1376705517	1	1	PRICE, CHILESHE N MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140234	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	43112 15TH STREET	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
268287	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268321	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
268323	Fee-for-Service	1598247991	1598247991	1	1	PAVEL V PETRIK MEDICAL CORPO	8/18/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	RATION	44725 10TH STREET WEST	STE 120	LANCASTER	CA	93534	3051	19	06037	34.695693	-118.1480965	Los Angeles County
268332	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	2/24/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
268337	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
268358	Fee-for-Service	1679836076	1679836076	1	1	PIVARAL ESTURBAN, GABRIELA	6/21/2024	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
268359	Fee-for-Service	1750639993	1750639993	1	1	PHAM, JOHN P MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123403	01	General Practice	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2614	43	06085	37.313433	-121.9318385	Santa Clara County
268366	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	12/30/2018	103T00000X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
268369	Fee-for-Service	1669557930	1669557930	1	1	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1180 BROADWAY ST	None	KING CITY	CA	93930	3602	27	06053	36.20487971	-121.1387748	Monterey County
268372	Fee-for-Service	1548343510	1548343510	1	45	PERMANENTE MEDICAL GROUP INC	11/7/2018	101YM0800X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HIGHWAY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
268384	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
268394	Fee-for-Service	1245394618	1245394618	1	1	PAPPAS, CHRISTOPHER	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
268396	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
268405	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
268408	Fee-for-Service	1184721284	1184721284	1	2	PARKER, PETER J MD INC	6/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44924	43	Pediatric Allergy	0	In state provider	None	414 N CAMDEN DR	STE 975	BEVERLY HILLS	CA	90210	4541	19	06037	34.06880486	-118.4042308	Los Angeles County
268416	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
268425	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	10/18/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268457	Fee-for-Service	1588649453	1588649453	1	1	PENNY J WILLIAMS MD	3/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	0000	00	None	33.486606	-112.071654	Maricopa County
268467	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	7/25/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
268476	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
268485	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	3/9/2016	152W00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
268549	Fee-for-Service	1194733436	1194733436	1	1	PRENTICE, THEODORE C JR	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	38015	13	Neurology (M.D. only)	0	In state provider	None	11525 BROOKSHIRE AVE	STE 400	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
268572	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268600	Fee-for-Service	1932468543	1932468543	1	1	PATJAWEE, MATTHEW A	8/28/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
268601	Fee-for-Service	1508902297	1508902297	2	1	PUROHIT, GIRDHARI S	5/22/1998	174400000X	NA	Other	026	PHYSICIANS	36387	None	None	0	In state provider	None	395 N SAN JACINTO ST	STE B	HEMET	CA	92543	3109	33	06065	33.752547	-116.958686	Riverside County
268606	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	3/25/2020	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
268614	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	2/11/2013	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
268615	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
268635	Fee-for-Service	1962783704	1962783704	1	1	PROHEALTH PARTNERS A MEDICAL	10/25/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3801 KATELLA AVENUE	SUITE 300	LOS ALAMITOS	CA	90720	3338	30	06059	33.80318951	-118.066068	Orange County
268647	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	7/20/2019	103T00000X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
268667	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
268672	Fee-for-Service	1073835831	1073835831	1	1	PAE, SARAH J MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121588	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
268680	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
268686	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
268694	Fee-for-Service	1578833190	1578833190	1	1	PAPPAS, JONATHAN LMFT	10/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E THOUSAND OAKS BLVD	STE 236	THOUSAND OAKS	CA	91360	8178	56	06111	34.17902886	-118.8749335	Ventura County
268700	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
268707	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268753	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	5/18/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
268758	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
268761	Fee-for-Service	1053363119	1053363119	1	1	PROVIDENCE HEALTH & SERVICES	8/1/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	3200 PROVIDENCE DR	None	ANCHORAGE	AK	99508	4615	00	None	61.188354	-149.8187475	Municipality of Anchorage
268767	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	3/9/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
268797	Fee-for-Service	1629736715	1629736715	1	1	PALM VIEW PLEASANT LIVING	3/17/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	710 N CHURCH STREET	None	REDLANDS	CA	92374	3538	36	06071	34.06175763	-117.1737388	San Bernardino County
268801	Fee-for-Service	1578190146	1578190146	1	1	PEARSON, NOLAN R MD	7/1/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	186043	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
268810	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	2/11/2013	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
268828	Fee-for-Service	1043472640	1043472640	1	1	PHAN, PHU G MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118484	36	Psychiatry	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
268834	Fee-for-Service	1992892707	1992892707	1	1	PRATHA,VIJAYALAKSHMI MD	12/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	51136	10	Gastroenterology (M.D. only)	0	In state provider	SURYA, A MED CORP	3330 3RD AVE	STE 304	SAN DIEGO	CA	92103	5639	37	06073	32.74053588	-117.1622264	San Diego County
268836	Fee-for-Service	1447598354	1447598354	1	1	PENA LEDON, GILBERTO NP	11/27/2017	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268852	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
268857	Fee-for-Service	1467536144	1467536144	1	1	PANZARELLA, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 GARTH RD	None	BAYTOWN	TX	77521	2122	00	None	29.76910842	-94.97759843	Harris County
268870	Fee-for-Service	1306978945	1306978945	2	1	PORT CITY OPERATING COMPANY	6/1/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	3555 DEER PARK DR	100	STOCKTON	CA	95219	2379	39	06077	37.98695468	-121.3523032	San Joaquin County
268874	Fee-for-Service	1457882821	1457882821	1	1	PATEL, KRUPAL MD	4/8/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
268888	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
268897	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	10/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
268905	Fee-for-Service	1538267778	1538267778	1	1	PRATHIPATI, KUMARA S MD	12/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	40438	41	Internal Medicine	0	In state provider	None	4276 54TH PL	STE B	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
268906	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
268918	Fee-for-Service	1043700776	1043700776	1	1	PATTATHU, ROSHNY MD	11/20/2018	261Q00000X	NA	Other	026	PHYSICIANS	106185	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
268929	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	10/3/2012	103T00000X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
268948	Fee-for-Service	1235226531	1235226531	1	5	PERMANENTE MEDICAL GROUP INC	7/9/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
268949	Fee-for-Service	1710465521	1710465521	1	1	PARKER, FELONDA RCP	8/27/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
268957	Fee-for-Service	1346277605	1346277605	1	1	POA, LI MD	11/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76922	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1430 ESPLANADE	STE 10	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
268960	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
268968	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
268979	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
268991	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269018	Fee-for-Service	1538333513	1538333513	1	1	PODLISKA, MEDY CNP	6/1/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
269023	Fee-for-Service	1215379003	1215379003	1	2	PUGH, ESTHER T	7/1/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
269029	Fee-for-Service	1730234709	1730234709	1	1	PHILLIPS, MICHAEL B CP	7/13/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	24475 SUNNYMEAD BLVD	None	MORENO VALLEY	CA	92533	9313	33	06065	33.93903053	-117.23616	Riverside County
269035	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
269040	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
269042	Fee-for-Service	1558464990	1558464990	1	1	PHILLIPS, TRACY T MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84062	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
269044	Fee-for-Service	1053363119	1053363119	1	1	PROVIDENCE HEALTH & SERVICES	8/1/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	3200 PROVIDENCE DR	None	ANCHORAGE	AK	99508	4615	00	None	61.188354	-149.8187475	Municipality of Anchorage
269049	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	9/11/2012	152W00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
269059	Fee-for-Service	1154390144	1154390144	1	1	PYUN, CATHERINE K DO	6/20/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	6823	41	Internal Medicine	0	In state provider	None	3918 HANLY RD	None	OAKLAND	CA	94602	1827	01	06001	37.80753313	-122.2143877	Alameda County
269092	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	4/22/2020	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
269136	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269168	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
269179	Fee-for-Service	1548343510	1548343510	1	16	PERMANENTE MEDICAL GROUP INC	4/6/2016	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
269182	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
269187	Fee-for-Service	1033140058	1033140058	1	1	PERL ADATTO, LINDA L MD	10/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60159	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
269209	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
269226	Fee-for-Service	1225173180	1225173180	1	1	PACIFIC CLINICS	8/29/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11741 E TELEGRAPH ROAD	SUITE G	SANTA FE SPRINGS	CA	90670	3687	19	06037	33.9462235	-118.0830161	Los Angeles County
269233	Fee-for-Service	1275513293	1275513293	1	1	PARADISE VALLEY HEALTH	7/1/1992	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER INC	2575 E 8TH ST	None	NATIONAL CITY	CA	91950	2913	37	06073	32.68334765	-117.0802385	San Diego County
269239	Fee-for-Service	1346277605	1346277605	1	1	POA, LI MD	11/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76922	05	Anesthesiology	0	In state provider	None	1430 ESPLANADE	STE 10	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
269240	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
269248	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	6/15/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
269259	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	8/10/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
269265	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
269269	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	11/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269296	Fee-for-Service	1114007432	1114007432	1	2	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	SPECIALISTS MED GROUP	3100 DOUGLAS BLVD	STE 105	ROSEVILLE	CA	95661	3868	31	06061	38.74399612	-121.2349547	Placer County
269307	Fee-for-Service	1669965349	1669965349	1	1	PETIT AVE INC	8/6/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6719 QUAKERTOWN AVE	None	WINNETKA	CA	91306	4336	19	06037	34.19264499	-118.5698899	Los Angeles County
269308	Fee-for-Service	1427437227	1427437227	1	1	PARINA, RALITZA P MD	5/20/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	177319	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
269310	Fee-for-Service	1962935783	1962935783	1	1	PATADIA, SASHA MD	12/21/2021	208M00000X	NA	Other	026	PHYSICIANS	165704	None	None	0	In state provider	None	350 30TH ST	100	OAKLAND	CA	94609	3422	01	06001	37.81892183	-122.2640154	Alameda County
269311	Fee-for-Service	1619965357	1619965357	1	1	PREVOST HEALTHCARE	3/28/1991	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ENTERPRISES, INC	9909 COMPTON AVE	None	LOS ANGELES	CA	90002	2850	19	06037	33.946623	-118.2462895	Los Angeles County
269320	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
269322	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	10/15/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
269324	Fee-for-Service	1497068100	1497068100	1	1	PERERA, ISIRA A MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125288	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE #450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
269328	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
269341	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	10/22/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
269343	Fee-for-Service	1891324356	1891324356	1	1	PATEL, PUJA	4/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21533	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
269344	Fee-for-Service	1104875343	1104875343	1	1	PREMIER EMERGENCY	9/1/2004	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS OF CA MED GR	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
269366	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
269370	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	9/20/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
269376	Fee-for-Service	1417182593	1417182593	1	1	PURKEY, MICHAEL T MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128700	04	Otology, Laryngology, Rhinology	0	In state provider	None	2581 SAMARITAN DR	None	SAN JOSE	CA	95124	4112	43	06085	37.25305684	-121.9507351	Santa Clara County
269398	Fee-for-Service	1144516295	1144516295	1	1	PECKSON, LOUELLA MD INC	4/12/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53093	None	None	0	In state provider	None	14624 SHERMAN WAY	SUITE 401	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
269413	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269445	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	11/7/2013	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
269449	Fee-for-Service	1043276405	1043276405	2	1	PHILLIPS, NABIL A MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	46495	78	Neoplastic Diseases/Oncology	0	In state provider	None	1100 N TUSTIN AVENUE	SUITE A	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
269462	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
269475	Fee-for-Service	1144210253	1144210253	1	1	PROVIDENCE HOSPITAL AND	5/1/1996	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	16001 W 9 MILE RD	None	SOUTHFIELD	MI	48075	4803	00	None	42.45919085	-83.20518283	Oakland County
269490	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
269516	Fee-for-Service	1386293363	1386293363	1	1	PALACIOS, CHELSEA CRNA	5/28/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
269517	Fee-for-Service	1346277605	1346277605	1	1	POA, LI MD	11/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76922	33	Thoracic Surgery	0	In state provider	None	1430 ESPLANADE	STE 10	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
269518	Fee-for-Service	1033798202	1033798202	1	1	PHAK, DAVID MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	181814	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
269520	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
269528	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
269529	Fee-for-Service	1922363183	1922363183	1	2	PARK, SAMUEL MD	6/22/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127125	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
269539	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	4/6/2017	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
269547	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
269548	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269551	Fee-for-Service	1053613380	1053613380	1	1	PARSONS, ANDREA E LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
269576	Fee-for-Service	1114007432	1114007432	1	2	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SPECIALISTS MED GROUP	3100 DOUGLAS BLVD	STE 105	ROSEVILLE	CA	95661	3868	31	06061	38.74399612	-121.2349547	Placer County
269587	Fee-for-Service	1659902922	1659902922	1	1	PACIFIC COAST HOSPICE INC	12/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20953 DEVONSHIRE ST	STE 8B	CHATSWORTH	CA	91311	2371	19	06037	34.25728152	-118.5904935	Los Angeles County
269593	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	5/16/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
269594	Fee-for-Service	1679228183	1679228183	1	1	PINE DRUG HOLDINGS LLC	3/28/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 E KATELLA AVE	C	ORANGE	CA	92867	5089	30	06059	33.80915349	-117.83844	Orange County
269600	Fee-for-Service	1548343510	1548343510	1	55	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7309	39	06077	37.75489119	-121.4665269	San Joaquin County
269608	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	11/30/2018	152W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
269622	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	3/7/2022	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
269629	Fee-for-Service	1356394175	1356394175	1	5	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	405 N MACLAY AVE	STE 104	SAN FERNANDO	CA	91340	2445	19	06037	34.28673788	-118.4367207	Los Angeles County
269645	Fee-for-Service	1114534542	1114534542	1	1	PHAM, JACQUELINE CNP	4/27/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
269647	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	9/20/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
269648	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
269695	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269726	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
269728	Fee-for-Service	1043276405	1043276405	2	1	PHILLIPS, NABIL A MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	46495	68	Hematology	0	In state provider	None	1100 N TUSTIN AVENUE	SUITE A	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
269733	Fee-for-Service	1720377856	1720377856	1	1	PEZOLD, MICHAEL L MD	8/3/2020	2086S0129X	NA	General Surgery	026	PHYSICIANS	168740	02	General Surgery	0	In state provider	None	121 SOTOYOME ST	STE 203	SANTA ROSA	CA	95405	4822	49	06097	38.44224	-122.70195	Sonoma County
269739	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
269757	Fee-for-Service	1144210253	1144210253	1	1	PROVIDENCE HOSPITAL AND	8/29/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	16001 W 9 MILE RD	None	SOUTHFIELD	MI	48075	4803	00	None	42.45919085	-83.20518283	Oakland County
269768	Fee-for-Service	1548343510	1548343510	1	52	PERMANENTE MEDICAL GROUP INC	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
269798	Fee-for-Service	1447872288	1447872288	1	1	PERROT, ROSALIE MD	9/12/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	184954	None	None	0	In state provider	None	8170 LAGUNA BLVD	STE 210	ELK GROVE	CA	95758	7902	34	06067	38.421054	-121.405365	Sacramento County
269801	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
269807	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
269818	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
269823	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
269827	Fee-for-Service	1073606299	1073606299	1	31	PERMANENTE MEDICAL GROUP INC	11/7/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
269854	Fee-for-Service	1114007432	1114007432	1	2	PERINATAL & PEDIATRIC	7/7/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	SPECIALISTS MED GROUP	3100 DOUGLAS BLVD	STE 105	ROSEVILLE	CA	95661	3868	31	06061	38.74399612	-121.2349547	Placer County
269864	Fee-for-Service	1659902922	1659902922	1	1	PACIFIC COAST HOSPICE INC	12/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20953 DEVONSHIRE ST	STE 8B	CHATSWORTH	CA	91311	2371	19	06037	34.25728152	-118.5904935	Los Angeles County
269868	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
269884	Fee-for-Service	1710373162	1710373162	1	1	PRESSOIR, KATHLEEN	2/2/2024	207UN0901X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	17420	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
269888	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	5/3/2019	152W00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
269896	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/9/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
269926	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
269929	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	2/24/2020	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
269941	Fee-for-Service	1063182822	1063182822	1	1	PANDYA, BHUMIKA OD	10/6/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
269946	Fee-for-Service	1366855124	1366855124	1	1	PROSTHETIC & ORTHOTICS	10/28/2016	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	MANAGEMENT INC	75150 SHERYL AVE	STE A	PALM DESERT	CA	92211	5118	33	06065	33.73771849	-116.353764	Riverside County
269971	Fee-for-Service	1073606299	1073606299	1	22	PERMANENTE MEDICAL GROUP INC	12/29/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
270006	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	4/24/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
270020	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
270049	Fee-for-Service	1235421710	1235421710	1	1	PRESS, OLIVER A MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119630	22	Pathology (M.D. only)	0	In state provider	None	400 PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
270051	Fee-for-Service	1477940997	1477940997	1	1	PREMKUMAR, MUKUND MD	9/4/2019	390200000X	NA	Other	026	PHYSICIANS	162649	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
270073	Fee-for-Service	1750321378	1750321378	1	1	PABERS, JOHN M	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74686	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
270076	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
270084	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	5/18/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
270086	Fee-for-Service	1801944616	1801944616	1	1	PHAM, NICOLE M MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68978	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
270095	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
270101	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
270103	Fee-for-Service	1487152740	1487152740	1	2	PARAMEDICS LOGISTICS CALIFOR	2/20/2019	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	38505 CHERRY ST	STE A	NEWARK	CA	94560	4700	01	06001	37.521738	-122.016978	Alameda County
270125	Fee-for-Service	1043396708	1043396708	1	1	POWELL, HEIDI S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4245 ROOSEVELT WAY NE	None	SEATTLE	WA	98105	6008	00	None	47.65883901	-122.3177928	King County
270132	Fee-for-Service	1740574557	1740574557	1	1	PERDONCIN, EMILY MD	9/9/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	177476	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
270134	Fee-for-Service	1760570600	1760570600	1	15	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	DICAL GROUP	1035 JEFFERSON BLVD	1	WEST SACRAMENTO	CA	95691	3343	57	06113	38.57339903	-121.523861	Yolo County
270146	Fee-for-Service	1255359964	1255359964	1	1	PANOSSIAN, VAHE MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66450	20	Orthopedic Surgery	0	In state provider	None	10 CONGRESS ST	STE 103	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
270147	Fee-for-Service	1073606299	1073606299	1	34	PERMANENTE MEDICAL GROUP INC	2/4/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
270165	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	2/5/2019	152W00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
270177	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/9/2021	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
270178	Fee-for-Service	1912990870	1912990870	1	1	PETERS, EDWIN E MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72982	40	Pediatrics	0	In state provider	None	PUEBLO AT BATH STREET	None	SANTA BARBARA	CA	93102	0000	42	06083	34.430526	-119.72196	Santa Barbara County
270193	Fee-for-Service	1144373408	1144373408	1	1	PHAN, HY V MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56033	36	Psychiatry	0	In state provider	None	10717 CAMINO RUIZ	SUITE 207	SAN DIEGO	CA	92126	2364	37	06073	32.91373261	-117.1437822	San Diego County
270203	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
270205	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	11/7/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
270226	Fee-for-Service	1659029965	1659029965	1	1	PLAYA CONCHAL LLC	5/2/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	361 E GRANGEVILLE BLVD	None	HANFORD	CA	93230	3054	16	06031	36.3426485	-119.641959	Kings County
270236	Fee-for-Service	1801203724	1801203724	1	1	PITTS, JENNIFER M MD	7/11/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185395	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
270252	Fee-for-Service	1649315292	1649315292	1	1	PAYNE, CHRISTOPHER MD	11/30/1991	208800000X	NA	Other	026	PHYSICIANS	74299	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
270258	Fee-for-Service	1700825205	1700825205	1	1	POLSFUSS, GARY R, MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66536	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
270266	Fee-for-Service	1770954711	1770954711	1	1	PALMER, KARRIE L LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
270284	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
270296	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
270355	Fee-for-Service	1548343510	1548343510	1	44	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	504 GIBSON DR	None	ROSEVILLE	CA	95678	5791	31	06061	38.77842304	-121.274421	Placer County
270362	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	8/8/2017	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
270363	Fee-for-Service	1962422709	1962422709	1	1	PACIFIC EYE INSTITUTE	4/30/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
270370	Fee-for-Service	1740553775	1740553775	1	1	PARKS, DAVID J MD INC	11/4/2013	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78517	18	Ophthalmology	0	In state provider	None	8920 WILSHIRE BLVD	SUITE 500	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
270373	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
270379	Fee-for-Service	1356394175	1356394175	1	3	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
270381	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
270389	Fee-for-Service	1447573472	1447573472	1	1	PARIKH, MEGHAL V MD INC	6/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110325	83	Rheumatology	0	In state provider	None	2908 G STREET	SUITE C	MERCED	CA	95340	2106	24	06047	37.31214885	-120.4693265	Merced County
270401	Fee-for-Service	1992956387	1992956387	1	1	PLAMBECK, KATHERINE L PSYD	11/2/2017	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
270413	Fee-for-Service	1760570600	1760570600	1	15	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	DICAL GROUP	1035 JEFFERSON BLVD	1	WEST SACRAMENTO	CA	95691	3343	57	06113	38.57339903	-121.523861	Yolo County
270434	Fee-for-Service	1447362686	1447362686	1	1	PARKS, BARNETT R OD	12/31/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	377 E COLORADO BLVD	None	PASADENA	CA	91101	1909	19	06037	34.1459133	-118.142582	Los Angeles County
270440	Fee-for-Service	1285041145	1285041145	1	1	POUPENEY, PADDY R LMFT	7/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
270444	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	11/30/2018	152W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
270464	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	7/21/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
270474	Fee-for-Service	1699090696	1699090696	1	1	PROFESSIONAL INHOME CARE	12/10/2010	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	25050 AVENUE KEARNEY	#201	VALENCIA	CA	91355	1253	19	06037	34.43522953	-118.5721617	Los Angeles County
270478	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
270483	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	10/29/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
270507	Fee-for-Service	1306879283	1306879283	1	1	PHAN, MAI T MD	4/1/1994	207R00000X	NA	Other	026	PHYSICIANS	51466	01	General Practice	0	In state provider	A PROFESSIONAL CORP	18625 SHERMAN WAY	STE 104	RESEDA	CA	91335	4183	19	06037	34.20121398	-118.5393529	Los Angeles County
270515	Fee-for-Service	1881793313	1881793313	1	1	PENNY LANE CENTERS	6/20/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
270559	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	11/8/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
270570	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
270582	Fee-for-Service	1790715795	1790715795	1	1	PORRAS, JORGE F MD	2/18/2009	2084P0805X	NA	Psychiatry	026	PHYSICIANS	50395	36	Psychiatry	0	In state provider	None	152 C AVE	None	CORONADO	CA	92118	1940	37	06073	32.6973124	-117.1717384	San Diego County
270630	Fee-for-Service	1730412941	1730412941	1	1	PARRY, DANA L CNM	7/17/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	333 LAWS AVE	None	UKIAH	CA	95482	6540	23	06045	39.12772164	-123.2111168	Mendocino County
270639	Fee-for-Service	1962422709	1962422709	1	1	PACIFIC EYE INSTITUTE	7/31/2019	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
270640	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	11/18/2016	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
270645	Fee-for-Service	1255561726	1255561726	1	1	POPA-RADU, MATEI DO	5/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16191	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4646 BROCKTON AVENUE	SUITE 301	RIVERSIDE	CA	92506	0103	33	06065	33.9760171	-117.3860626	Riverside County
270654	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
270657	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
270658	Fee-for-Service	1356394175	1356394175	1	3	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
270660	Fee-for-Service	1538742903	1538742903	1	1	PLAZA, NOEMI MD	2/2/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
270679	Fee-for-Service	1093126922	1093126922	1	1	PHAM, THU Q MD	10/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149445	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
270684	Fee-for-Service	1437238342	1437238342	1	1	PHAN, DENNIS NAMPHONG MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76704	41	Internal Medicine	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
270699	Fee-for-Service	1922115856	1922115856	1	1	PARIKH, MEGHAL MD	4/30/2021	207RR0500X	NA	Other	026	PHYSICIANS	110325	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
270711	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
270723	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	1/1/1979	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
270734	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/19/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
270754	Fee-for-Service	1982761532	1982761532	1	1	PIERCE, MELISSA J LMFT	6/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6 GOVERNORS LANE	None	CHICO	CA	95926	5590	04	06007	39.75531581	-121.8582802	Butte County
270756	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
270763	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
270770	Fee-for-Service	1508961004	1508961004	1	1	PATKA, JAMES B MD	12/1/1995	207L00000X	NA	Other	026	PHYSICIANS	34633	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
270776	Fee-for-Service	1568538445	1568538445	1	1	PLANNED PARENTHOOD/WORLD	12/1/1977	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ALAMEDA-SAN FRANCISC	815 EDDY ST	# 200	SAN FRANCISCO	CA	94109	7701	38	06075	37.78276173	-122.4215496	San Francisco County
270777	Fee-for-Service	1306070826	1306070826	1	1	PRIMARIA MEDICAL CLINIC	6/16/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	720 S RAMONA AVE	STE 105	CORONA	CA	92879	2150	33	06065	33.87364876	-117.5654939	Riverside County
270811	Fee-for-Service	1336174325	1336174325	1	1	PLANNED PARENTHOOD- OF THE	6/18/2004	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	PACIFIC SOUTHWEST	49-111 HWY 111	UNIT 6	COACHELLA	CA	92236	0000	33	06065	33.67241866	-116.1673887	Riverside County
270837	Fee-for-Service	1407089451	1407089451	1	1	PABAND, RASHID MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120108	47	Miscellaneous	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
270839	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
270852	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
270867	Fee-for-Service	1609220458	1609220458	1	1	PATEL, TULSIE MD	11/7/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	168244	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
270876	Fee-for-Service	1962734798	1962734798	1	1	PANG, WINNIE	10/17/2018	207RR0500X	NA	Other	026	PHYSICIANS	110999	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	#102	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
270887	Fee-for-Service	1811013386	1811013386	1	1	PENCE, BENJAMIN T DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10836	25	Physical Medicine and Rehabilitation	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
270918	Fee-for-Service	1184634628	1184634628	1	1	PHILLIPS, WILLIAM E MD	4/29/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89206	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
270919	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	4/6/2017	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
270931	Fee-for-Service	1073606299	1073606299	1	23	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
270934	Fee-for-Service	1356394175	1356394175	1	3	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1499 W 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
270935	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
270961	Fee-for-Service	1215979984	1215979984	1	1	POLLARD, JASON D DPM	2/11/2008	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
270974	Fee-for-Service	1851315097	1851315097	1	1	PIETILA, MICHAEL A	11/6/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83379	08	Family Practice	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
270989	Fee-for-Service	1548343510	1548343510	1	74	PERMANENTE MEDICAL GROUP INC	1/28/2025	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1930 NORTH DAVIS RD	None	SALINAS	CA	93907	2533	27	06053	36.7195222	-121.6679785	Monterey County
271001	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	7/14/2017	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271013	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	10/22/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
271020	Fee-for-Service	1477760080	1477760080	1	1	PANCHOLY, KAVITHA MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103159	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
271035	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
271041	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	11/30/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
271062	Fee-for-Service	1376028605	1376028605	1	1	PANNELL, MELODY LCSW	11/1/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122148	-	NOT APPLICABLE	0	In state provider	None	190 E HACKETT RD	None	MODESTO	CA	95358	9415	50	06099	37.58759858	-120.9911422	Stanislaus County
271118	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
271119	Fee-for-Service	1134197569	1134197569	1	1	PREYS, MICAHEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	949 HARMON ST	None	STURGIS	SD	57785	2452	00	None	44.40196678	-103.5084023	Meade County
271127	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
271164	Fee-for-Service	1255587580	1255587580	1	1	PATRUS, SABER J MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101366	41	Internal Medicine	0	In state provider	None	15451 SAN FERNANDO MISSI	STE 300	MISSION HILLS	CA	91345	1368	19	06037	34.27201722	-118.4684783	Los Angeles County
271198	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
271213	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
271216	Fee-for-Service	1639185580	1639185580	2	1	PATEL, KALPESH MD	10/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	91298	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
271227	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	5/7/2009	103K00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
271268	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
271272	Fee-for-Service	1487761227	1487761227	1	1	PETERSON TULSKY, JACQUELINE	10/31/1990	207R00000X	NA	Other	026	PHYSICIANS	71894	41	Internal Medicine	0	In state provider	MD	1001 POTRERO AVE	# 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
271276	Fee-for-Service	1164591533	1164591533	1	1	PHUNG, ANHTHU T MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	87716	40	Pediatrics	0	In state provider	None	10402 WESTMINSTER AVE	STE 100C	GARDEN GROVE	CA	92843	1813	30	06059	33.75951204	-117.9478527	Orange County
271277	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	152W00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271282	Fee-for-Service	1104915388	1104915388	1	1	PAK, CHI-NA MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115500	41	Internal Medicine	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
271291	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	1/3/2022	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
271314	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
271318	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
271340	Fee-for-Service	1881818185	1881818185	1	1	PETERSON, REBECCA K PSYD	1/24/2019	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4334 STERN AVE	#4	SHERMAN OAKS	CA	91423	3529	19	06037	34.14970498	-118.435475	Los Angeles County
271343	Fee-for-Service	1659520880	1659520880	1	1	PILLAI, RAJU K R MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103736	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BOULEVARD	ROOM 8725	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
271354	Fee-for-Service	1154408094	1154408094	1	1	PHAM, NGOC T MD	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80189	07	Dermatology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
271363	Fee-for-Service	1073569554	1073569554	1	1	PROSTHETIC & ORTHOTIC GROUP	12/26/2001	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2669 MYRTLE AVE	STE 101	SIGNAL HILL	CA	90755	2746	19	06037	33.805971	-118.181828	Los Angeles County
271387	Fee-for-Service	1548257991	1548257991	1	1	PLENYS, R MD INC	1/26/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	12044	None	None	0	In state provider	None	1313 E HERNDON AVE	STE 2	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
271393	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
271399	Fee-for-Service	1528391232	1528391232	1	2	PHILLIPS, STEPHANIE M	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271407	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
271410	Fee-for-Service	1508179326	1508179326	1	1	POMONA MEDICAL SUPPLY INC	2/28/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	733 E HOLT AVE	None	POMONA	CA	91767	5627	19	06037	34.06273818	-117.7359165	Los Angeles County
271413	Fee-for-Service	1669486429	1669486429	2	1	PACIFIC HEALTH SYSTEMS LP	1/24/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	37	06073	32.68419388	-117.0829524	San Diego County
271430	Fee-for-Service	1841261096	1841261096	1	1	PICKARD, BRIAN J MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99034	20	Orthopedic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
271442	Fee-for-Service	1740523059	1740523059	1	1	PETERS, ERIC M MD	7/1/2019	2085N0904X	NA	Other	026	PHYSICIANS	135405	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
271473	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	8/8/2017	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
271484	Fee-for-Service	1902881808	1902881808	1	1	PANADERO, CHARLES V MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77796	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
271490	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
271502	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	5/2/2019	103K00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
271503	Fee-for-Service	1508972803	1508972803	1	1	PETERSON, DWIGHT H PT	6/20/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
271543	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
271554	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	12/8/2018	152W00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271569	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	7/8/2022	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
271588	Fee-for-Service	1710324496	1710324496	1	1	PROTACIO, JOSEPH G DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
271589	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
271594	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	10/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
271607	Fee-for-Service	1790428167	1790428167	1	1	PERSONRX, INCORPORATED	5/24/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1717 MING AVE	None	BAKERSFIELD	CA	93304	4522	15	06029	35.33940853	-119.0221515	Kern County
271609	Fee-for-Service	1760570600	1760570600	1	20	PEDIATRIC MEDICAL ASSOCIATES	12/2/2024	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4220	31	06061	38.7294585	-121.2763095	Placer County
271623	Fee-for-Service	1215149141	1215149141	1	1	PERSCHAU,BENJAMIN R	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
271635	Fee-for-Service	1285185470	1285185470	1	1	PULSE ONE CARE	9/20/2016	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1260 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	2548	19	06037	34.05353604	-118.3761483	Los Angeles County
271668	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
271682	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
271690	Fee-for-Service	1669486429	1669486429	2	1	PACIFIC HEALTH SYSTEMS LP	5/10/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	37	06073	32.68419388	-117.0829524	San Diego County
271718	Fee-for-Service	1184678542	1184678542	1	1	PAPARELLA, TANYA PHD	5/23/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
271749	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
271765	Fee-for-Service	1750356283	1750356283	1	1	PASTOR-SOLER, NURIA M MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136093	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
271767	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
271779	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	11/18/2016	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
271792	Fee-for-Service	1619514676	1619514676	1	1	PALAFOX, HEIDI LMFT	11/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1351 GEER RD	#107	TURLOCK	CA	95380	3269	50	06099	37.50571084	-120.8489913	Stanislaus County
271794	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	11/8/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
271821	Fee-for-Service	1548343510	1548343510	1	74	PERMANENTE MEDICAL GROUP INC	5/19/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1930 NORTH DAVIS RD	None	SALINAS	CA	93907	2533	27	06053	36.7195222	-121.6679785	Monterey County
271830	Fee-for-Service	1235226531	1235226531	1	2	PERMANENTE MEDICAL GROUP INC	9/12/2018	152W00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
271840	Fee-for-Service	1154525335	1154525335	1	1	PANSE, SWATI MD INC	4/27/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51794	40	Pediatrics	0	In state provider	None	621 N STATE ST	SUITE 1	SAN JACINTO	CA	92583	6568	33	06065	33.79501272	-116.9715035	Riverside County
271841	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
271865	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
271869	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	3/16/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
271871	Fee-for-Service	1578793261	1578793261	1	1	PAMULAPATI, VEENA MD	9/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168139	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
271872	Fee-for-Service	1801042130	1801042130	1	1	PATTERSON JUDD, REBECCA	9/11/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99773	01	General Practice	0	In state provider	None	26357 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	3708	19	06037	34.41257644	-118.5597683	Los Angeles County
271885	Fee-for-Service	1760570600	1760570600	1	20	PEDIATRIC MEDICAL ASSOCIATES	4/19/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4220	31	06061	38.7294585	-121.2763095	Placer County
271890	Fee-for-Service	1609296268	1609296268	1	1	PATHRIA, MOHINI MD	12/12/2023	207K00000X	NA	Other	026	PHYSICIANS	189787	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
271909	Fee-for-Service	1053357244	1053357244	1	1	PUBLIC HOSPITAL DIST	6/17/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NO 1 SKAGIT COUNTY	1415 E KINCAID ST	None	MOUNT VERNON	WA	98274	4126	00	None	48.41748257	-122.3241732	Skagit County
271914	Fee-for-Service	1205082799	1205082799	1	1	PAZ-LUM, MARIA THERESA L MD	11/24/2009	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	109693	38	Geriatrics	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
271929	Fee-for-Service	1497122360	1497122360	1	1	PASSANISI, CHERYL A NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271934	Fee-for-Service	1538402441	1538402441	1	1	PRUSS, ERIKA L MD	11/1/2023	2080S0010X	NA	Orthopedic Surgery	026	PHYSICIANS	174606	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
271940	Fee-for-Service	1497751457	1497751457	1	1	PALLIA, CHRIS S MD APC	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74481	20	Orthopedic Surgery	0	In state provider	None	230 PROSPECT PL	STE 230	CORONADO	CA	92118	1976	37	06073	32.69468235	-117.1677128	San Diego County
271944	Fee-for-Service	1073606299	1073606299	1	13	PERMANENTE MEDICAL GROUP INC	10/8/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
271955	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
271958	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
271963	Fee-for-Service	1336370543	1336370543	1	1	PHILLIPS, KELLY M NP	2/20/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
271964	Fee-for-Service	1669486429	1669486429	2	1	PACIFIC HEALTH SYSTEMS LP	5/10/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	37	06073	32.68419388	-117.0829524	San Diego County
271966	Fee-for-Service	1588955694	1588955694	1	1	PAK, PETER S MD	5/31/2021	208600000X	NA	General Surgery	026	PHYSICIANS	139698	None	None	0	In state provider	None	160 E. ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
271977	Fee-for-Service	1194036624	1194036624	1	1	PRUETT, BENJAMIN J DO	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14838	30	Radiology	0	In state provider	None	1504 N WISHON AVE	None	FRESNO	CA	93728	1827	10	06019	36.763497	-119.8010405	Fresno County
271985	Fee-for-Service	1730556184	1730556184	1	1	PATEL, PRINA P	9/20/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VENTERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
272009	Fee-for-Service	1295266344	1295266344	1	1	PATRIZI, SARA T DO	1/13/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	16757	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
272025	Fee-for-Service	1235226531	1235226531	1	8	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
272028	Fee-for-Service	1770633596	1770633596	1	1	PENG, PHYLLIS H MD	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94698	84	Surgery-Head and Neck	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
272042	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
272054	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	12/2/2016	103K00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
272069	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
272074	Fee-for-Service	1548825284	1548825284	1	1	PHAM, JONATHAN T MD	11/4/2022	208M00000X	NA	Other	026	PHYSICIANS	176996	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
272093	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
272113	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	3/25/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
272120	Fee-for-Service	1962825935	1962825935	1	1	PICKREN, WENDELYN G OT	11/15/2022	103TC1900X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4987 GOLDEN FOOTHILL PKW	100	EL DORADO HILLS	CA	95762	9364	09	06017	38.63795293	-121.0685958	El Dorado County
272138	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	8/16/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
272141	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	12/20/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
272151	Fee-for-Service	1538653332	1538653332	1	1	PERROTTA, NICOLE S CCC-SLP	5/15/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
272162	Fee-for-Service	1497166987	1497166987	1	1	PATEL, HIRAL A DO	12/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14766	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 280	FRESNO	CA	93721	2211	10	06019	36.74333844	-119.7831874	Fresno County
272181	Fee-for-Service	1871539569	1871539569	1	1	PEREZ, NANCY LOUISE CRNA	4/1/1998	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2030 COFFEE RD	STE A1	MODESTO	CA	95355	2413	50	06099	37.672569	-120.9757125	Stanislaus County
272184	Fee-for-Service	1053357244	1053357244	1	1	PUBLIC HOSPITAL DIST	6/17/2004	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NO 1 SKAGIT COUNTY	1415 E KINCAID ST	None	MOUNT VERNON	WA	98274	4126	00	None	48.41748257	-122.3241732	Skagit County
272188	Fee-for-Service	1205082799	1205082799	1	1	PAZ-LUM, MARIA THERESA L MD	11/24/2009	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	109693	41	Internal Medicine	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
272213	Fee-for-Service	1386176048	1386176048	1	1	PATEL, REEMA MD	6/16/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	157553	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
272222	Fee-for-Service	1205359387	1205359387	1	1	PALMS HOME SERVICES, INC	12/26/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6444 BELLINGHAM AVE	SUITE 203	NORTH HOLLYWOOD	CA	91606	1400	19	06037	34.18805854	-118.3987182	Los Angeles County
272228	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
272231	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
272238	Fee-for-Service	1669486429	1669486429	2	1	PACIFIC HEALTH SYSTEMS LP	4/26/2024	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	37	06073	32.68419388	-117.0829524	San Diego County
272248	Fee-for-Service	1487040705	1487040705	1	1	PARDO, ISELA MD	10/1/2021	2084P0805X	NA	Psychiatry	026	PHYSICIANS	147606	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
272291	Fee-for-Service	1902903164	1902903164	1	1	PAN, VIVIEN L MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71280	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27800 MEDICAL CENTER RD	STE 100	MISSION VIEJO	CA	92691	6407	30	06059	33.55952733	-117.6645199	Orange County
272314	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
272326	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	11/8/2018	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
272342	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
272364	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
272385	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/14/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
272410	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
272416	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
272420	Fee-for-Service	1063867638	1063867638	1	1	PAPARISTO, ERGIT MD	8/6/2020	390200000X	NA	Other	026	PHYSICIANS	144249	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
272486	Fee-for-Service	1588157648	1588157648	1	1	PEREZ LOPEZ, YOSELIN Y LMFT	8/14/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	Z LMFT	2002 W DALI WAY	None	HANFORD	CA	93230	9787	16	06031	36.3549403	-119.6744108	Kings County
272499	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
272502	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
272516	Fee-for-Service	1386822930	1386822930	1	1	PANACEA HEALTHCARE MEDICAL	6/17/2013	193400000X	NA	Other	026	PHYSICIANS	51505	None	None	0	In state provider	GROUP INC	2630 PACIFIC AVENUE	None	LONG BEACH	CA	90806	2611	19	06037	33.80499389	-118.1936782	Los Angeles County
272535	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	3/9/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
272576	Fee-for-Service	1194953349	1194953349	1	1	PAREKH, AMI M MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121342	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
272578	Fee-for-Service	1184927964	1184927964	1	1	PALM DRIVE EMERGENCY	1/1/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
272584	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	3/23/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
272595	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	7/6/2017	103K00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
272597	Fee-for-Service	1033603824	1033603824	1	1	PIECHOWIAK, MARY B MD	10/7/2021	207R00000X	NA	Other	026	PHYSICIANS	173484	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
272609	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
272634	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
272657	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	7/21/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
272660	Fee-for-Service	1477019669	1477019669	1	1	PEDIATRIC CARDIAC CENTER INC	12/9/2019	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	433 DEL NORTE AVE	None	YUBA CITY	CA	95991	4113	51	06101	39.14391681	-121.6189581	Sutter County
272678	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	8/10/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
272686	Fee-for-Service	1548343510	1548343510	1	31	PERMANENTE MEDICAL GROUP INC	7/20/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
272752	Fee-for-Service	1144580580	1144580580	1	1	PERRY, RASHEL M LCSW	5/11/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
272770	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
272771	Fee-for-Service	1073606299	1073606299	1	21	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 HOMESTEAD RD	None	SANTA CLARA	CA	95051	4542	43	06085	37.3377485	-122.001453	Santa Clara County
272795	Fee-for-Service	1174090161	1174090161	1	1	PURCELL, ANNE NP	11/19/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
272797	Fee-for-Service	1497220172	1497220172	1	1	PILON, MATTHEW S PT	11/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1350 41ST AVE STE 100	None	CAPITOLA	CA	95010	3934	44	06087	36.970515	-121.9648325	Santa Cruz County
272806	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	3/29/2019	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
272818	Fee-for-Service	1972836054	1972836054	1	1	PAGAN, NISHA N PT	9/17/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11105 KNOT AVENUE	STE B	CYPRESS	CA	99063	0513	30	06059	33.80083909	-118.0111199	Orange County
272824	Fee-for-Service	1417298894	1417298894	1	1	PROVIDENT CARE, INC	10/1/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	915 14TH STREET	None	MODESTO	CA	95354	9535	50	06099	37.64286098	-120.9959274	Stanislaus County
272856	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
272866	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
272875	Fee-for-Service	1003136565	1003136565	1	1	PETROSSIAN, ALBERT A MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136810	34	Urology and Urological Surgery	0	In state provider	None	3650 SOUTH ST	SUITE 408	LAKEWOOD	CA	90712	1510	19	06037	33.86019847	-118.149255	Los Angeles County
272879	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	4/24/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
272900	Fee-for-Service	1578783791	1578783791	1	1	PAN, TIANLI MD	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91025	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
272903	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
272920	Fee-for-Service	1487152740	1487152740	1	3	PARAMEDICS LOGISTICS CALIFOR	2/20/2019	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	335 LINDBERGH AVE	None	LIVERMORE	CA	94551	9291	01	06001	37.69749563	-121.8129055	Alameda County
272926	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	7/2/2021	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
272949	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
272978	Fee-for-Service	1932404902	1932404902	1	1	PENDERGRAFT, LARISSA LCSW	3/18/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8911 LAKEWOOD DR	27I	WINDSOR	CA	95492	7856	49	06097	38.55034733	-122.8042316	Sonoma County
272991	Fee-for-Service	1407023906	1407023906	1	1	PATEL, AMIT A MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115208	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272999	Fee-for-Service	1588949275	1588949275	1	1	PERSUE HEALTH PARTNERSHIP	10/27/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2740 S BRISTOL STREET	STE 218	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
273037	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
273067	Fee-for-Service	1174927594	1174927594	1	1	PARAND, LEILA MD	10/12/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	153877	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
273077	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	9/14/2018	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
273100	Fee-for-Service	1053689786	1053689786	1	1	PETRENKO, ANTON PHD	12/30/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
273124	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	2/20/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
273129	Fee-for-Service	1699457465	1699457465	1	1	PROSPERO VASCULAR AND INTERV	8/7/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ENTIONAL, PC	22268 FOOTHILL BLVD	STE#3	HAYWARD	CA	94541	2723	01	06001	37.67992529	-122.0850788	Alameda County
273130	Fee-for-Service	1407897762	1407897762	1	1	PATEL, PIYUSH MD	1/31/1990	207L00000X	NA	Other	026	PHYSICIANS	49046	05	Anesthesiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
273131	Fee-for-Service	1720006992	1720006992	1	1	PATEL, RAMANBHAI M MD	6/5/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38482	10	Gastroenterology (M.D. only)	0	In state provider	None	1331 W AVENUE J	STE 102	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
273136	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	3/25/2020	103K00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
273150	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	8/20/2013	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
273171	Fee-for-Service	1548343510	1548343510	1	74	PERMANENTE MEDICAL GROUP INC	5/19/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1930 NORTH DAVIS RD	None	SALINAS	CA	93907	2533	27	06053	36.7195222	-121.6679785	Monterey County
273173	Fee-for-Service	1245373406	1245373406	1	1	PINKHAM, CELESTE L OD	4/24/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	601 E WHITTIER BLVD	SUITE 102	LA HABRA	CA	90631	3972	30	06059	33.93914479	-117.9399579	Orange County
273185	Fee-for-Service	1356845028	1356845028	1	1	PATEL, TRISHA A MD	9/1/2021	207R00000X	NA	Other	026	PHYSICIANS	17671	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
273194	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	1/7/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
273222	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
273242	Fee-for-Service	1851734495	1851734495	1	1	PAQUETTE, JONAH R PHD	10/23/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
273253	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273261	Fee-for-Service	1982771994	1982771994	1	1	PATEL, SHAILESH P MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53811	45	Nephrology (Renal-Kidney)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273281	Fee-for-Service	1316584907	1316584907	1	1	PEREIDA, CHRISTOPHER T	11/22/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
273304	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
273332	Fee-for-Service	1245694256	1245694256	1	1	PETROU, PHILIP A MD	7/21/2021	207L00000X	NA	Other	026	PHYSICIANS	150825	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
273344	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	2/24/2020	1041C0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
273359	Fee-for-Service	1861478778	1861478778	1	1	PATRICK GRAY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	4M EMERGENCY SYSTEM INC	667 EASTLAND AVE	None	WARREN	OH	44484	4531	00	None	41.23080722	-80.77832106	Trumbull County
273362	Fee-for-Service	1801057732	1801057732	1	1	PARK, ELLEN J MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110668	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
273376	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
273395	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273398	Fee-for-Service	1720006992	1720006992	1	1	PATEL, RAMANBHAI M MD	6/5/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38482	41	Internal Medicine	0	In state provider	None	1331 W AVENUE J	STE 102	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
273399	Fee-for-Service	1609938489	1609938489	1	1	PEARSON, PHILIP G MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	52579	34	Urology and Urological Surgery	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
273405	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	3/31/2020	103K00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
273418	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	5/18/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
273427	Fee-for-Service	1851451710	1851451710	1	1	PACIFIC WATER THERAPY	10/12/2012	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3156 SPORTS ARENA BLVD	STE 104	SAN DIEGO	CA	92110	4525	37	06073	32.75273139	-117.2070529	San Diego County
273442	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
273449	Fee-for-Service	1821327826	1821327826	1	1	PARK, ELLEN JUNG	10/30/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W SAN JOSE AVE	UNIT A	CLAREMONT	CA	91711	5204	19	06037	34.08314253	-117.7159185	Los Angeles County
273460	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
273465	Fee-for-Service	1548343510	1548343510	1	73	PERMANENTE MEDICAL GROUP INC	11/27/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
273477	Fee-for-Service	1609564970	1609564970	1	1	PILLARS OF HEALTH ENTERPRISE	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	S	2855 PINECREEK DR	B305	COSTA MESA	CA	92626	5400	30	06059	33.6765198	-117.9144092	Orange County
273486	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
273517	Fee-for-Service	1205217866	1205217866	1	1	PEART, MISHKA MD	10/4/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172987	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
273524	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	12/8/2016	103TC0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273527	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
273550	Fee-for-Service	1477841666	1477841666	1	1	PONCE, JENNIFER D LCSW	5/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
273554	Fee-for-Service	1811278682	1811278682	1	1	PELVITSKI, MARIYA DO	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11953	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
273563	Fee-for-Service	1912994179	1912994179	1	1	PELED, HARRY B MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65769	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	41210 11TH ST W	STE G	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
273572	Fee-for-Service	1568963312	1568963312	2	2	PHARMEDQUEST PHARMACY SERVIC	2/12/2025	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3020 SATURN ST.	100	BREA	CA	92821	6262	30	06059	33.9089406	-117.857311	Orange County
273573	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
273574	Fee-for-Service	1053499798	1053499798	1	1	POLLOCK, ANDREW J MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56052	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
273600	Fee-for-Service	1255436028	1255436028	1	1	PASADENA SURGERY CENTER, INC	7/17/2001	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1035 S FAIR OAKS AVE	STE 101	PASADENA	CA	91105	2653	19	06037	34.128	-118.1503455	Los Angeles County
273610	Fee-for-Service	1043245822	1043245822	1	1	PLASENCIA, GILBERT O MD	2/16/1999	174400000X	NA	Other	026	PHYSICIANS	33034	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	854 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3109	33	06065	33.8605591	-117.5513844	Riverside County
273611	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	7/20/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
273641	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
273656	Fee-for-Service	1831371749	1831371749	1	1	PRISTINE SURGERY CNETER INC	10/17/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7085 N MAPLE AVE	None	FRESNO	CA	93720	8011	10	06019	36.83899417	-119.7453483	Fresno County
273659	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273671	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	5/2/2019	103K00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
273685	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
273694	Fee-for-Service	1780071142	1780071142	1	1	PANTON, CHRISTINA E MD	7/24/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	144867	15	Obstetrics (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
273707	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
273729	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
273751	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
273773	Fee-for-Service	1679193395	1679193395	1	1	PARKER, ALEXIS K LPCC	5/3/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
273792	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	3/31/2020	103TC0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273794	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
273812	Fee-for-Service	1720241375	1720241375	1	1	POSSEHN, JESSICA L MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109909	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
273826	Fee-for-Service	1043412661	1043412661	1	1	PARAMOUNT UNIFIED SCHOOL	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	15110 CALIFORNIA AVE	None	PARAMOUNT	CA	90723	4320	19	06037	33.89614874	-118.158681	Los Angeles County
273829	Fee-for-Service	1457503617	1457503617	1	1	PRESSER BELKIN, LIZA G	2/13/2009	207RA0201X	NA	Other	026	PHYSICIANS	71127	03	Allergy	0	In state provider	MD INC	5333 HOLLISTER AVE	STE 237	SANTA BARBARA	CA	93111	3326	42	06083	34.43491982	-119.8105484	Santa Barbara County
273832	Fee-for-Service	1912994179	1912994179	1	1	PELED, HARRY B MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65769	01	General Practice	0	In state provider	None	41210 11TH ST W	STE G	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
273839	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
273843	Fee-for-Service	1053499798	1053499798	1	1	POLLOCK, ANDREW J MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56052	01	General Practice	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
273856	Fee-for-Service	1124176946	1124176946	1	1	PIACQUADIO, KATHLEEN MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59580	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
273878	Fee-for-Service	1043245822	1043245822	1	1	PLASENCIA, GILBERT O MD	2/16/1999	174400000X	NA	Other	026	PHYSICIANS	33034	41	Internal Medicine	0	In state provider	None	854 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3109	33	06065	33.8605591	-117.5513844	Riverside County
273879	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	5/3/2019	1041C0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
273905	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
273911	Fee-for-Service	1073620514	1073620514	1	1	POLITE, OKEEMA N LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
273922	Fee-for-Service	1205396231	1205396231	1	1	PENA, DAVID E MD	9/21/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
273932	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273939	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	6/3/2019	103K00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
273954	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
273961	Fee-for-Service	1780071142	1780071142	1	1	PANTON, CHRISTINA E MD	7/24/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	144867	09	Gynecology (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
273976	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
273997	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
274007	Fee-for-Service	1619910213	1619910213	1	1	PRECI, RICHARD L OD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
274022	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
274028	Fee-for-Service	1972569200	1972569200	1	1	PEDERSEN, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1712 W ANKLAM RD	STE 103	TUCSON	AZ	85745	2660	00	None	32.226075	-111.0023865	Pima County
274031	Fee-for-Service	1780066076	1780066076	1	1	PACIFIC PARADISE EMERGENCY	8/1/2015	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
274035	Fee-for-Service	1902984677	1902984677	1	1	PARK, CHAN H MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75545	30	Radiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
274043	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	3/26/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
274056	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	5/2/2019	103TC0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274060	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	12/8/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
274062	Fee-for-Service	1265789721	1265789721	1	1	PACIFIC CENTRAL COAST HEALTH	11/15/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	1325 E CHURCH STREET	STE 202	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
274105	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
274113	Fee-for-Service	1790863306	1790863306	1	1	PANHWAR, SIERA MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97303	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
274137	Fee-for-Service	1902937873	1902937873	1	1	PASTER, JANIS R LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
274146	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
274150	Fee-for-Service	1437537818	1437537818	1	1	PATEL, ANKIT M MD	9/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171073	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
274151	Fee-for-Service	1609800952	1609800952	1	1	PERWAD, FARZANA MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76953	45	Nephrology (Renal-Kidney)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
274166	Fee-for-Service	1639394117	1639394117	1	1	PINE RIVER INC.	2/3/2023	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	LE	673 MERCHANT ST	STE B	VACAVILLE	CA	95688	6952	48	06095	38.35122655	-121.9935126	Solano County
274175	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
274194	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274207	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
274219	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
274224	Fee-for-Service	1639557150	1639557150	1	1	PICK, JUSTIN M MD	7/16/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	146210	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
274230	Fee-for-Service	1578838520	1578838520	1	3	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3820 WIBLE ROAD	SUITE A	BAKERSFIELD	CA	93309	6741	15	06029	35.320536	-119.038973	Kern County
274240	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
274244	Fee-for-Service	1467950345	1467950345	1	1	PARENTS BY CHOICE	7/17/2024	225XM0800X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	306 E MAIN ST	SUITE 300	STOCKTON	CA	95202	2908	39	06077	37.95318725	-121.2867842	San Joaquin County
274250	Fee-for-Service	1811345960	1811345960	1	1	PACIFIC CENTRAL COAST HEALTH	2/27/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTERS	2901 N VENTURA BLVD	SUITE 110	OXNARD	CA	93036	9705	56	06111	34.24479149	-119.1814409	Ventura County
274257	Fee-for-Service	1720323991	1720323991	1	1	PAPPAS, KRISTIN MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129317	05	Anesthesiology	0	In state provider	None	900 HYDE STREET	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
274260	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
274267	Fee-for-Service	1013096064	1013096064	1	1	PEVNICK, JOSHUA M MD	12/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85267	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
274287	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
274305	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	2/5/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
274321	Fee-for-Service	1982879169	1982879169	1	1	PREMMER, KAMESIAU D MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	115966	05	Anesthesiology	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
274322	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	1/28/2019	103TC0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274325	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
274369	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
274375	Fee-for-Service	1013445436	1013445436	1	1	PUREWAL, JASKARAN MD	7/8/2023	390200000X	NA	Other	026	PHYSICIANS	185392	None	None	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
274402	Fee-for-Service	1497941132	1497941132	1	1	PETERSON, JENNIFER L NP	6/16/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
274409	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
274423	Fee-for-Service	1023128485	1023128485	2	1	PACIFIC CLINICS	3/17/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11721 TELEGRAPH RD	SUITE A-G, M&N	SANTA FE SPRINGS	CA	90670	3674	19	06037	33.94629336	-118.0832752	Los Angeles County
274438	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	6/19/2017	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
274459	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
274470	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	1/28/2019	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
274476	Fee-for-Service	1972794659	1972794659	1	1	PATEL, RISHI K MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104709	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
274479	Fee-for-Service	1235450131	1235450131	1	1	PARIKH, SAHIL P DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13817	02	General Surgery	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
274489	Fee-for-Service	1588697155	1588697155	2	1	PHARMERICA DRUG SYSTEMS LLC	8/2/2007	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMERICA	8930 ACTIVITY RD	STE K	SAN DIEGO	CA	92126	4457	37	06073	32.89640509	-117.1339835	San Diego County
274494	Fee-for-Service	1578838520	1578838520	1	3	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3820 WIBLE ROAD	SUITE A	BAKERSFIELD	CA	93309	6741	15	06029	35.320536	-119.038973	Kern County
274501	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
274508	Fee-for-Service	1548343510	1548343510	1	74	PERMANENTE MEDICAL GROUP INC	5/19/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1930 NORTH DAVIS RD	None	SALINAS	CA	93907	2533	27	06053	36.7195222	-121.6679785	Monterey County
274526	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
274530	Fee-for-Service	1619164738	1619164738	1	1	PIXLEY, ASHLEE L	1/6/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
274551	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
274555	Fee-for-Service	1902826266	1902826266	1	1	PEDERSEN, REBECCA A LMFT	8/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1608 SUNRISE AVE	STE 5	MODESTO	CA	95350	4678	50	06099	37.66782938	-120.9848364	Stanislaus County
274556	Fee-for-Service	1750532610	1750532610	1	1	PARK, SAMUEL Y MD	4/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111437	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
274574	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
274587	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	6/3/2019	103TC0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274590	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
274610	Fee-for-Service	1801829874	1801829874	1	1	PHYO, PHUNT MD	7/4/2020	207R00000X	NA	Other	026	PHYSICIANS	75899	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
274624	Fee-for-Service	1679308977	1679308977	1	1	PERIGON PHARMACY 360 NW, LLC	10/8/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	442 N MOORPARK RD	None	THOUSAND OAKS	CA	91360	3702	56	06111	34.18446292	-118.8752362	Ventura County
274636	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
274656	Fee-for-Service	1467799742	1467799742	1	1	PAIN AND HEALING INSTITUTE	8/11/2016	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1964 WESTWOOD BLVD	STE 435	LOS ANGELES	CA	90025	4695	19	06037	34.04729378	-118.4346267	Los Angeles County
274674	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
274675	Fee-for-Service	1134651797	1134651797	1	1	PHELPS, KATHERINE MD	10/6/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	191091	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
274693	Fee-for-Service	1740698794	1740698794	1	1	PANOYAN, AREN MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146132	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
274703	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	11/8/2017	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
274713	Fee-for-Service	1669465266	1669465266	1	1	PETRINI, JOSEPH C MD	5/31/1985	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	35662	01	General Practice	0	In state provider	None	1000 PAJARO ST	None	SALINAS	CA	93901	3060	27	06053	36.66179575	-121.6553489	Monterey County
274721	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274734	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	7/6/2017	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
274744	Fee-for-Service	1598779522	1598779522	1	1	PACE, JOSEPH L MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79365	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
274747	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
274770	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
274774	Fee-for-Service	1104832351	1104832351	1	1	PHILLIPS, STEVEN ALLAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	317 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
274786	Fee-for-Service	1437253556	1437253556	1	1	PASADENA MEDICAL IMG LLC	3/2/2009	261QR0200X	NA	Mammography/MRI Provider	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	751 CORDOVA STREET	None	PASADENA	CA	91101	2617	19	06037	34.1425735	-118.134927	Los Angeles County
274790	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	3/23/2016	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
274793	Fee-for-Service	1396373130	1396373130	1	1	PITHADIA, DEETI MD	9/3/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	191805	07	Dermatology	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
274794	Fee-for-Service	1407934391	1407934391	1	1	PROBST, WILLIAM E MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75094	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
274813	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
274819	Fee-for-Service	1396031381	1396031381	1	1	PETERS, JONEL C LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
274834	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	7/12/2021	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
274850	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	6/3/2019	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274851	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
274859	Fee-for-Service	1669914396	1669914396	1	1	PRIME REHAB CENTER, PHYSICAL	3/9/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THERAPY APC	8110 MANGO AVE	STE 107	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
274899	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
274910	Fee-for-Service	1205896792	1205896792	1	1	PARABIA, PERIN F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46014	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
274931	Fee-for-Service	1881740702	1881740702	1	1	PLANCHON, LYNN PHD	7/2/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3100 MOWRY AVENUE	SUITE 301	FREMONT	CA	94538	1531	01	06001	37.55425535	-121.9836939	Alameda County
274935	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
274956	Fee-for-Service	1619526704	1619526704	1	1	PAYTON, INGRID PT	9/24/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
274962	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	11/21/2016	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
274971	Fee-for-Service	1669465266	1669465266	1	1	PETRINI, JOSEPH C MD	5/31/1985	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	35662	08	Family Practice	0	In state provider	None	1000 PAJARO ST	None	SALINAS	CA	93901	3060	27	06053	36.66179575	-121.6553489	Monterey County
274982	Fee-for-Service	1386664498	1386664498	1	2	PETERSON, SOFIA MD	5/20/2024	207R00000X	NA	Other	026	PHYSICIANS	76621	41	Internal Medicine	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
274984	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
274996	Fee-for-Service	1073606299	1073606299	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
275010	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
275012	Fee-for-Service	1750671533	1750671533	1	1	PANDURANGA, VEENA MD	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138244	01	General Practice	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
275033	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
275042	Fee-for-Service	1750392361	1750392361	1	1	PARVEZ, ZAFAR MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50247	02	General Surgery	0	In state provider	None	5151 N PALM AVE	STE 930	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
275050	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
275079	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
275082	Fee-for-Service	1053173559	1053173559	1	1	PERFECT PATHOLOGY MEDICAL PC	10/1/2024	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
275088	Fee-for-Service	1487851432	1487851432	1	2	PREMIER HOME HLTH CARE INC	10/21/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9010 CORBIN AVE	STE 18	NORTHRIDGE	CA	91324	3377	19	06037	34.23447488	-118.5622843	Los Angeles County
275095	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	2/12/2021	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
275111	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
275115	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
275120	Fee-for-Service	1669914396	1669914396	1	1	PRIME REHAB CENTER, PHYSICAL	3/9/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY APC	8110 MANGO AVE	STE 107	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
275154	Fee-for-Service	1225099880	1225099880	1	1	PEREZ, LUIS J	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72538	None	None	0	In state provider	None	716 E MISSION BLVD	STE D	POMONA	CA	91766	2040	19	06037	34.05523981	-117.743173	Los Angeles County
275159	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
275197	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
275222	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
275245	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
275271	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
275289	Fee-for-Service	1407874472	1407874472	1	1	PORSUELO, GEMMA E NP	8/8/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8080 PARKWAY DR	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
275293	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
275301	Fee-for-Service	1750392361	1750392361	1	1	PARVEZ, ZAFAR MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50247	33	Thoracic Surgery	0	In state provider	None	5151 N PALM AVE	STE 930	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
275304	Fee-for-Service	1700057312	1700057312	1	1	PHILIPP, SCOTT R MD	3/7/2011	208600000X	NA	General Surgery	026	PHYSICIANS	91399	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
275305	Fee-for-Service	1538362017	1538362017	1	1	PEZESHKIAN, NAYEREH G MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77356	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
275310	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	2/11/2013	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
275332	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	2/24/2020	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
275336	Fee-for-Service	1992868723	1992868723	1	1	PAUXTIS, GREGORY F MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	58568	45	Nephrology (Renal-Kidney)	0	In state provider	None	45 CASTRO ST	STE 418	SAN FRANCISCO	CA	94114	1027	38	06075	37.76829732	-122.4357056	San Francisco County
275347	Fee-for-Service	1083915763	1083915763	1	1	PADUA, DAVID M MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118834	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	SUITE 202	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
275355	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
275369	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
275371	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
275415	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
275422	Fee-for-Service	1134142870	1134142870	1	1	PAUL, BOBBIE J LMFT	2/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	625 THIRD AVE	None	SAN DIEGO	CA	91910	5703	37	06073	32.62998356	-117.0754419	San Diego
275456	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	3/29/2019	1041C0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
275481	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
275504	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
275531	Fee-for-Service	1073606299	1073606299	1	12	PERMANENTE MEDICAL GROUP INC	3/23/2016	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
275548	Fee-for-Service	1548343510	1548343510	1	50	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
275568	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	2/11/2013	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
275590	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
275603	Fee-for-Service	1043659956	1043659956	1	1	PARK, MICHAEL R MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142082	41	Internal Medicine	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
275604	Fee-for-Service	1083978050	1083978050	1	1	PATEL, KINNARI M MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143561	05	Anesthesiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
275612	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	11/2/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
275626	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	10/8/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
275629	Fee-for-Service	1528112331	1528112331	1	1	PENINSULA FIRE DISTRICT	9/25/2017	3416S0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	801 GOLF CLUB RD	None	LAKE ALAMANOR	CA	96137	9524	32	06063	40.24795952	-121.1449513	Plumas County
275630	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
275639	Fee-for-Service	1831192483	1831192483	1	1	PURTILL, MARY-ANNE MD	4/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76836	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
275656	Fee-for-Service	1528045374	1528045374	1	1	PATEL,ATUL J MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71897	None	None	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
275674	Fee-for-Service	1548343510	1548343510	1	15	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	40595 WESTLAKE DRIVE	None	OAKHURST	CA	93644	9024	20	06039	37.33873736	-119.6691473	Madera County
275689	Fee-for-Service	1235593823	1235593823	1	1	PARTHASARATHY, VISHNU MD	6/22/2019	207P00000X	NA	Other	026	PHYSICIANS	152985	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
275692	Fee-for-Service	1912786526	1912786526	1	1	PAMBID, GARY PT	12/17/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
275700	Fee-for-Service	1881187151	1881187151	1	1	POURMIRZAIE, ROXANNA MD	10/17/2023	207R00000X	NA	Other	026	PHYSICIANS	186145	None	None	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
275705	Fee-for-Service	1306092838	1306092838	1	1	PATEL, ANIT B MD	3/16/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	76092	29	Pulmonary Diseases (M.D. only)	0	In state provider	BAY AREA PULMONARY	1525 WEBSTER ST	STE A	FAIRFIELD	CA	94533	4935	48	06095	38.2570563	-122.0475622	Solano County
275709	Fee-for-Service	1235206640	1235206640	1	1	PRUGININ, YARON PHD	4/3/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8804 BALBOA AVE	None	SAN DIEGO	CA	92123	1506	37	06073	32.82059406	-117.1382382	San Diego County
275713	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	4/22/2020	1041C0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
275741	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
275749	Fee-for-Service	1710918495	1710918495	1	1	PARINDA MEHTA, M.D.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
275759	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
275763	Fee-for-Service	1194387886	1194387886	1	1	PETTY, ANDREA I NP	12/27/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
275772	Fee-for-Service	1457058653	1457058653	1	1	PROVERI VENTURES LLC	2/23/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 MCHENRY AVE	160	MODESTO	CA	95350	4575	50	06099	37.666233	-120.993933	Stanislaus County
275778	Fee-for-Service	1093707085	1093707085	1	1	PHAN, BICHVAN MD	4/30/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61219	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 JOSE FIGUERES AVE	STE 370	SAN JOSE	CA	95116	1591	43	06085	37.36122014	-121.8505998	Santa Clara County
275799	Fee-for-Service	1457516510	1457516510	1	1	PATTERSON, JOANNE L CNP	6/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	18239	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
275823	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
275847	Fee-for-Service	1649420456	1649420456	1	1	PATTON, VALERIE L LCSW	7/29/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	631 TENNESSEE ST	None	VALLEJO	CA	94590	4432	48	06095	38.10992398	-122.2522919	Solano County
275849	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
275850	Fee-for-Service	1720547623	1720547623	1	1	PAPP, STEPHAN J MD	10/3/2022	208M00000X	NA	Other	026	PHYSICIANS	180096	None	None	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
275857	Fee-for-Service	1962727123	1962727123	1	1	PHAOSAWASDI, PIANGWARIN MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124444	01	General Practice	0	In state provider	None	1360 BURTON DRIVE	SUITE 160	VACAVILLE	CA	95687	3560	48	06095	38.36439485	-121.9548858	Solano County
275858	Fee-for-Service	1629027412	1629027412	1	1	PRATT, FRANKLIN D MD	10/31/1983	207P00000X	NA	Other	026	PHYSICIANS	47773	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
275869	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/18/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
275872	Fee-for-Service	1003349366	1003349366	1	1	PHAM, ALEXANDER MD	11/6/2023	208600000X	NA	General Surgery	026	PHYSICIANS	188218	None	None	0	In state provider	None	720 NORTH TUSTIN AVE	SUITE 100	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
275880	Fee-for-Service	1790005999	1790005999	1	1	PALILIS, DIMITRIOS M	5/31/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	744 EMPIRE ST STE 210	None	FAIRFIELD	CA	94533	5562	48	06095	38.2503715	-122.0429115	Solano County
275881	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	11/7/2018	103TC0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
275883	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
275904	Fee-for-Service	1497109342	1497109342	1	1	PADILLA, JESSICA	8/29/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
275957	Fee-for-Service	1306092838	1306092838	1	1	PATEL, ANIT B MD	3/16/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	76092	41	Internal Medicine	0	In state provider	BAY AREA PULMONARY	1525 WEBSTER ST	STE A	FAIRFIELD	CA	94533	4935	48	06095	38.2570563	-122.0475622	Solano County
275962	Fee-for-Service	1922495464	1922495464	1	1	PATEL, SIMA C MD	10/1/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	160002	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
275966	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
275993	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	3/16/2009	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
275999	Fee-for-Service	1619113503	1619113503	1	1	PHAN, THAO M MD	2/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	101844	01	General Practice	0	In state provider	None	8970 WARNER AVENUE	None	FOUNTAIN VALLEY	CA	92708	3211	30	06059	33.71571347	-117.972747	Orange County
276014	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
276018	Fee-for-Service	1124362884	1124362884	1	1	PAKAZ, MARY A LCSW	8/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
276035	Fee-for-Service	1982624425	1982624425	1	1	PENTON, CORBETT LEE MD	5/31/1994	207L00000X	NA	Other	026	PHYSICIANS	21858	05	Anesthesiology	0	In state provider	A PROFESSIONAL CORP	5055 E ANAHEIM ST	None	LONG BEACH	CA	90804	3215	19	06037	33.78261447	-118.134891	Los Angeles County
276060	Fee-for-Service	1346505294	1346505294	1	1	PATHIKONDA, NEELAM G DO	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13100	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
276076	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	5/11/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
276078	Fee-for-Service	1912263229	1912263229	1	1	PHILLIPS, JONATHAN J MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131610	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
276104	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
276110	Fee-for-Service	1962727123	1962727123	1	1	PHAOSAWASDI, PIANGWARIN MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124444	45	Nephrology (Renal-Kidney)	0	In state provider	None	1360 BURTON DRIVE	SUITE 160	VACAVILLE	CA	95687	3560	48	06095	38.36439485	-121.9548858	Solano County
276118	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	2/26/2021	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
276125	Fee-for-Service	1255777439	1255777439	1	1	PATEL, HEMANSHU R MD	3/12/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	143699	08	Family Practice	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
276135	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	3/25/2020	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276136	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
276147	Fee-for-Service	1386406445	1386406445	1	1	PIMENTEL, HEATHER	4/3/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	25	06049	0	0	None
276170	Fee-for-Service	1417156605	1417156605	1	1	PEREZ, EDMUNDO LMFT	1/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
276172	Fee-for-Service	1528299229	1528299229	1	1	PARTNER, DWIGHT T CNP	6/12/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
276212	Fee-for-Service	1417150913	1417150913	1	1	PEPPER, JON-PAUL MD	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127025	04	Otology, Laryngology, Rhinology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
276221	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	9/14/2018	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
276222	Fee-for-Service	1396241105	1396241105	1	1	PURSWANI, HEENA MD	9/6/2022	390200000X	NA	Other	026	PHYSICIANS	164371	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
276235	Fee-for-Service	1982221131	1982221131	1	1	PASCALL, SHAWNIE D MD	7/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186817	None	None	0	In state provider	PASCALL	200 S WELLS ROAD	100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
276246	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
276268	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276274	Fee-for-Service	1902848831	1902848831	1	1	PONZIO, DENNIS MD	5/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68922	08	Family Practice	0	In state provider	None	18210 YORBA LINDA BLVD	SUITE 404	YORBA LINDA	CA	92886	4060	30	06059	33.8883981	-117.8154098	Orange County
276322	Fee-for-Service	1376619023	1376619023	1	1	PHAM, HUONG T OD	5/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14251 EUCLID ST	STE F101	GARDEN GROVE	CA	92843	4957	30	06059	33.755166	-117.937627	Orange County
276328	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
276353	Fee-for-Service	1902958002	1902958002	1	1	PURVEY, MICHELLE H PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
276355	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
276372	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
276375	Fee-for-Service	1790963502	1790963502	1	1	PERISSINOTTO, CARLA M MD	5/28/2010	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	102634	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
276381	Fee-for-Service	1891944260	1891944260	1	1	POOJA R. VORIA MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 MADISON ST	STE 310	SEATTLE	WA	98104	1320	00	None	47.60953436	-122.3245882	King County
276388	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	5/2/2019	103TC0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276389	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
276417	Fee-for-Service	1184626418	1184626418	1	1	PAKULA, JOHN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36756	08	Family Practice	0	In state provider	None	778 JAMACHA RD	None	EL CAJON	CA	92019	3201	37	06073	32.7859399	-116.9279962	San Diego County
276425	Fee-for-Service	1093764052	1093764052	1	1	PHUNG, THU-TRANG L MD	11/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68430	18	Ophthalmology	0	In state provider	None	2809 OLIVE HWY	STE 250	OROVILLE	CA	95966	6134	04	06007	39.50386798	-121.5410203	Butte County
276446	Fee-for-Service	1376922757	1376922757	1	1	PASIPANODYA, ELIZABETH PHD	2/17/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
276474	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	11/28/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
276501	Fee-for-Service	1235226531	1235226531	1	6	PERMANENTE MEDICAL GROUP INC	5/3/2019	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
276518	Fee-for-Service	1831536531	1831536531	1	1	PREMIERCARE ANESTHESIA	1/16/2014	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNTAIN VALLEY INC	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
276521	Fee-for-Service	1073606299	1073606299	1	3	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276530	Fee-for-Service	1841214053	1841214053	1	1	PLETCHER, STEVEN D MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79249	04	Otology, Laryngology, Rhinology	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
276579	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
276581	Fee-for-Service	1346510104	1346510104	1	1	PAI, BINA G MD	4/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129068	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
276600	Fee-for-Service	1013932318	1013932318	1	1	PARMER, ROBERT MD	7/1/1984	207RN0300X	NA	Nephrology	026	PHYSICIANS	36622	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
276603	Fee-for-Service	1518115047	1518115047	1	1	PRADHANANGA, JYOTI	3/5/2024	207R00000X	NA	Other	026	PHYSICIANS	186801	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
276605	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	12/16/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
276616	Fee-for-Service	1881221190	1881221190	1	1	PANCHAL, HEMALI V MD	8/30/2023	207R00000X	NA	Other	026	PHYSICIANS	176903	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
276618	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	3/12/2021	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
276620	Fee-for-Service	1083610596	1083610596	1	1	PARK, DOROTHY J MD	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	64946	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 665W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
276630	Fee-for-Service	1083251532	1083251532	1	1	PRIME WELLNESS COMMUNITY	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	8610 S SEPULVEDA BLVD	SUITE 104	LOS ANGELES	CA	90045	4009	19	06037	33.959448	-118.396202	Los Angeles County
276634	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	9/12/2018	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276637	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
276653	Fee-for-Service	1881703353	1881703353	1	1	PROCARE PHARMACY LLC	11/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1002 EAST MCDOWELL ROAD	None	PHOENIX	AZ	85006	2625	00	None	33.466032	-112.060503	Maricopa County
276723	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
276731	Fee-for-Service	1255403994	1255403994	1	1	PAN, JEANNE P NP	4/28/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12470 E WHITTIER	None	WHITTIER	CA	90603	1017	19	06037	33.97081587	-118.04422	Los Angeles County
276734	Fee-for-Service	1164633970	1164633970	1	1	PARTIDA, CARMEN N MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91826	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
276744	Fee-for-Service	1750376174	1750376174	1	1	PATEL, ROBERT K MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83841	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
276754	Fee-for-Service	1528107745	1528107745	1	1	PINERS NURSING HOME INC	7/1/1985	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1800 PUEBLO AVE	None	NAPA	CA	94558	4751	28	06055	38.31438369	-122.3050295	Napa County
276759	Fee-for-Service	1649312174	1649312174	2	1	PACE ZONE PHARMACY LLC	8/31/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	407 MAIN ST	None	RIO VISTA	CA	94571	1616	48	06095	38.15793977	-121.6934559	Solano County
276767	Fee-for-Service	1134913411	1134913411	1	1	PIYUSH GUPTA, M.D., P.C.	5/13/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	442 N BARRANCA AVE SUITE	210	COVINA	CA	91723	1722	19	06037	34.09013126	-117.8812798	Los Angeles County
276768	Fee-for-Service	1073606299	1073606299	1	27	PERMANENTE MEDICAL GROUP INC	2/20/2014	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
276774	Fee-for-Service	1235461385	1235461385	1	1	PICCO, CHRISTINE C MD	4/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109181	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2950 WHIPPLE AVE	None	REDWOOD CITY	CA	94062	2850	41	06081	37.4783159	-122.2550908	San Mateo County
276804	Fee-for-Service	1184128589	1184128589	1	1	PANDHER, NAVREEN MD	12/17/2021	207R00000X	NA	Other	026	PHYSICIANS	17856	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
276813	Fee-for-Service	1063496651	1063496651	1	55	PACIFIC CENTRAL COAST HEALTH	6/15/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2486 N PONDEROSA DRIVE	STE D-205	CAMARILLO	CA	93010	2471	56	06111	34.24266768	-119.0228157	Ventura County
276827	Fee-for-Service	1073606299	1073606299	1	16	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
276834	Fee-for-Service	1891796165	1891796165	1	1	PANDIT, IVY D MD	8/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53735	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
276838	Fee-for-Service	1255688032	1255688032	1	1	PANAMENO CAMPOS, JAVIER M LC	10/11/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	255 NORTH D STREET	401 - C	SAN BERNARDINO	CA	92401	1701	36	06071	34.1036709	-117.291874	San Bernardino County
276853	Fee-for-Service	1548343510	1548343510	1	49	PERMANENTE MEDICAL GROUP INC	4/22/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
276858	Fee-for-Service	1295053650	1295053650	1	1	PALM, ERIN A MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	118126	02	General Surgery	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
276869	Fee-for-Service	1043897663	1043897663	1	1	PALMER, SAMANTHA MD	7/3/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
276876	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	3/12/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
276881	Fee-for-Service	1083251532	1083251532	1	1	PRIME WELLNESS COMMUNITY	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	8610 S SEPULVEDA BLVD	SUITE 104	LOS ANGELES	CA	90045	4009	19	06037	33.959448	-118.396202	Los Angeles County
276882	Fee-for-Service	1073606299	1073606299	1	29	PERMANENTE MEDICAL GROUP INC	10/18/2019	103TC0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
276885	Fee-for-Service	1073606299	1073606299	1	26	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
276960	Fee-for-Service	1366511370	1366511370	1	1	PAVIA, JOSE M MD INC	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	43068	08	Family Practice	0	In state provider	None	13768 ROSWELL AVE	STE 101	CHINO	CA	91710	1401	36	06071	34.0038	-117.7218555	San Bernardino County
276966	Fee-for-Service	1891994174	1891994174	1	1	PREMIER EMERGENCY	1/27/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS OF CALIFORNIA	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
276969	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	7/12/2019	1041C0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
276989	Fee-for-Service	1164473187	1164473187	1	1	PAGE, SAUNDRIA L NP	1/21/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
277000	Fee-for-Service	1336776772	1336776772	1	1	PARK, CHRISTINA J MD	6/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186711	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277021	Fee-for-Service	1275759102	1275759102	1	1	PRINE, REBECCA LCSW	1/16/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	29890	-	NOT APPLICABLE	0	In state provider	None	8 CRESTWOOD RD	None	BOULEVARD	CA	91905	9725	37	06073	32.7075769	-116.3623755	San Diego County
277067	Fee-for-Service	1467896183	1467896183	1	1	PATEL, KAJAL P MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133788	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
277099	Fee-for-Service	1548343510	1548343510	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
277115	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	8/18/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
277124	Fee-for-Service	1831524321	1831524321	1	1	PALMER, MARY K CCC-SLP	6/7/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
277182	Fee-for-Service	1609906379	1609906379	1	1	PURA, LYNN M NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	442 SUNSET BLVD	None	HAYWARD	CA	94541	3832	01	06001	37.67421974	-122.0975231	Alameda County
277183	Fee-for-Service	1265051460	1265051460	1	1	PIERCE, JAMES MD	11/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184688	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
277185	Fee-for-Service	1316021942	1316021942	1	9	PILAR M DE CASTRO & CO	9/27/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9581 W CRESTWOOD LANE	None	ANAHEIM	CA	92804	6370	30	06059	33.80632357	-117.9659485	Orange County
277205	Fee-for-Service	1730304023	1730304023	1	1	PRICE, ROBERT E MD	4/19/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	75414	-	NOT APPLICABLE	0	In state provider	None	768 PLEASANT VALLEY RD	STE 201	DIAMOND SPRINGS	CA	95691	9260	09	06017	38.69498433	-120.8070771	El Dorado County
277216	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	4/9/2019	1041C0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
277264	Fee-for-Service	1649539206	1649539206	1	2	PROHEALTH PARTNERS, MEDICAL	9/4/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
277294	Fee-for-Service	1689167751	1689167751	1	1	PALMER, JACQUELINE N NP	11/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43839 N 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
277355	Fee-for-Service	1992747653	1992747653	1	1	PASTRANA, THEODORE B JR MD	5/20/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75347	01	General Practice	0	In state provider	None	100 E VALENCIA MESA DR	STE 309	FULLERTON	CA	92835	3805	30	06059	33.89343304	-117.9279349	Orange County
277360	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	1/15/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
277434	Fee-for-Service	1770503369	1770503369	1	1	PEDRAZA, ISABEL F MD	6/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83574	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 420	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277460	Fee-for-Service	1225238538	1225238538	1	1	PHAM, KHOA THOMAS A MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129715	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277465	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	9/25/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
277476	Fee-for-Service	1356652788	1356652788	1	1	PEPITO, DON L MD	7/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
277508	Fee-for-Service	1235312935	1235312935	1	1	PARK, CHRIS J DPM INC	12/1/1998	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	18895 COLIMA RD	STE A	ROWLAND HEIGHTS	CA	91748	2978	19	06037	33.98772522	-117.8915158	Los Angeles County
277511	Fee-for-Service	1649539206	1649539206	1	2	PROHEALTH PARTNERS, MEDICAL	3/17/2020	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
277529	Fee-for-Service	1609063593	1609063593	1	1	PHIPPS, MARY J LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
277530	Fee-for-Service	1023137197	1023137197	1	1	PROTHRO, JOYCELIN K	9/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
277531	Fee-for-Service	1841217734	1841217734	1	1	PEELEN, JOEL A MD	6/16/1995	207L00000X	NA	Other	026	PHYSICIANS	68673	05	Anesthesiology	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
277538	Fee-for-Service	1588677124	1588677124	1	1	PARSONS, C LOWELL MD	4/1/1977	208800000X	NA	Other	026	PHYSICIANS	33834	34	Urology and Urological Surgery	0	In state provider	DEPT OF SURGERY	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
277568	Fee-for-Service	1275521130	1275521130	1	1	PINTO, DUANE S MD	12/13/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
277574	Fee-for-Service	1497808794	1497808794	1	1	PHAM, MATT T OD	6/19/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8080 PARKWAY DRIVE	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
277604	Fee-for-Service	1043218944	1043218944	1	1	PITT COUNTY MEMORIAL HSP	1/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2100 STANTONSBURG RD	None	GREENVILLE	NC	27834	2832	00	None	35.607447	-77.4037035	Pitt County
277606	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	1/15/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
277636	Fee-for-Service	1194258996	1194258996	1	1	PHAM, MICHAEL DO	7/21/2022	207R00000X	NA	Other	026	PHYSICIANS	19208	None	None	0	In state provider	None	8901 ACTIVITY RD	STE 205	SAN DIEGO	CA	92126	4436	37	06073	32.8960193	-117.1345934	San Diego County
277663	Fee-for-Service	1912383183	1912383183	1	1	PMDCA, LLC	2/12/2019	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	23297 S POINTE DR	SUITE 100	LAGUNA HILLS	CA	92653	1491	30	06059	33.62651773	-117.7229447	Orange County
277706	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
277730	Fee-for-Service	1043848351	1043848351	1	1	PANDYA, RUTVIJ P	9/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
277735	Fee-for-Service	1750488995	1750488995	1	1	PALMERTON HOSPITAL	3/22/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	135 LAFAYETTE AVE	None	PALMERTON	PA	18071	1596	00	None	40.8023983	-75.61473374	Carbon County
277761	Fee-for-Service	1649539206	1649539206	1	2	PROHEALTH PARTNERS, MEDICAL	9/4/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
277775	Fee-for-Service	1962013870	1962013870	1	1	PHILIP RYAN M CAMILON, MD	8/19/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	84	Surgery-Head and Neck	0	In state provider	None	505 S MAIN ST	STE 275	ORANGE	CA	92868	4547	30	06059	33.78004808	-117.8672472	Orange County
277782	Fee-for-Service	1134894694	1134894694	1	1	PARK, TARA M PT	9/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
277798	Fee-for-Service	1750447454	1750447454	1	1	POWERS, ANNE T NP	3/30/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
277799	Fee-for-Service	1164470571	1164470571	1	1	PRUNEAN, CRISTIAN MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85694	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
277814	Fee-for-Service	1780717652	1780717652	1	1	PROHEALTH PARTNERS A MEDICAL	2/15/2008	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1040 ELM AVE	SUITE 302	LONG BEACH	CA	90813	3264	19	06037	33.779799	-118.1879535	Los Angeles County
277816	Fee-for-Service	1275521130	1275521130	1	1	PINTO, DUANE S MD	12/13/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
277833	Fee-for-Service	1154741254	1154741254	1	1	PATEL, BHATKI H MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142439	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
277837	Fee-for-Service	1316021942	1316021942	1	2	PILAR M DE CASTRO & CO	9/1/2000	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	6052 SAN YUBA WAY	None	BUENA PARK	CA	90620	2853	30	06059	33.84368654	-118.0270755	Orange County
277849	Fee-for-Service	1043218944	1043218944	1	1	PITT COUNTY MEMORIAL HSP	10/9/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2100 STANTONSBURG RD	None	GREENVILLE	NC	27834	2832	00	None	35.607447	-77.4037035	Pitt County
277854	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	9/27/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
277857	Fee-for-Service	1366804965	1366804965	1	1	PATEL, ROHAN V MD	10/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158085	None	None	0	In state provider	None	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	19	06037	33.97751255	-118.417598	Los Angeles County
277886	Fee-for-Service	1669827994	1669827994	2	1	PARTOW-NAVID, ROD MD	7/10/2024	207R00000X	NA	Other	026	PHYSICIANS	151083	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	374 E. VANDERBILT WAY	None	SAN BERNARDINO	CA	92408	3593	36	06071	34.06877142	-117.2770094	San Bernardino County
277915	Fee-for-Service	1225397037	1225397037	1	1	PATHAK, AMIT MD	12/27/2022	208M00000X	NA	Other	026	PHYSICIANS	138065	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
277950	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	10/29/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
277981	Fee-for-Service	1528527181	1528527181	1	3	PARAGON CHICO MEDICAL GROUP,	1/5/2022	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	None	74000 COUNTRY CLUB DR	STE D	PALM DESERT	CA	92260	1678	33	06065	33.75805952	-116.373249	Riverside County
277999	Fee-for-Service	1598746125	1598746125	1	1	PIPOLY, DANIEL J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1661 HOLLAND RD	STE 200	MAUMEE	OH	43537	4207	00	None	41.58935532	-83.6771859	Lucas County
278032	Fee-for-Service	1922345875	1922345875	1	1	POMERANZ, DAVID L MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124167	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278046	Fee-for-Service	1669506705	1669506705	1	1	PENG, EDWIN H MD	7/17/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	69543	36	Psychiatry	0	In state provider	None	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	19	06037	34.12158153	-117.723276	Los Angeles County
278052	Fee-for-Service	1659493658	1659493658	1	1	PAI, SHAN MD	4/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90513	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
278077	Fee-for-Service	1386622306	1386622306	1	1	PEREZ, PABLO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2001 STULTS RD	None	HUNTINGTON	IN	46750	1291	00	None	40.9057512	-85.49052046	Huntington County
278098	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	2/12/2021	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
278133	Fee-for-Service	1942071980	1942071980	1	1	PLAUGHER, RYAN J PT	3/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
278147	Fee-for-Service	1407273691	1407273691	1	1	PACKARD, JIN M MD DO	2/1/2018	207R00000X	NA	Other	026	PHYSICIANS	143149	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
278197	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	12/20/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
278206	Fee-for-Service	1427398205	1427398205	1	1	PULIZZI, PAULA LMFT	3/3/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
278215	Fee-for-Service	1265814198	1265814198	1	1	PEREZ, DAYANA LMFT	9/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
278216	Fee-for-Service	1619416773	1619416773	2	1	PARADISE PHARMACY, INC.	7/16/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	502 EUCLID AVE	100	NATIONAL CITY	CA	91950	2931	37	06073	32.68505421	-117.0832793	San Diego County
278238	Fee-for-Service	1447921176	1447921176	1	1	PRIME RX BELL GARDENS, INC.	1/9/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7625 EASTERN AVE	STE. E	BELL GARDENS	CA	90201	4515	19	06037	33.96350478	-118.1654354	Los Angeles County
278241	Fee-for-Service	1629573340	1629573340	1	1	PEOPLES COMMUNITY CLINIC	4/2/2018	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4626 NORTH GRAND AVENUE	None	COVINA	CA	91724	2055	19	06037	34.096419	-117.872472	Los Angeles County
278254	Fee-for-Service	1508228040	1508228040	1	1	PATRICK, LAUREN B MD	7/29/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	154115	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278271	Fee-for-Service	1588775886	1588775886	1	1	PETERS, KATHERINE R	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10780 SANTA MONICA BLVD	STE 450	LOS ANGELES	CA	90025	7635	19	06037	34.05043291	-118.4339921	Los Angeles County
278291	Fee-for-Service	1740487743	1740487743	1	1	PRAKASH, MEENA MD	7/31/2020	208M00000X	NA	Other	026	PHYSICIANS	167732	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
278341	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
278353	Fee-for-Service	1568540375	1568540375	1	1	PADERO, MA CLARA M MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	66875	67	Endocrinology	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
278359	Fee-for-Service	1568516276	1568516276	1	1	PLUMMER, JENNIFER E PHD	1/22/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	SUITE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
278381	Fee-for-Service	1972870095	1972870095	1	1	PAK, DARIYA NP	3/21/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
278400	Fee-for-Service	1134685605	1134685605	1	1	PEREZ, LESA C PT	3/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
278410	Fee-for-Service	1104936343	1104936343	1	1	PRUSINER, STAMLEY B MD	5/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	22619	13	Neurology (M.D. only)	0	In state provider	SFGH DEPT NEUROLOGY	1001 POTRERO AVE	# 4	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
278415	Fee-for-Service	1205935913	1205935913	1	1	PIGAZZI, ALESSIO MD	1/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87281	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
278424	Fee-for-Service	1205055282	1205055282	1	1	PALLEY, REBECCA J LMFT	7/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	408 BROAD ST	STE 10B	NEVADA CITY	CA	95959	2454	29	06057	39.26292145	-121.0198334	Nevada County
278426	Fee-for-Service	1114125085	1114125085	1	1	POPAT, UMANGI P OD	7/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	SUITE 101	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
278435	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	9/20/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
278436	Fee-for-Service	1669616306	1669616306	1	1	PIERCE, BRENDAN H G MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134214	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
278457	Fee-for-Service	1730574393	1730574393	1	1	PARK, LEEANNE MD	8/4/2019	207L00000X	NA	Other	026	PHYSICIANS	146290	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
278471	Fee-for-Service	1942362488	1942362488	1	1	PREMA, NITYA LMFT	6/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11740 DUBLIN BLVD	None	DUBLIN	CA	94568	2823	01	06001	37.70081596	-121.9400706	Alameda County
278478	Fee-for-Service	1376747204	1376747204	1	1	PEREZ, MARIO L DO	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	8963	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
278534	Fee-for-Service	1912981606	1912981606	1	1	POWERS, THOMAS W MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36722	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	166 E FOOTHILL BLVD	None	ARCADIA	CA	91006	2568	19	06037	34.15103348	-118.0257435	Los Angeles County
278541	Fee-for-Service	1508250747	1508250747	1	1	PATEL, VIJAY A MD	6/28/2022	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	172174	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
278555	Fee-for-Service	1245316769	1245316769	1	1	PHAM, Y LONG MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82122	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
278562	Fee-for-Service	1578838520	1578838520	1	8	PACIFIC COAST MEDICAL CENTER	6/9/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2013 W BEVERLY BLVD	SUITE A	MONTEBELLO	CA	90640	3972	19	06037	34.0202866	-118.1209134	Los Angeles County
278581	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	8/18/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
278588	Fee-for-Service	1205832706	1205832706	1	1	PONAS STEPHEN H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 601	PHOENIX	AZ	85012	2395	00	None	33.486606	-112.071654	Maricopa County
278657	Fee-for-Service	1528844933	1528844933	1	1	PAULSEN, PAUL OTTO JONAS	3/29/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
278673	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	11/28/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
278725	Fee-for-Service	1740489020	1740489020	1	1	PARNES, JOSHUA S MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99643	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
278726	Fee-for-Service	1396072971	1396072971	1	2	PLACER HILLS UNION SD	1/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	16801 PLACER HILLS RD	None	MEADOW VISTA	CA	95722	9531	31	06061	38.99607483	-121.0231448	Placer County
278746	Fee-for-Service	1851552293	1851552293	1	1	PATEL, NINA A MD	3/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114975	41	Internal Medicine	0	In state provider	None	3114 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02383346	-118.137193	Los Angeles County
278752	Fee-for-Service	1487626966	1487626966	1	1	PINGER, WHITNEY A CNM	10/9/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
278782	Fee-for-Service	1104834647	1104834647	1	1	PASSMORE, THOMAS A. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
278799	Fee-for-Service	1578838520	1578838520	1	8	PACIFIC COAST MEDICAL CENTER	6/9/2014	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2013 W BEVERLY BLVD	SUITE A	MONTEBELLO	CA	90640	3972	19	06037	34.0202866	-118.1209134	Los Angeles County
278813	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	1/7/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
278824	Fee-for-Service	1790105856	1790105856	1	1	PONS, JENNIFER P MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139154	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
278881	Fee-for-Service	1194719740	1194719740	1	1	PACIFIC PATHOLOGY	1/28/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MEDICAL ASSOCIATES	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
278907	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	3/29/2019	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
278909	Fee-for-Service	1861591646	1861591646	1	2	PRATT, CAROLYN K MD	12/7/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	55706	-	NOT APPLICABLE	0	In state provider	None	564 RIO LINDO AVENUE	SUITE 204	CHICO	CA	95926	1852	04	06007	39.75522091	-121.8490462	Butte County
279012	Fee-for-Service	1104353317	1104353317	1	1	PELAEZ ROMERO, CARLOS A MD	7/30/2021	208M00000X	NA	Other	026	PHYSICIANS	171058	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
279014	Fee-for-Service	1306225545	1306225545	1	1	PARWEEN, RASHIDA DO	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15218	01	General Practice	0	In state provider	None	475 PIONEER AVE	SUITE 200	WOODLAND	CA	95776	4905	57	06113	38.67357823	-121.7456787	Yolo County
279032	Fee-for-Service	1528127289	1528127289	1	1	PATEL, TUSHAR MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55313	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
279052	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	11/14/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
279072	Fee-for-Service	1316255508	1316255508	1	1	PETROSYAN, MARIANNA T OD	1/21/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 GLENOAKS BLVD	None	SAN FERNANDO	CA	91340	1436	19	06037	34.29074927	-118.4296911	Los Angeles County
279101	Fee-for-Service	1750148748	1750148748	1	1	PETTUS, ALEXANDRA L NP	3/27/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
279137	Fee-for-Service	1124698139	1124698139	1	1	PALOMAR EMERGENCY PHYSICIANS	8/1/2021	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	, INC	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
279144	Fee-for-Service	1548343510	1548343510	1	60	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
279173	Fee-for-Service	1104123652	1104123652	1	1	PROHEALTH MEDICAL SUPPLY,INC	11/2/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4509 EAGLE ROCK BLVD	SUITE B	LOS ANGELES	CA	90041	3214	19	06037	34.12639986	-118.2189437	Los Angeles County
279196	Fee-for-Service	1942332937	1942332937	1	1	PROHEALTH PARTNERS	1/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	3816 WOODRUFF AVE	STE 401	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
279213	Fee-for-Service	1194803684	1194803684	1	1	PATERNO, RONALD D DPM	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
279216	Fee-for-Service	1831278308	1831278308	1	1	PHILLIP EVAN BARNETTE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
279239	Fee-for-Service	1689230450	1689230450	1	1	PETERSON, NICHOLAS E MD	6/17/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	185351	25	Physical Medicine and Rehabilitation	0	In state provider	None	6363 WILSHIRE BLVD	STE 516	LOS ANGELES	CA	90048	5726	19	06037	34.06367823	-118.3675294	Los Angeles County
279252	Fee-for-Service	1588242986	1588242986	1	1	PHAM, LINDA DO	2/23/2025	207R00000X	NA	Other	026	PHYSICIANS	21583	41	Internal Medicine	0	In state provider	None	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
279257	Fee-for-Service	1851438311	1851438311	1	1	POWELL, ANTHONY F MD	4/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98327	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
279259	Fee-for-Service	1184196263	1184196263	1	1	PINK CROSS HOME HEALTH INC	4/27/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7250 VALJEAN AVE	None	VAN NUYS	CA	91406	3412	19	06037	34.202682	-118.485901	Los Angeles County
279278	Fee-for-Service	1891762985	1891762985	1	4	PIT RIVER HEALTH SERVICE, IN	6/28/2021	No Taxonomy Provided	NA	None	096	TRIBAL FQHC PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	RAL HEALTH AND OUTREACH	701 N MAIN ST	2E	ALTURAS	CA	96101	3493	25	06049	41.4905012	-120.5425921	Modoc County
279282	Fee-for-Service	1104922491	1104922491	1	1	PETERSON, ROBERT G MD	2/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45382	None	None	0	In state provider	None	1973 FOOTHILL PKWY	104	CORONA	CA	92881	4110	33	06065	33.83172462	-117.530378	Riverside County
279286	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
279290	Fee-for-Service	1003950585	1003950585	1	1	PACIFIC TOXICOLOGY	10/2/2015	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORIES	9348 DE SOTO AVE	None	CHATSWORTH	CA	91311	4926	19	06037	34.2403887	-118.5884892	Los Angeles County
279306	Fee-for-Service	1073662110	1073662110	1	1	PACIFIC SHORES MED GROUP	3/24/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	3791 KATELLA AVE	STE 205	LOS ALAMITOS	CA	90720	2016	30	06059	33.80318449	-118.0672965	Orange County
279375	Fee-for-Service	1538453634	1538453634	1	1	PIERCE, NATHAN	4/22/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	143533	None	None	0	In state provider	None	850 S ATLANTIC BLVD	305	MONTEREY PARK	CA	91754	6714	19	06037	34.05097684	-118.1379979	Los Angeles County
279377	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	2/19/2020	1041C0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
279384	Fee-for-Service	1417078072	1417078072	1	1	PARKER, KEITH D LMFT	1/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
279398	Fee-for-Service	1003810953	1003810953	1	1	POMER, ARCADIO H V MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134105	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
279404	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	9/25/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
279437	Fee-for-Service	1104958339	1104958339	1	1	PLASTIC SURG & HAND SURG	1/27/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	MED CLINIC OF SANTA BARB	511 E ARRELLAGE ST	None	SANTA BARBARA	CA	93103	2205	42	06083	34.43276021	-119.7035741	Santa Barbara County
279473	Fee-for-Service	1730384876	1730384876	1	1	PATEL, SARJU S MD	1/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146195	18	Ophthalmology	0	In state provider	None	3939 J ST	SUITE 106	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
279480	Fee-for-Service	1922242585	1922242585	1	1	PEZESHKIAN, PATRICK MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107481	14	Neurological Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
279510	Fee-for-Service	1891762985	1891762985	1	4	PIT RIVER HEALTH SERVICE, IN	7/3/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	RAL HEALTH AND OUTREACH	701 N MAIN ST	2E	ALTURAS	CA	96101	3493	25	06049	41.4905012	-120.5425921	Modoc County
279517	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/31/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
279524	Fee-for-Service	1285711937	1285711937	1	1	PROSPERA GROUP CORP	10/1/2013	261QM1300X	NA	Other	026	PHYSICIANS	89143	40	Pediatrics	0	In state provider	None	3831 HUGHES AVE	STE 602	CULVER CITY	CA	90232	6845	19	06037	34.02243278	-118.3981492	Los Angeles County
279531	Fee-for-Service	1366486243	1366486243	1	1	PATEL, RAJ J MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81561	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
279539	Fee-for-Service	1073662110	1073662110	1	1	PACIFIC SHORES MED GROUP	3/24/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3791 KATELLA AVE	STE 205	LOS ALAMITOS	CA	90720	2016	30	06059	33.80318449	-118.0672965	Orange County
279555	Fee-for-Service	1730498601	1730498601	1	1	PERKINS, ROBERT A MD	3/5/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161786	30	Radiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
279599	Fee-for-Service	1548703036	1548703036	1	1	PENNISI, DOMINIC MD	2/22/2022	207R00000X	NA	Other	026	PHYSICIANS	175794	None	None	0	In state provider	None	1503 E MARCH LN	A	STOCKTON	CA	95210	5622	39	06077	38.00228434	-121.2903651	San Joaquin County
279607	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	7/12/2019	1041C0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
279622	Fee-for-Service	1780007096	1780007096	1	1	PRISTINE HOME HEALTH INC	1/31/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1419 N SAN FERNANDO BLVD	SUITE 100	BURBANK	CA	91504	4100	19	06037	34.19071688	-118.322281	Los Angeles County
279638	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	11/24/2019	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
279645	Fee-for-Service	1356572267	1356572267	1	1	PAE, EUNICE K MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113819	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
279653	Fee-for-Service	1366680530	1366680530	1	1	PANITHI, RANJANI MD	7/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	121480	None	None	0	In state provider	None	625 34TH ST	100 & 200	BAKERSFIELD	CA	93301	2305	15	06029	35.39046051	-119.0092725	Kern County
279673	Fee-for-Service	1790104693	1790104693	1	1	PATEL, CECIL A MD	7/9/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	137752	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
279745	Fee-for-Service	1336600758	1336600758	1	1	PHAM, ALEX D MD	6/21/2023	207LP2900X	NA	Other	026	PHYSICIANS	186147	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
279748	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	3/12/2021	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
279750	Fee-for-Service	1497803209	1497803209	2	1	PETER A. OKWUASABA M.D.	12/12/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8803 S 101ST EAST AVE	STE 350	TULSA	OK	74133	5772	00	None	36.036423	-95.86464352	Tulsa County
279768	Fee-for-Service	1598901274	1598901274	1	1	PARIKH, PARUL A	2/4/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3575 BEACON AVENUE	None	FREMONT	CA	94538	1407	01	06001	37.54913518	-121.9816504	Alameda County
279792	Fee-for-Service	1194842930	1194842930	1	1	PAPENFUS, KURT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1906 BLAKE ST	None	GLENWOOD SPRINGS	CO	81601	0000	00	None	39.5325491	-107.3227821	Garfield County
279794	Fee-for-Service	1295802296	1295802296	1	1	PRIETTO, NOELANI M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71079	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
279805	Fee-for-Service	1902250194	1902250194	1	1	POYSOPHON, POYSOPHON MD	3/2/2022	207R00000X	NA	Other	026	PHYSICIANS	150669	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
279808	Fee-for-Service	1922032564	1922032564	1	1	PETERS, MAURICE R MD	6/28/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	68249	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
279825	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	6/3/2019	207R00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
279833	Fee-for-Service	1336754894	1336754894	1	1	PATEL, SHIVANI P PHD	10/13/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
279840	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	2/24/2020	1041C0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
279852	Fee-for-Service	1265552095	1265552095	1	1	PADILLA, CEFERINA R LMFT	7/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
279869	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	12/11/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
279877	Fee-for-Service	1962233924	1962233924	1	1	PIERCE, RASHIDA BIRTH DOULA	9/12/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
279902	Fee-for-Service	1710330287	1710330287	1	1	POST, KENNETH S AU	3/1/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23010 LAKE FOREST DRIVE	SUITE B	LAGUNA HILLS	CA	92653	1351	30	06059	33.62886462	-117.7258933	Orange County
279918	Fee-for-Service	1528300753	1528300753	1	1	POLLOCK, GABRIEL A MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149031	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	W HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
279981	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/18/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
279992	Fee-for-Service	1427208081	1427208081	1	1	POQUECHOQUE, ROBERT MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118031	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
279994	Fee-for-Service	1770557845	1770557845	1	1	PRAGER, ROBERT J MD	8/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	27737	30	Radiology	0	In state provider	None	7910 FROST ST	STE 202	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
280010	Fee-for-Service	1558998914	1558998914	1	1	PENALOSA, PATRICK J	6/6/2024	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187108	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
280035	Fee-for-Service	1871655035	1871655035	1	1	PARISH, REBECCA A MD	4/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98073	41	Internal Medicine	0	In state provider	None	106 LA CASA VIA	STE 100	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
280051	Fee-for-Service	1205426285	1205426285	1	1	PUSHTI CORPORATION	2/23/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39872 LOS ALAMOS RD	STE A10	MURRIETA	CA	92562	5871	33	06065	33.5712411	-117.1838408	Riverside County
280056	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	5/2/2019	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
280061	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280067	Fee-for-Service	1548343510	1548343510	1	66	PERMANENTE MEDICAL GROUP INC	7/20/2019	1041C0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
280075	Fee-for-Service	1932149580	1932149580	1	1	PERRY, CHRISTOPHER	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81957	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
280079	Fee-for-Service	1710956818	1710956818	1	1	POLANCO, LETICIA A MD	1/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76528	08	Family Practice	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
280095	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	12/19/2016	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
280117	Fee-for-Service	1790043131	1790043131	1	1	PERRY, EDWARD T JR MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127126	01	General Practice	0	In state provider	None	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
280119	Fee-for-Service	1891907085	1891907085	1	1	PIRANI, NADEER A	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
280120	Fee-for-Service	1073900429	1073900429	1	1	PHIPPS, DENISE M LMFT	7/17/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3511 CAMINO DEL RIO S	SUITE 500	SAN DIEGO	CA	92108	4022	37	06073	32.77772762	-117.1180597	San Diego County
280151	Fee-for-Service	1255429338	1255429338	1	3	PROVIDENCE HEALTH & SERVICES	6/27/2018	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	810 12TH STREET	None	HOOD RIVER	OR	97031	1587	00	None	45.70414182	-121.5237405	Hood River County
280190	Fee-for-Service	1316232796	1316232796	1	1	PEREZ, ELIZABETH M MD	11/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126085	01	General Practice	0	In state provider	None	1220 ROSSMOOR PARKWAY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
280193	Fee-for-Service	1710999255	1710999255	1	1	PARNELL, SHAWN E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
280197	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	4/17/2017	176B00000X	NA	Licensed Midwife	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
280203	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	3/5/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
280224	Fee-for-Service	1487296059	1487296059	1	1	PARRA HAYNES, CATHERINE LMF	10/15/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM ST	110	RIVERSIDE	CA	92501	1773	33	06065	34.00198519	-117.3739252	Riverside County
280235	Fee-for-Service	1639365018	1639365018	1	1	PALMER, MICHELLE R PSYD	1/29/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
280249	Fee-for-Service	1285809822	1285809822	1	1	PHILIP, FEMI MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131752	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
280259	Fee-for-Service	1770682536	1770682536	1	1	POLITOSKE, EDWARD J MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41806	10	Gastroenterology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
280281	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	5/2/2019	207R00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
280288	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280323	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	1/11/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
280334	Fee-for-Service	1770007130	1770007130	1	1	PINNEY, DANIEL J LMFT	7/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
280341	Fee-for-Service	1164559837	1164559837	1	1	PRESSMAN, BARRY D MD	12/30/1975	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	24000	None	None	0	In state provider	None	2044 ARMACOST AVE	# 2	LOS ANGELES	CA	90025	6113	19	06037	34.03393989	-118.4533053	Los Angeles County
280362	Fee-for-Service	1699216879	1699216879	1	1	POSTON, LINDSAY N MD	8/20/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173523	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
280377	Fee-for-Service	1255429338	1255429338	1	3	PROVIDENCE HEALTH & SERVICES	6/27/2018	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OREGON	810 12TH STREET	None	HOOD RIVER	OR	97031	1587	00	None	45.70414182	-121.5237405	Hood River County
280383	Fee-for-Service	1225415193	1225415193	1	1	POEHLER, KIMBERLY A LMFT	8/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	SUITE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
280390	Fee-for-Service	1891254108	1891254108	1	1	PENA, LAUREN E LMFT	2/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
280402	Fee-for-Service	1013332725	1013332725	1	1	PSYCHTOOLS PSYCHOLOGY GROUP	11/2/2015	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PC	1402 PARK ST	STE G	ALAMEDA	CA	94501	4562	01	06001	37.76436168	-122.2426797	Alameda County
280414	Fee-for-Service	1336567908	1336567908	1	1	PAPOIAN, VARDAN MD	9/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	166539	02	General Surgery	0	In state provider	None	805 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
280418	Fee-for-Service	1861812984	1861812984	1	1	POLACH, PATRICK DO	8/22/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14777	08	Family Practice	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
280423	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	6/23/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
280427	Fee-for-Service	1871981522	1871981522	1	1	PAREDES, CAROLINE LCSW	2/1/2016	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	103 S GORDON AVE	None	GLENDORA	CA	91741	3824	19	06037	34.1360714	-117.8329138	Los Angeles County
280428	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	4/23/2021	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
280432	Fee-for-Service	1245771971	1245771971	1	1	PANI, AMITA K	12/19/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
280451	Fee-for-Service	1386636165	1386636165	1	1	P GILL OBSTETRICS & GYN	2/1/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GROUP, INC	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
280474	Fee-for-Service	1285809822	1285809822	1	1	PHILIP, FEMI MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131752	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
280503	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	11/8/2018	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
280511	Fee-for-Service	1124698139	1124698139	1	2	PALOMAR EMERGENCY PHYSICIANS	8/8/2021	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	, INC	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
280512	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	7/9/2018	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280513	Fee-for-Service	1104029776	1104029776	1	1	PALETZ, DAVI L MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101562	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
280521	Fee-for-Service	1770641482	1770641482	1	1	PLANNED PARENTHOOD	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	RICHMOND CENTER	2970 HILLTOP MALL	STE 307	RICHMOND	CA	94806	5238	07	06013	37.97819764	-122.329244	Contra Costa County
280533	Fee-for-Service	1366539884	1366539884	1	1	PACIFIC PED MED GRP INC	1/6/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	45 CASTRO ST	STE 232	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
280542	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
280550	Fee-for-Service	1023770146	1023770146	1	1	PHAN, CAROLYN C PT	5/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
280564	Fee-for-Service	1013137991	1013137991	1	1	PERRY, TIFFANY G MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137839	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
280592	Fee-for-Service	1952577322	1952577322	1	1	PIYARATNA, ROHITH MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109383	05	Anesthesiology	0	In state provider	None	3315 WATT AVENUE	None	SACRAMENTO	CA	95821	6800	34	06067	38.626056	-121.3834455	Sacramento County
280627	Fee-for-Service	1093852493	1093852493	1	1	PIPKIN, JESSICA M CRNA	1/14/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93650	3109	16	06031	36.32396253	-119.6688834	Kings County
280628	Fee-for-Service	1316021942	1316021942	1	7	PILAR M DE CASTRO & CO	5/15/2003	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	2540 W GRAMERCY AVE	None	ANAHEIM	CA	92801	3140	30	06059	33.8409636	-117.9737288	Orange County
280642	Fee-for-Service	1861812984	1861812984	1	1	POLACH, PATRICK DO	8/22/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14777	01	General Practice	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
280649	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	12/20/2018	176B00000X	NA	Licensed Midwife	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
280650	Fee-for-Service	1013526268	1013526268	1	1	PATHWAY HOME HEALTH SERVICES	6/29/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	50 W LEMON AVE	STE 24	MONROVIA	CA	91016	6152	19	06037	34.14691794	-118.0013392	Los Angeles County
280656	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	11/27/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
280659	Fee-for-Service	1457391740	1457391740	1	1	PORZIO, DAVID G MD	3/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76138	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2011 WESTCLIFF DRIVE	SUITE 6	NEWPORT BEACH	CA	92660	5508	30	06059	33.62741724	-117.9073738	Orange County
280680	Fee-for-Service	1750592127	1750592127	1	1	PEDROZA, TRICIA MARIE	9/1/2008	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATOR	14110 CORDARY AVE	None	HAWTHORNE	CA	90250	8005	19	06037	33.903216	-118.341693	Los Angeles County
280694	Fee-for-Service	1790836500	1790836500	1	2	PICKETT, ANTHONY C MD IN	11/1/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	76921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MATERNITY CENTER OF VERN	4230 S FIGUEROA ST	None	LOS ANGELES	CA	90037	2640	19	06037	34.006428	-118.2827115	Los Angeles County
280729	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	1/28/2019	207R00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
280734	Fee-for-Service	1376123026	1376123026	1	1	PIERCE, COLE L MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
280735	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280768	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
280784	Fee-for-Service	1225096126	1225096126	1	1	PAULSEN, JANICE D MD	12/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60748	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4021	50	06099	37.653219	-120.975542	Stanislaus County
280814	Fee-for-Service	1538572516	1538572516	1	1	PEI, THEODORE MD	9/20/2022	2080P0203X	NA	Other	026	PHYSICIANS	179777	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
280816	Fee-for-Service	1457762155	1457762155	1	1	PROHEALTH PARTNERS	10/23/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	A MEDICAL GROUP INC	2020 S BREA CANYON RD	SUITE A1	DIAMOND BAR	CA	91765	4012	19	06037	33.9852146	-117.8449156	Los Angeles County
280867	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	7/20/2019	176B00000X	NA	Licensed Midwife	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
280877	Fee-for-Service	1548343510	1548343510	1	71	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5617 SCOTTS VALLEY	None	SCOTTS VALLEY	CA	95066	3482	44	06087	37.06204883	-122.0069319	Santa Cruz County
280927	Fee-for-Service	1154680536	1154680536	1	1	PARKER, ANGEL K MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118696	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
280949	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
280955	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
280958	Fee-for-Service	1437269420	1437269420	1	1	PANDIT, LALITA MD INC	10/1/2001	207RH0003X	NA	Oncology	026	PHYSICIANS	47707	68	Hematology	0	In state provider	None	11180 WARNER AVE	STE 467	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
280988	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	12/8/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
281011	Fee-for-Service	1992750137	1992750137	1	1	PACIFIC HOSPITALIST ASSOCIAT	5/1/2003	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ES A MEDICAL CORPORATIO	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
281025	Fee-for-Service	1356394175	1356394175	1	1	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	621 S BUTTE STREET	None	SAN PEDRO	CA	90732	3510	19	06037	33.73839738	-118.3065444	Los Angeles County
281033	Fee-for-Service	1508975079	1508975079	2	1	PROCARE PHARMACY, LLC	2/1/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	445 CASTRO STREET	None	SAN FRANCISCO	CA	94114	2019	38	06075	37.76171884	-122.4350516	San Francisco County
281038	Fee-for-Service	1457762155	1457762155	1	1	PROHEALTH PARTNERS	10/23/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	A MEDICAL GROUP INC	2020 S BREA CANYON RD	SUITE A1	DIAMOND BAR	CA	91765	4012	19	06037	33.9852146	-117.8449156	Los Angeles County
281055	Fee-for-Service	1457762155	1457762155	1	2	PROHEALTH PARTNERS, A MEDICA	7/12/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	L GROUP, INC.	8706 IMPERIAL HWY	SUITE A1	DOWNEY	CA	90242	3906	19	06037	33.91802345	-118.1407927	Los Angeles County
281079	Fee-for-Service	1477519445	1477519445	1	1	PRASAD, CHANNA B MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
281087	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	11/30/2018	176B00000X	NA	Licensed Midwife	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
281093	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	11/27/2022	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
281114	Fee-for-Service	1144358235	1144358235	1	1	PARSON, ERMA S LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
281167	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	6/3/2019	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
281173	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
281178	Fee-for-Service	1437269420	1437269420	1	1	PANDIT, LALITA MD INC	10/1/2001	207RH0003X	NA	Oncology	026	PHYSICIANS	47707	78	Neoplastic Diseases/Oncology	0	In state provider	None	11180 WARNER AVE	STE 467	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
281197	Fee-for-Service	1316338619	1316338619	1	1	PREMIER URGENT CARE CENTERS	4/27/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA, INC	82013 DR CARREON BLVD	SUITE 4G	INDIO	CA	99201	9203	33	06065	33.70738152	-116.233002	Riverside County
281200	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	5/24/2017	103TC0700X	NA	Mental Health Outpatient Services	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
281208	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
281235	Fee-for-Service	1952796377	1952796377	1	1	PATEL, VEESHAL H MD	7/27/2022	390200000X	NA	Other	026	PHYSICIANS	151683	None	None	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
281271	Fee-for-Service	1457762155	1457762155	1	2	PROHEALTH PARTNERS, A MEDICA	7/12/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	L GROUP, INC.	8706 IMPERIAL HWY	SUITE A1	DOWNEY	CA	90242	3906	19	06037	33.91802345	-118.1407927	Los Angeles County
281276	Fee-for-Service	1336155308	1336155308	1	1	PEREZ, LEONID K MD	12/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74145	05	Anesthesiology	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
281277	Fee-for-Service	1972551174	1972551174	1	1	PACIFIC ALLIANCE MED CTR	7/13/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	4837 HUNTINGTON DR N	None	LOS ANGELES	CA	90032	1953	19	06037	34.0860874	-118.1788432	Los Angeles County
281280	Fee-for-Service	1225589864	1225589864	1	1	PARK, DO-YOUNG NP	11/19/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
281287	Fee-for-Service	1861578684	1861578684	1	1	PATTEN, PETER K VAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	6255	00	None	45.20010494	-123.1656951	Yamhill County
281297	Fee-for-Service	1477519445	1477519445	1	1	PRASAD, CHANNA B MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
281308	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	12/30/2018	176B00000X	NA	Licensed Midwife	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
281310	Fee-for-Service	1548343510	1548343510	1	72	PERMANENTE MEDICAL GROUP INC	3/19/2021	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
281339	Fee-for-Service	1447801097	1447801097	1	1	PAMOJA ADVANCED NURSING PRAC	3/12/2020	364SP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	TICE INC	710 N EUCLID ST	STE 208	ANAHEIM	CA	92801	4132	30	06059	33.8420837	-117.9415765	Orange County
281348	Fee-for-Service	1891844759	1891844759	1	1	PURI, VARSHA M DO	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9142	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281384	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	10/18/2019	207R00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
281386	Fee-for-Service	1336227362	1336227362	1	2	PEDIATRIC MEDICAL GROUP OF R	12/27/2018	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IVERSIDE INC.	6950 BROCKTON AVE	5	RIVERSIDE	CA	92506	3831	33	06065	33.9474392	-117.3967287	Riverside County
281390	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
281393	Fee-for-Service	1437269420	1437269420	1	1	PANDIT, LALITA MD INC	10/1/2001	207RH0003X	NA	Oncology	026	PHYSICIANS	47707	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 467	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
281397	Fee-for-Service	1407219009	1407219009	1	1	PATEL, RESHMA P MD	4/4/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	150824	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
281401	Fee-for-Service	1497252969	1497252969	1	1	PHUNG, SAMANTHA C DO	5/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20980	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
281412	Fee-for-Service	1316338619	1316338619	1	1	PREMIER URGENT CARE CENTERS	4/27/2020	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	82013 DR CARREON BLVD	SUITE 4G	INDIO	CA	99201	9203	33	06065	33.70738152	-116.233002	Riverside County
281417	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	6/25/2009	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
281423	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	4/2/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
281427	Fee-for-Service	1598977415	1598977415	1	1	PHAN, ISABELLA T MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99033	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
281428	Fee-for-Service	1245387067	1245387067	1	1	PERKINS, JENNIFER MD	10/7/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	170375	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
281435	Fee-for-Service	1336657725	1336657725	1	1	PILLAI, KSENIA S MD	4/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
281450	Fee-for-Service	1689105819	1689105819	1	1	PALMER, RACHEL T DO	12/30/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18485	None	None	0	In state provider	None	147 NORTH BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
281464	Fee-for-Service	1699722397	1699722397	1	1	PASHMFOROUSH, MOHAMMAD	2/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60730	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
281479	Fee-for-Service	1871024935	1871024935	1	1	PINA PAZ, SYLVIA A MD	5/11/2021	207P00000X	NA	Other	026	PHYSICIANS	162736	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
281490	Fee-for-Service	1144234519	1144234519	1	1	PARK, CHRIS J DPM	5/24/2009	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	18897 COLIMA RD	STE B	ROWLAND HEIGHTS	CA	91748	2977	19	06037	33.98769974	-117.8912223	Los Angeles County
281495	Fee-for-Service	1114159381	1114159381	1	1	PREMIER HEALTHCARE SERVICE	4/14/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	14724 VENTURA BLVD	SUITE 400	SHERMAN OAKS	CA	91403	3501	19	06037	34.15179235	-118.4541787	Los Angeles County
281521	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	12/30/2018	176B00000X	NA	Licensed Midwife	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
281550	Fee-for-Service	1619404159	1619404159	1	1	PATEL, NEIL MD	4/3/2024	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
281553	Fee-for-Service	1447801097	1447801097	1	1	PAMOJA ADVANCED NURSING PRAC	9/20/2023	364SP0808X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	TICE INC	710 N EUCLID ST	STE 208	ANAHEIM	CA	92801	4132	30	06059	33.8420837	-117.9415765	Orange County
281557	Fee-for-Service	1770640047	1770640047	1	1	PARISEAU, KIM T LMFT	6/19/2019	103TC0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	920 W 17TH ST	SUITE C	SANTA ANA	CA	92706	3576	30	06059	33.75994454	-117.8770455	Orange County
281581	Fee-for-Service	1538591102	1538591102	1	1	PADAL, JOSE CARLO B	7/24/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
281583	Fee-for-Service	1013350529	1013350529	1	1	PIRANI, ZAHRA MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144535	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
281591	Fee-for-Service	1780181917	1780181917	1	1	PATEL, ZAID I MD	5/10/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185448	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
281597	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	10/8/2018	207R00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
281602	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
281608	Fee-for-Service	1386140028	1386140028	1	1	PATEL, ASHLEY MD	8/25/2024	1835C0206X	NA	None	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
281629	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
281635	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
281653	Fee-for-Service	1043656416	1043656416	1	1	PARK, HEE CHAN MD	8/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134803	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3899	36	06071	34.04824949	-117.2401425	San Bernardino County
281670	Fee-for-Service	1740467299	1740467299	1	1	PAVLOVICH, WENDY D MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126181	40	Pediatrics	0	In state provider	None	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	37	06073	32.742936	-117.130118	San Diego County
281671	Fee-for-Service	1649647769	1649647769	1	1	PARKER, CLINTON LPCC	10/7/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
281714	Fee-for-Service	1295121770	1295121770	1	1	PARKER, COLIN J MD	8/6/2018	390200000X	NA	Other	026	PHYSICIANS	146501	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
281729	Fee-for-Service	1154661460	1154661460	1	1	PALIS, NATHALIA LMFT	12/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
281731	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	9/11/2012	176B00000X	NA	Licensed Midwife	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
281750	Fee-for-Service	1083213961	1083213961	1	1	PROFIZIX PHYSICAL THERAPY AN	3/26/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D WELLNESS P.C.	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
281760	Fee-for-Service	1619273224	1619273224	1	1	PLOTIN, JESSICA LMFT	7/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
281765	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
281777	Fee-for-Service	1497713267	1497713267	1	1	PATIL, SADANAND MD	9/26/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	190724	None	None	0	In state provider	None	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
281807	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	3/25/2020	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
281810	Fee-for-Service	1669557930	1669557930	1	3	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	2 ROSSI CIR	None	SALINAS	CA	93907	2370	27	06053	36.68813959	-121.6715296	Monterey County
281814	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
281822	Fee-for-Service	1386140028	1386140028	1	1	PATEL, ASHLEY MD	8/25/2024	1835C0206X	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
281823	Fee-for-Service	1942460506	1942460506	1	1	POURMEHR, SHARONA LMFT	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51789	-	NOT APPLICABLE	0	In state provider	None	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
281841	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	11/30/2018	103TC0700X	NA	Mental Health Outpatient Services	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
281847	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	11/30/2018	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
281848	Fee-for-Service	1639367410	1639367410	1	2	PATTERSON, SHANE M MD	5/17/2021	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	101166	-	NOT APPLICABLE	0	In state provider	None	891 MOUNTAIN RANCH RD	BUILDING L	SAN ANDREAS	CA	95249	9713	05	06009	38.19035603	-120.6679939	Calaveras County
281929	Fee-for-Service	1053186791	1053186791	1	1	POLARIS SPECIALTY PHARMACY,	8/13/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	837 W ARROW HWY	None	GLENDORA	CA	91740	5413	19	06037	34.10579799	-117.8784686	Los Angeles County
281941	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	2/24/2020	176B00000X	NA	Licensed Midwife	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
281970	Fee-for-Service	1124654454	1124654454	1	1	PRINA, JENNIFER NP	5/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
281974	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
281999	Fee-for-Service	1013977768	1013977768	1	1	POTRUCH, MICHAEL I MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70733	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
282018	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
282019	Fee-for-Service	1669557930	1669557930	1	3	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2 ROSSI CIR	None	SALINAS	CA	93907	2370	27	06053	36.68813959	-121.6715296	Monterey County
282023	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	3/31/2020	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
282045	Fee-for-Service	1346323094	1346323094	1	1	PRAMANIK, RAJIV MD	5/7/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83452	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
282049	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	6/28/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
282055	Fee-for-Service	1235182569	1235182569	1	1	PROVIDENCE MEDICAL INSTITUTE	3/23/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1294 W 6TH ST	SUITE 104	SAN PEDRO	CA	90731	2987	19	06037	33.73885348	-118.3056165	Los Angeles County
282057	Fee-for-Service	1639394117	1639394117	1	2	PINE RIVER INC.	2/3/2023	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	480 REDWOOD ST	STE 14	VALLEJO	CA	94590	2958	48	06095	38.12315545	-122.2597619	Solano County
282059	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	9/12/2018	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
282119	Fee-for-Service	1669686796	1669686796	1	1	PROHEALTH PARTNERS	6/26/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	A MEDICAL GROUP	1045 ATLANTIC AVE	STE 611	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
282135	Fee-for-Service	1104825033	1104825033	1	1	PARK, PETER S W DPM	12/11/2002	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
282136	Fee-for-Service	1770524290	1770524290	1	1	PAI, RAMDAS G MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48280	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
282148	Fee-for-Service	1659551299	1659551299	1	1	PATRICK, SHANNON K MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88339	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
282149	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	11/7/2018	176B00000X	NA	Licensed Midwife	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
282181	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
282223	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	12/30/2018	207R00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
282225	Fee-for-Service	1669557930	1669557930	1	3	PINNACLE MEDICAL GROUP INC	4/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2 ROSSI CIR	None	SALINAS	CA	93907	2370	27	06053	36.68813959	-121.6715296	Monterey County
282228	Fee-for-Service	1073606299	1073606299	1	20	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
282253	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	6/28/2017	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
282260	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
282264	Fee-for-Service	1285711937	1285711937	1	3	PROSPERA GROUP CORP	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	89143	40	Pediatrics	0	In state provider	None	2929 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5825	19	06037	33.97336735	-118.2165953	Los Angeles County
282322	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	1/28/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
282342	Fee-for-Service	1770524290	1770524290	1	1	PAI, RAMDAS G MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48280	41	Internal Medicine	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
282352	Fee-for-Service	1811073166	1811073166	1	1	PAN JEN-JUNG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	660 S EUCLID AVE	CAMPUS BOX 8015	ST LOUIS	MO	63110	1010	00	None	38.63518793	-90.26307576	St. Louis city
282356	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	10/29/2018	176B00000X	NA	Licensed Midwife	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
282367	Fee-for-Service	1124155643	1124155643	1	1	PARK, JOHN J MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85814	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
282379	Fee-for-Service	1720038458	1720038458	1	1	POLINER, LON S MD	6/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60369	18	Ophthalmology	0	In state provider	None	12630 MONTE VISTA RD	STE 104	POWAY	CA	92064	2526	37	06073	32.99533582	-117.0560031	San Diego County
282385	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2015	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
282392	Fee-for-Service	1710188065	1710188065	1	1	PATEL, KAMAL M MD	9/1/2020	2085R0001X	NA	Other	026	PHYSICIANS	168649	30	Radiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
282408	Fee-for-Service	1548381577	1548381577	1	1	PASADENA UROLOGICAL MED	5/12/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	112 N MADISON AVE	None	PASADENA	CA	91101	1793	19	06037	34.147926	-118.1383915	Los Angeles County
282427	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	11/7/2018	207R00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
282456	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	12/8/2018	103TC0700X	NA	Mental Health Outpatient Services	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
282466	Fee-for-Service	1235226531	1235226531	1	18	PERMANENTE MEDICAL GROUP INC	2/5/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
282480	Fee-for-Service	1053345926	1053345926	1	1	PATEL, NIKHILKUMAR C MD	7/24/2019	2085R0204X	NA	Other	026	PHYSICIANS	71184	30	Radiology	0	In state provider	None	36955 COOK ST	STE 101	PALM DESERT	CA	92211	6084	33	06065	33.77893112	-116.355881	Riverside County
282525	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
282551	Fee-for-Service	1164765574	1164765574	1	1	PATEL, EKTA H MD	11/9/2022	2084P0804X	NA	Psychiatry	026	PHYSICIANS	145114	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
282555	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	4/22/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
282584	Fee-for-Service	1720361215	1720361215	1	1	POWERS, KATIE L LMFT	7/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
282586	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
282601	Fee-for-Service	1053488866	1053488866	1	1	PATEL, PRAGNESH M MD	6/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79417	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
282623	Fee-for-Service	1235106741	1235106741	1	1	PATEL, RAJNISH A MD	12/31/1996	207L00000X	NA	Other	026	PHYSICIANS	79246	None	None	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
282629	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	4/24/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
282643	Fee-for-Service	1356662209	1356662209	1	1	PRECISION PATHOLOGY MEDICAL	2/15/2011	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	6001 NORRIS CANYON ROAD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
282659	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	9/11/2012	103TC0700X	NA	Mental Health Outpatient Services	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
282688	Fee-for-Service	1902000839	1902000839	1	1	PAULSON, LORIEN M MD	3/25/2021	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	171757	None	None	0	In state provider	None	2350 BUHNE STREET	STE B & C	EUREKA	CA	95501	3205	12	06023	40.78592523	-124.1422103	Humboldt County
282710	Fee-for-Service	1790034056	1790034056	1	1	POWERS, AMY LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17000 S. HARLAN RD	None	LATHROP	CA	95330	8738	39	06077	37.80929182	-121.2956055	San Joaquin County
282722	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
282724	Fee-for-Service	1740755065	1740755065	1	1	PALMA, KATHLEEN M	5/19/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
282754	Fee-for-Service	1265751697	1265751697	1	1	PARK, ANTHONY J MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135983	34	Urology and Urological Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
282755	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	8/28/2009	176B00000X	NA	Licensed Midwife	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
282779	Fee-for-Service	1104969229	1104969229	1	1	PARSA, FIROOZEH N MD	10/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90823	66	Emergency Medicine (Urgent Care)	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
282784	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
282799	Fee-for-Service	1346506730	1346506730	1	1	PATEL, NIRAJ M MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135336	41	Internal Medicine	0	In state provider	None	400 EAST OAK AVENUE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
282817	Fee-for-Service	1073691838	1073691838	1	1	PARK, DANIEL C MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51054	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
282827	Fee-for-Service	1073606299	1073606299	1	8	PERMANENTE MEDICAL GROUP INC	3/31/2020	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26914953	-121.9566285	Santa Clara County
282856	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	10/2/2017	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
282888	Fee-for-Service	1518200856	1518200856	1	1	PRICE, ADI J MD	4/26/2020	2085R0204X	NA	Other	026	PHYSICIANS	137170	30	Radiology	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
282917	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
282920	Fee-for-Service	1740570555	1740570555	1	1	PEARCE, BROOKE L	6/6/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 OLD NEWPORT BLVD	STE 101	NEWPORT BEACH	CA	92663	4234	30	06059	33.62961361	-117.9255034	Orange County
282932	Fee-for-Service	1689615221	1689615221	1	1	PHAM, DUC Q MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62320	41	Internal Medicine	0	In state provider	None	14160 BROOKHURST ST	None	GARDEN GROVE	CA	92843	4657	30	06059	33.757002	-117.9548115	Orange County
282951	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	9/20/2018	176B00000X	NA	Licensed Midwife	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
282968	Fee-for-Service	1659802247	1659802247	1	1	PALMER, MADELINE A MD	8/28/2023	207P00000X	NA	Other	026	PHYSICIANS	185443	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
282981	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
282991	Fee-for-Service	1659323012	1659323012	1	1	PROGRESSIVE 2000 HOME	11/12/1997	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE INC	948 N FAIRFAX AVE	STE 200	LOS ANGELES	CA	90046	7204	19	06037	34.088571	-118.3613525	Los Angeles County
283014	Fee-for-Service	1073691838	1073691838	1	1	PARK, DANIEL C MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	51054	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
283051	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	2/5/2019	103TC0700X	NA	Mental Health Outpatient Services	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283054	Fee-for-Service	1578596698	1578596698	1	1	PERALTA, CYNTHIA M MD	4/1/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49144	40	Pediatrics	0	In state provider	None	1135 S SUNSET AVE	STE 210	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
283102	Fee-for-Service	1033183553	1033183553	1	1	PERALTA, MAYLENE CLAIRE I MD	2/2/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	159045	None	None	0	In state provider	None	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
283112	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	11/7/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
283117	Fee-for-Service	1306040357	1306040357	1	1	PACHECO UNION ELEMENTARY	2/15/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	7424 PACHECO SCHOOL RD	None	REDDING	CA	96002	4069	45	06089	40.50554952	-122.330628	Shasta County
283128	Fee-for-Service	1134719347	1134719347	1	1	PILE, CYNTHIA LMFT	3/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1242 PARK ST	SUITE C	ALAMEDA	CA	94501	5500	01	06001	37.76187672	-122.2447503	Alameda County
283135	Fee-for-Service	1154337384	1154337384	1	1	PRYOMSKI, MICHAEL Z MD	12/9/1998	207L00000X	NA	Other	026	PHYSICIANS	4879	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	# 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
283143	Fee-for-Service	1548343510	1548343510	1	39	PERMANENTE MEDICAL GROUP INC	10/8/2018	176B00000X	NA	Licensed Midwife	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
283151	Fee-for-Service	1699485540	1699485540	1	1	PETTIS, KENNETH LMFT	3/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
283175	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	5/29/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
283180	Fee-for-Service	1396780425	1396780425	1	1	POSIN, JONATHAN P MD	2/28/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	47350	30	Radiology	0	In state provider	NORTH BAY MRI CENTER	2149 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
283200	Fee-for-Service	1245418748	1245418748	1	1	PHYSICAL THERAPY &	1/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ORTHOPEDIC REHABILITATIO	9301 WILSHIRE BLVD.	#502	BEVERLY HILLS	CA	90210	0000	19	06037	34.06707307	-118.3946743	Los Angeles County
283215	Fee-for-Service	1093893687	1093893687	1	1	PRAGER, LAURA A MD	6/16/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74369	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
283221	Fee-for-Service	1992091870	1992091870	1	1	PYLES, KAREN J LMFT	9/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 CAMPUS DR.	None	DALY CITY	CA	94015	4900	41	06081	37.66535778	-122.4763793	San Mateo County
283241	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	1/11/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283265	Fee-for-Service	1952336687	1952336687	1	1	PHAM, HIEN T DC	5/31/2006	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	5880 STOCKTON BLVD	STE B	SACRAMENTO	CA	95824	3055	34	06067	38.520036	-121.440744	Sacramento County
283276	Fee-for-Service	1104288497	1104288497	1	1	PATIL, ABHIJIT MD	7/18/2023	111NR0200X	NA	Other	026	PHYSICIANS	171170	None	None	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
283305	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	11/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
283308	Fee-for-Service	1255741005	1255741005	1	1	PYO, AUGUSTINE MD	11/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	139002	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
283344	Fee-for-Service	1700510252	1700510252	1	1	PALOMAR HEIGHTS HEALTHCARE	8/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1260 E OHIO AVE	None	ESCONDIDO	CA	92027	3054	37	06073	33.12859638	-117.0647058	San Diego County
283362	Fee-for-Service	1942770417	1942770417	1	1	PENINSULA ASSOCIATES SPEECH	7/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THERAPY SERVICES, INC.	760 POLHEMUS RD	None	SAN MATEO	CA	94402	3938	41	06081	37.52051982	-122.3386627	San Mateo County
283363	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
283369	Fee-for-Service	1841746237	1841746237	1	1	PICARD, REBECCA M LMFT	6/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45121 UKIAH STREET	STE C	MENDOCINO	CA	95460	0832	23	06045	39.3056514	-123.8023093	Mendocino County
283408	Fee-for-Service	1427132596	1427132596	1	1	PRESCOTT, ALEX V MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	78558	20	Orthopedic Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
283416	Fee-for-Service	1669914396	1669914396	1	2	PRIME REHAB CENTER, PHYSICAL	4/6/2019	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THERAPY, A PROFESSIONAL	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
283431	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	6/28/2017	103TC0700X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283436	Fee-for-Service	1588656268	1588656268	1	5	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	500 VALLEJO ST	None	PETALUMA	CA	94952	3364	49	06097	38.23813147	-122.6283226	Sonoma County
283456	Fee-for-Service	1184870933	1184870933	1	1	PERFECT TOUCH HOME HEALTH	7/1/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	7250 BEVERLY BLVD	SUITE 205-206	LOS ANGELES	CA	90036	2560	19	06037	34.07613953	-118.347669	Los Angeles County
283465	Fee-for-Service	1205114899	1205114899	1	1	PATEL, AJAY M MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117724	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
283467	Fee-for-Service	1639223837	1639223837	2	1	PAK, YUNCHUL J MD	11/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	38260	40	Pediatrics	0	In state provider	None	1433 W MERCED AVE	STE 205	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
283492	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
283551	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
283574	Fee-for-Service	1417219254	1417219254	1	1	POURMOUSSA, ALLEN S MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134592	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
283604	Fee-for-Service	1669914396	1669914396	1	2	PRIME REHAB CENTER, PHYSICAL	4/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY, A PROFESSIONAL	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
283605	Fee-for-Service	1639186786	1639186786	1	1	PACIFIC CLINICS	8/30/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 VALLEY BOULEVARD	None	ROSEMEAD	CA	91770	1934	19	06037	34.08115618	-118.0651957	Los Angeles County
283618	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	9/12/2018	103TC0700X	NA	Mental Health Outpatient Services	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283624	Fee-for-Service	1588656268	1588656268	1	5	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	500 VALLEJO ST	None	PETALUMA	CA	94952	3364	49	06097	38.23813147	-122.6283226	Sonoma County
283660	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
283662	Fee-for-Service	1932334281	1932334281	1	1	PFAENDLER, KRISTA S MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130987	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
283679	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	3/25/2020	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
283698	Fee-for-Service	1750867404	1750867404	1	1	PURTILL, JAMES P	1/18/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
283722	Fee-for-Service	1720472335	1720472335	1	1	PARAISO, DANIEL LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
283727	Fee-for-Service	1295024420	1295024420	1	1	PROVENCHER, HEATHER L MD	3/31/2022	208M00000X	NA	Other	026	PHYSICIANS	125198	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
283735	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
283757	Fee-for-Service	1225520109	1225520109	1	1	PROVIDA HOME HEALTH INC	8/23/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 VICTORY BLVD	SUITE 418	VAN NUYS	CA	91411	4182	19	06037	34.18668846	-118.450152	Los Angeles County
283801	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	12/27/2016	103TC0700X	NA	Mental Health Outpatient Services	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
283847	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
283862	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	3/31/2020	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
283865	Fee-for-Service	1881773430	1881773430	1	2	PARAMOUNT HOME CARE INC	1/15/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12235 BEACH BLVD	SUITE 102	STANTON	CA	90680	3943	30	06059	33.784425	-117.9930265	Orange County
283882	Fee-for-Service	1871649087	1871649087	1	1	PARDO, JOHN P OT	4/20/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
283890	Fee-for-Service	1164566568	1164566568	1	1	PHAM, PHUC H MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101589	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
283919	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
283957	Fee-for-Service	1134757453	1134757453	1	1	PHAM, KIMBERLY A DO	1/20/2023	207P00000X	NA	Other	026	PHYSICIANS	20301	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
283982	Fee-for-Service	1235226531	1235226531	1	30	PERMANENTE MEDICAL GROUP INC	12/30/2018	103TC0700X	NA	Mental Health Outpatient Services	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
284000	Fee-for-Service	1275615734	1275615734	1	1	PATEL, NAYNA MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	98396	25	Physical Medicine and Rehabilitation	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
284012	Fee-for-Service	1548366404	1548366404	1	1	POTOMAC HOSPITAL CORPORATION	7/3/2012	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF PRINCE WILLIAM	2300 OPITZ BLVD	None	WOODBRIDGE	VA	22191	3311	00	None	38.63718	-77.2863255	Prince William County
284018	Fee-for-Service	1174529291	1174529291	1	1	PONCE, ROBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5700 N EXPRESSWAY	STE 303	BROWNSVILLE	TX	78526	4355	00	None	25.98745526	-97.51982068	Cameron County
284025	Fee-for-Service	1700239357	1700239357	1	1	PARDIS AMIRHOUSHMAND, PH.D.,	1/30/2019	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	A PSYCHOLOGY CORPORATIO	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
284026	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284040	Fee-for-Service	1669662755	1669662755	1	1	PLOESSER, MARKUS MD	11/14/2016	2084F0202X	NA	Psychiatry	026	PHYSICIANS	101564	None	None	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
284046	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	10/18/2019	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284049	Fee-for-Service	1720467251	1720467251	1	2	PLETT OPTOMETRY INC	2/27/2025	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1001 COLORADO AVE	None	TURLOCK	CA	95380	2749	50	06099	37.50234753	-120.8353005	Stanislaus County
284088	Fee-for-Service	1770581332	1770581332	1	2	PARKS, ROBERT EA MD	8/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86792	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
284102	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
284184	Fee-for-Service	1437174182	1437174182	1	1	PACINI,RICHARD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 N BOISE AVE	None	LOVELAND	CO	80538	0000	00	None	40.41340296	-105.0535746	Larimer County
284188	Fee-for-Service	1841528957	1841528957	1	1	PATEL, TEJAS MD AMC	4/2/2010	193400000X	NA	Other	026	PHYSICIANS	88498	41	Internal Medicine	0	In state provider	None	2625 W ALAMEDA AVENUE	SUITE 412	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
284193	Fee-for-Service	1548366404	1548366404	1	1	POTOMAC HOSPITAL CORPORATION	7/3/2012	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OF PRINCE WILLIAM	2300 OPITZ BLVD	None	WOODBRIDGE	VA	22191	3311	00	None	38.63718	-77.2863255	Prince William County
284199	Fee-for-Service	1639217904	1639217904	1	1	PET CT IMAGING OF	11/3/2005	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	BERKELEY	2855 TELEGRAPH AVE	STE 100	BERKELEY	CA	94705	1149	01	06001	37.85824203	-122.2593624	Alameda County
284205	Fee-for-Service	1700239357	1700239357	1	1	PARDIS AMIRHOUSHMAND, PH.D.,	1/30/2019	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	A PSYCHOLOGY CORPORATIO	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
284207	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	12/8/2016	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284225	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	10/8/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284229	Fee-for-Service	1467712604	1467712604	1	1	PALANA, CESAR D II MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137027	41	Internal Medicine	0	In state provider	None	375 HUNTINGTON DR	SUITE G	SAN MARINO	CA	91108	2357	19	06037	34.1067704	-118.1349621	Los Angeles County
284265	Fee-for-Service	1356394175	1356394175	1	4	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91091877	-118.3527745	Los Angeles County
284269	Fee-for-Service	1316416670	1316416670	1	1	PSYCHIATRIC EXCELLENCE	3/29/2021	273R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	5555 GROSSMONT CENTER	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
284274	Fee-for-Service	1396026472	1396026472	1	1	PEASE, JACLYN PSYD	3/13/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2701 COTTAGE WAY	16	SACRAMENTO	CA	95825	1225	34	06067	38.604078	-121.3996365	Sacramento County
284279	Fee-for-Service	1073606299	1073606299	1	24	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
284292	Fee-for-Service	1669098653	1669098653	1	1	PIRA, ABIGAIL	10/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2210 DEL PASO RD	None	SACRAMENTO	CA	95834	9671	34	06067	38.655189	-121.5091575	Sacramento County
284326	Fee-for-Service	1982044244	1982044244	1	1	PULUMATI, KRISHNA ANURAG MD	9/14/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	156749	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
284332	Fee-for-Service	1023247285	1023247285	1	1	PLEVIN, REBECCA E MD	5/12/2017	208600000X	NA	General Surgery	026	PHYSICIANS	142918	89	Surgery-Traumatic	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
284344	Fee-for-Service	1932633039	1932633039	1	1	PARE, PAOLA DO	1/19/2021	390200000X	NA	Other	026	PHYSICIANS	18489	None	None	0	In state provider	None	111 W 17TH ST	None	SANTA ANA	CA	92706	2718	30	06059	33.76013946	-117.86832	Orange County
284368	Fee-for-Service	1942748413	1942748413	1	1	PATEL, KEVIN MD	6/19/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146425	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
284381	Fee-for-Service	1700239357	1700239357	1	1	PARDIS AMIRHOUSHMAND, PH.D.,	1/30/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	A PSYCHOLOGY CORPORATIO	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
284382	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	9/11/2012	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284399	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	6/3/2019	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284400	Fee-for-Service	1548718612	1548718612	1	1	PROSTHETIC & ORTHOTIC GROUP	5/3/2018	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	SAN GABRIEL VALLEY INC	931 BUENA VISTA ST	STE 105	DUARTE	CA	91010	1780	19	06037	34.141635	-117.9775755	Los Angeles County
284440	Fee-for-Service	1356394175	1356394175	1	2	PROVIDENCE MEDICAL INSTITUTE	1/8/2019	207VC0200X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2601 W ALAMEDA AVENUE	STE 212	BURBANK	CA	91505	4818	19	06037	34.15783817	-118.3293969	Los Angeles County
284458	Fee-for-Service	1558055921	1558055921	1	1	PARACLETE 38 PHYSICAL THERAP	7/9/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y INC	7320 WOODLAKE AVE STE 27	None	WEST HILLS	CA	91307	1477	19	06037	34.20245266	-118.6321273	Los Angeles County
284464	Fee-for-Service	1669098653	1669098653	1	1	PIRA, ABIGAIL	10/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2210 DEL PASO RD	None	SACRAMENTO	CA	95834	9671	34	06067	38.655189	-121.5091575	Sacramento County
284489	Fee-for-Service	1437785573	1437785573	1	1	PARK, YOON AH MD	5/16/2024	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
284495	Fee-for-Service	1013078211	1013078211	1	1	PAEK, JUN H LAC	2/24/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1036 E BASTANCHURY RD	B	FULLERTON	CA	92835	2794	30	06059	33.89934717	-117.9114748	Orange County
284501	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	9/11/2020	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
284511	Fee-for-Service	1497823306	1497823306	1	1	PHAN, CHRISTYN M OD INC	12/10/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9862 CHAPMAN AVE	STE A	GARDEN GROVE	CA	92841	2726	30	06059	33.78849558	-117.9607338	Orange County
284520	Fee-for-Service	1083673446	1083673446	1	1	PIDGEON, KEVIN J MD	9/28/2004	2081P0004X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	41583	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
284551	Fee-for-Service	1700239357	1700239357	1	1	PARDIS AMIRHOUSHMAND, PH.D.,	1/30/2019	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	A PSYCHOLOGY CORPORATIO	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
284554	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	11/27/2007	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284570	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	12/30/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284584	Fee-for-Service	1588192579	1588192579	1	1	PRESTIFILIPPO, JENNIFER L DO	10/28/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16816	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
284588	Fee-for-Service	1225059124	1225059124	1	1	PROCHAZKA, SIMONA F MD	6/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74021	05	Anesthesiology	0	In state provider	None	995 BLANCO CIR	STE A	SALINAS	CA	93901	4447	27	06053	36.65488958	-121.6372749	Monterey County
284631	Fee-for-Service	1295007938	1295007938	1	1	POA, LI M D INC	6/6/2012	208G00000X	NA	General Surgery	026	PHYSICIANS	76922	33	Thoracic Surgery	0	In state provider	None	20911 EARL STREET	STE 245	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
284672	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/25/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
284709	Fee-for-Service	1679526610	1679526610	1	1	PLANNED PARENTHOOD MAR MONTE	10/1/1996	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	5385 FRANKLIN BLVD	STE A-D	SACRAMENTO	CA	95820	4717	34	06067	38.526282	-121.471398	Sacramento County
284721	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284734	Fee-for-Service	1588626923	1588626923	1	1	PAGE,ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 WEST 9000 SOUTH	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
284739	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	5/2/2019	No Taxonomy Provided	NA	None	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284769	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	7/6/2017	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
284797	Fee-for-Service	1295007938	1295007938	1	1	POA, LI M D INC	6/6/2012	208G00000X	NA	General Surgery	026	PHYSICIANS	76922	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	20911 EARL STREET	STE 245	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
284809	Fee-for-Service	1225116031	1225116031	1	1	PONDICHERRY, DEVI MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76285	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
284831	Fee-for-Service	1932633799	1932633799	1	1	PARANJAPE, CHINMAY S MD	8/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	175753	None	None	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
284838	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	8/3/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
284846	Fee-for-Service	1437313863	1437313863	1	1	PRIMA MEDICAL GROUP INC	10/8/2008	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	181 ANDRIEUX ST	STE 201	SONOMA	CA	95476	6920	49	06097	38.28809911	-122.4613026	Sonoma County
284863	Fee-for-Service	1558508663	1558508663	1	1	POPALZAI, ADEEL M DO	5/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	10930	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	9009	19	06037	34.098525	-117.7368955	Los Angeles County
284890	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
284906	Fee-for-Service	1073606299	1073606299	1	2	PERMANENTE MEDICAL GROUP INC	10/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	GROUP INC	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
284934	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	3/23/2016	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
284969	Fee-for-Service	1730389362	1730389362	2	1	PATEL, CHARMI MD	5/14/2020	207ZP0102X	NA	Other	026	PHYSICIANS	146702	22	Pathology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
285004	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	5/21/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285007	Fee-for-Service	1760589584	1760589584	1	1	PHAM, TAMMY D MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80555	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
285049	Fee-for-Service	1568190064	1568190064	1	1	PREMIER CANCER CARE AND INFU	10/13/2023	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SION CENTER	7065 N MAPLE AVE	None	FRESNO	CA	93720	8013	10	06019	36.83869878	-119.7453141	Fresno County
285058	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285059	Fee-for-Service	1407930571	1407930571	1	1	PERMUTT, RICHARD P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37905	01	General Practice	0	In state provider	None	95 MONTGOMERY DR	None	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
285060	Fee-for-Service	1841376738	1841376738	1	1	PATEL, MAHENDRA S MD	2/16/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38027	01	General Practice	0	In state provider	None	5451 LA PALMA AVE	STE 24	LA PALMA	CA	90623	1730	30	06059	33.84643146	-118.038843	Orange County
285070	Fee-for-Service	1801837604	1801837604	1	1	POUSSON, GREGORY K MD	7/15/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
285100	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285105	Fee-for-Service	1053040329	1053040329	1	1	PHAN, AMY Q CNP	7/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5575 RUFFIN RD	STE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
285149	Fee-for-Service	1609442920	1609442920	1	1	PRINS, MITCHELL MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
285151	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/22/2020	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285166	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/10/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285175	Fee-for-Service	1891173142	1891173142	1	1	PHAN, YEN N DO	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15003	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
285189	Fee-for-Service	1538796578	1538796578	1	1	PHU, WILSON OD	10/26/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3345 ROSECRANS STREET	STE B	SAN DIEGO	CA	92110	4225	37	06073	32.74779742	-117.2076448	San Diego County
285208	Fee-for-Service	1699025031	1699025031	1	1	PODELL, JENNIFER L PHD	10/22/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	5353	19	06037	34.07067	-118.4432445	Los Angeles County
285217	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	3/23/2016	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285223	Fee-for-Service	1841376738	1841376738	1	1	PATEL, MAHENDRA S MD	2/16/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38027	41	Internal Medicine	0	In state provider	None	5451 LA PALMA AVE	STE 24	LA PALMA	CA	90623	1730	30	06059	33.84643146	-118.038843	Orange County
285259	Fee-for-Service	1649406141	1649406141	1	1	PAIK, TOMALIKA A MD	12/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116369	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
285263	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	6/3/2019	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285273	Fee-for-Service	1972139756	1972139756	1	1	PALOCHAK, CHERILYN MAE A MD	3/25/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
285275	Fee-for-Service	1073230769	1073230769	1	1	PIERCE, MIRANDA NP	1/16/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
285316	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/31/2020	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285328	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	8/3/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285379	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285393	Fee-for-Service	1578838520	1578838520	1	2	PACIFIC COAST MEDICAL CENTER	10/29/2013	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INCORPORATED APC	2351 W MARCH LN	STE A	STOCKTON	CA	95207	5292	39	06077	37.98545356	-121.336457	San Joaquin County
285408	Fee-for-Service	1568676583	1568676583	1	1	PALMER, REBECCA L. MD	10/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
285414	Fee-for-Service	1508493008	1508493008	1	1	PARK, JONG MD	8/28/2023	390200000X	NA	Other	026	PHYSICIANS	186433	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
285424	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285434	Fee-for-Service	1023199924	1023199924	1	1	PARK, JAE Y LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	240 MERIDIAN AVE	SUITE 2	SAN JOSE	CA	95126	2927	43	06085	37.32468731	-121.9137566	Santa Clara County
285466	Fee-for-Service	1730111816	1730111816	1	1	PENA OFFERDAHL, NUBIA A LCSW	5/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7777 ALVARADO RD	STE 315	LA MESA	CA	91942	8247	37	06073	32.7725521	-117.0315402	San Diego County
285474	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/15/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285490	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	5/21/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285535	Fee-for-Service	1710928601	1710928601	1	1	PADDA, MANMEET S MD	10/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85290	10	Gastroenterology (M.D. only)	0	In state provider	None	4520 BUSINESS CENTER DR	SUITE 180	FAIRFIELD	CA	94534	6406	48	06095	38.22519621	-122.1327459	Solano County
285538	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285547	Fee-for-Service	1205240454	1205240454	1	1	PATEL, RAVI M	10/27/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
285552	Fee-for-Service	1578838520	1578838520	1	2	PACIFIC COAST MEDICAL CENTER	10/29/2013	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED APC	2351 W MARCH LN	STE A	STOCKTON	CA	95207	5292	39	06077	37.98545356	-121.336457	San Joaquin County
285553	Fee-for-Service	1003173089	1003173089	1	1	PEREZ-VALLES, CHRISTY	4/4/2024	207ZP0102X	NA	Other	026	PHYSICIANS	141913	None	None	0	In state provider	None	4301 NORTHSTAR WAY	None	MODESTO	CA	95356	9535	50	06099	0	0	None
285583	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	5/11/2009	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285629	Fee-for-Service	1316021942	1316021942	1	6	PILAR M DE CASTRO & CO	7/14/1990	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	804 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	3109	30	06059	33.841755	-117.9760625	Orange County
285631	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	7/30/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285642	Fee-for-Service	1073757183	1073757183	1	1	PRASHER, ANUJ MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116559	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
285644	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285663	Fee-for-Service	1356438204	1356438204	1	2	POURSHAHMIR, MOHAMMAD MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78449	02	General Surgery	0	In state provider	LA SURGERY/COLORECTAL	5400 BALBOA BLVD	STE 228	ENCINO	CA	91316	5212	19	06037	34.169283	-118.501072	Los Angeles County
285670	Fee-for-Service	1306913249	1306913249	1	1	PHAN, KIET T MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61161	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
285686	Fee-for-Service	1558354373	1558354373	1	1	PELLEGRIN BROAD & MORSE	4/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	LOS GATOS FAM PHYS MED	143 E MAIN ST	None	LOS GATOS	CA	95030	6903	43	06085	37.22117263	-121.9775316	Santa Clara County
285693	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285695	Fee-for-Service	1710928601	1710928601	1	1	PADDA, MANMEET S MD	10/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85290	41	Internal Medicine	0	In state provider	None	4520 BUSINESS CENTER DR	SUITE 180	FAIRFIELD	CA	94534	6406	48	06095	38.22519621	-122.1327459	Solano County
285702	Fee-for-Service	1730236092	1730236092	1	1	PARSONS, STEVEN OD	6/30/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
285703	Fee-for-Service	1972697605	1972697605	1	1	PERCY, KRISTINE S MD	11/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77388	08	Family Practice	0	In state provider	None	1414 S GRAND AVE	FL 2	LOS ANGELES	CA	90015	3067	19	06037	34.03661142	-118.2657227	Los Angeles County
285721	Fee-for-Service	1588615009	1588615009	1	1	PETERSON,MARCIE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
285735	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	7/6/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285757	Fee-for-Service	1922447317	1922447317	1	1	PORRAS BLANCO, ROMMY M MD	12/21/2017	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	152915	40	Pediatrics	0	In state provider	None	1190 OLIVEWOOD DR	SUITE B	MERCED	CA	95348	1256	24	06047	37.31824467	-120.49032	Merced County
285766	Fee-for-Service	1316021942	1316021942	1	8	PILAR M DE CASTRO & CO	3/22/2000	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	2100 CAROL DR	None	FULLERTON	CA	92833	3010	30	06059	33.86879615	-117.9665343	Orange County
285767	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	7/21/2023	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
285772	Fee-for-Service	1568584035	1568584035	1	1	PARSON, JENA D CNM	8/31/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
285775	Fee-for-Service	1578647566	1578647566	1	1	PENN, DANIEL R MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82741	30	Radiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
285786	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	7/21/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285793	Fee-for-Service	1003974064	1003974064	1	1	PLANNED PARENTHOOD	12/1/1977	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SHASTA DIABLO INC	1357 OAKLAND CT	None	WALNUT CREEK	CA	94596	4337	07	06013	37.89772006	-122.0704393	Contra Costa County
285799	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	3/5/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285812	Fee-for-Service	1699907428	1699907428	1	1	POON, KITTY I K NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
285822	Fee-for-Service	1477095149	1477095149	1	1	PUATU, SHEILA M NP	2/21/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	600 N GARFIELD AVE	STE 111	MONTEREY PARK	CA	91754	1167	19	06037	34.06820797	-118.1228835	Los Angeles County
285836	Fee-for-Service	1245526391	1245526391	1	1	PANCHAL, MITA H MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131129	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
285848	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	11/27/2007	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
285850	Fee-for-Service	1841774114	1841774114	1	1	PADUA, AUSTIN PT	8/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
285885	Fee-for-Service	1952510778	1952510778	1	1	PATEL, CHIRAG V MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105288	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
285891	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	1/28/2019	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
285892	Fee-for-Service	1790054393	1790054393	1	1	PAPASTERGIOU, GEORGIOS MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127706	18	Ophthalmology	0	In state provider	None	835 THIRD AVE	SUITE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
285896	Fee-for-Service	1265470520	1265470520	1	1	PRIEST, DAVID R MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71466	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
285897	Fee-for-Service	1770778490	1770778490	1	1	PETRUS, EARL P MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19750	36	Psychiatry	0	In state provider	None	21000 PLUMMER ST	None	CHATSWORTH	CA	91311	4996	19	06037	34.24271597	-118.5915861	Los Angeles County
285901	Fee-for-Service	1811195563	1811195563	1	1	PHAN, PETER M MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91299	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
285906	Fee-for-Service	1740326404	1740326404	1	1	PROULX, ROBERT E LMFT	5/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	288 W 9TH ST	None	UPLAND	CA	91786	5949	36	06071	34.0960435	-117.6548445	San Bernardino County
285920	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	3/5/2021	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
285940	Fee-for-Service	1578838520	1578838520	1	1	PACIFIC COAST MEDICAL CENTER	7/12/2012	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED, APC	1600 SACRAMENTO INN WAY	STE 116	SACRAMENTO	CA	95815	3448	34	06067	38.60775	-121.429233	Sacramento County
285943	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/29/2021	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
285951	Fee-for-Service	1760507495	1760507495	1	1	PAIKAL, DAVID MD INC	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76744	18	Ophthalmology	0	In state provider	None	16661 VENTURA BLVD	STE 522	ENCINO	CA	91436	1976	19	06037	34.15820737	-118.496492	Los Angeles County
285963	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	5/21/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
285997	Fee-for-Service	1326432626	1326432626	1	1	PARK, SARAH H MD	12/12/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	147001	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
286002	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
286044	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286074	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	11/2/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286094	Fee-for-Service	1578838520	1578838520	1	1	PACIFIC COAST MEDICAL CENTER	7/12/2012	111N00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INCORPORATED, APC	1600 SACRAMENTO INN WAY	STE 116	SACRAMENTO	CA	95815	3448	34	06067	38.60775	-121.429233	Sacramento County
286097	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	2/20/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286109	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
286122	Fee-for-Service	1376049411	1376049411	1	1	PROIA, ANTHONY M MD	8/27/2021	193200000X	NA	Other	026	PHYSICIANS	164769	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
286150	Fee-for-Service	1841232394	1841232394	2	1	PICO RIVERA COMMUNITY MEDICA	6/4/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	L CLINIC	4705 DURFEE AVE	None	PICO RIVERA	CA	90660	2037	19	06037	34.00442566	-118.077831	Los Angeles County
286156	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
286159	Fee-for-Service	1578838520	1578838520	1	4	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3191 M STREET	SUITE A	MERCED	CA	95348	2404	24	06047	37.32176904	-120.4784343	Merced County
286195	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	11/18/2016	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286196	Fee-for-Service	1477940658	1477940658	1	1	PHAM, MICHAEL T DO	12/16/2020	207R00000X	NA	Other	026	PHYSICIANS	18260	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
286198	Fee-for-Service	1992903686	1992903686	1	1	PREMIER ENT AMC	11/24/2009	174400000X	NA	Other	026	PHYSICIANS	50970	04	Otology, Laryngology, Rhinology	0	In state provider	None	255 TERRACINA BLVD	STE 201	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
286200	Fee-for-Service	1891813085	1891813085	1	2	PALATNIK MEDICAL CORP	11/30/2021	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
286226	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	3/9/2021	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286236	Fee-for-Service	1518995729	1518995729	1	1	POAGE, JEFFREY A MD	2/28/1984	207L00000X	NA	Other	026	PHYSICIANS	53540	None	None	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
286249	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/22/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286260	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	8/20/2021	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
286265	Fee-for-Service	1366088213	1366088213	1	1	PEREZ, MARGOT A CCC-SLP	7/22/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
286272	Fee-for-Service	1518492172	1518492172	1	1	PEARSON, HATTIE D DO	7/28/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18806	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
286273	Fee-for-Service	1760879753	1760879753	1	1	PATEL, NEESHA S DO	7/31/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	185401	89	Surgery-Traumatic	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
286301	Fee-for-Service	1841232394	1841232394	2	1	PICO RIVERA COMMUNITY MEDICA	6/4/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	L CLINIC	4705 DURFEE AVE	None	PICO RIVERA	CA	90660	2037	19	06037	34.00442566	-118.077831	Los Angeles County
286307	Fee-for-Service	1073606299	1073606299	1	5	PERMANENTE MEDICAL GROUP INC	11/27/2007	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
286310	Fee-for-Service	1578838520	1578838520	1	4	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3191 M STREET	SUITE A	MERCED	CA	95348	2404	24	06047	37.32176904	-120.4784343	Merced County
286331	Fee-for-Service	1598091837	1598091837	1	1	PHAN, DEREK TRUONG MD INC	4/12/2010	207R00000X	NA	Other	026	PHYSICIANS	99908	41	Internal Medicine	0	In state provider	None	9191 BOLSA AVE	STE 205	WESTMINSTER	CA	92683	5561	30	06059	33.74494947	-117.969093	Orange County
286338	Fee-for-Service	1245356898	1245356898	1	1	PEREZ, ERIC S MD	7/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	59354	40	Pediatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 307	DALY CITY	CA	94015	2223	41	06081	37.68077723	-122.4728941	San Mateo County
286347	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	3/31/2020	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286350	Fee-for-Service	1891813085	1891813085	1	2	PALATNIK MEDICAL CORP	5/13/2010	261Q00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
286369	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
286374	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	6/4/2021	207L00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286395	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/31/2020	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286407	Fee-for-Service	1164419073	1164419073	1	1	PARMAR, ASHOK M MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	89459	05	Anesthesiology	0	In state provider	None	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2245	15	06029	35.36875951	-119.0959206	Kern County
286408	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
286410	Fee-for-Service	1124229638	1124229638	1	1	POUND, GRETCHEN A PHD	8/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
286424	Fee-for-Service	1588006860	1588006860	1	1	PROVIDENT PLACE	11/25/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13943 TRIGGER LANE	None	VICTORVILLE	CA	92392	6333	36	06071	34.48547184	-117.3589932	San Bernardino County
286433	Fee-for-Service	1215048830	1215048830	1	1	PAKNIKAR,SUBHASH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 N 30TH STREET	None	OMAHA	NE	68103	2159	00	None	41.2654263	-95.95644327	Douglas County
286460	Fee-for-Service	1477841625	1477841625	1	1	POLIDO, DAISY C LMFT	10/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1765 GOODYEAR AVE	STE 206-207	VENTURA	CA	93003	0128	56	06111	34.25673859	-119.2325449	Ventura County
286465	Fee-for-Service	1740611938	1740611938	1	1	PALLIATIVE CARE GROUP INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	765 THE CITY DRIVE	SUITE 120	ORANGE	CA	92868	4942	30	06059	33.77570319	-117.8901417	Orange County
286492	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286499	Fee-for-Service	1891813085	1891813085	1	2	PALATNIK MEDICAL CORP	5/13/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
286516	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
286519	Fee-for-Service	1841229135	1841229135	2	1	POKROY, RAANAN E MD	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
286522	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	6/30/2021	207L00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286541	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/15/2020	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286551	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
286554	Fee-for-Service	1487760716	1487760716	1	1	PAN, JIANQIU MD	8/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85232	22	Pathology (M.D. only)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
286566	Fee-for-Service	1164736476	1164736476	1	1	PARK ROW PODIATRY INC	10/11/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2306 SIXTH AVE	None	SAN DIEGO	CA	92101	1643	37	06073	32.72942583	-117.1594896	San Diego County
286589	Fee-for-Service	1215517396	1215517396	1	1	PI, DEREK OD	8/16/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 CHINO HILLS PKWY	STE 390	CHINO HILLS	CA	91709	5825	36	06071	33.98274451	-117.7129305	San Bernardino County
286609	Fee-for-Service	1740611938	1740611938	1	1	PALLIATIVE CARE GROUP INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	765 THE CITY DRIVE	SUITE 120	ORANGE	CA	92868	4942	30	06059	33.77570319	-117.8901417	Orange County
286612	Fee-for-Service	1326096785	1326096785	1	1	PACE, WILLIAM M	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54532	42	Nuclear Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
286637	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286642	Fee-for-Service	1891813085	1891813085	1	2	PALATNIK MEDICAL CORP	5/13/2010	207R00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
286648	Fee-for-Service	1790183424	1790183424	1	1	PIM, MARYNA LCSW	7/25/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
286659	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
286665	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	2/12/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286673	Fee-for-Service	1952854663	1952854663	1	1	PEREZ, GUADALUPE LMFT	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
286683	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/5/2020	207L00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286689	Fee-for-Service	1073606299	1073606299	1	30	PERMANENTE MEDICAL GROUP INC	10/2/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
286698	Fee-for-Service	1235226531	1235226531	1	61	PERMANENTE MEDICAL GROUP INC	7/26/2020	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
286709	Fee-for-Service	1891266839	1891266839	1	1	PAN, ANN NP	1/16/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
286711	Fee-for-Service	1346373222	1346373222	1	1	PROHEALTH PARTNERS	10/31/1995	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	None	2888 LONG BEACH BLVD	STE 235	LONG BEACH	CA	90806	1562	19	06037	33.809706	-118.189343	Los Angeles County
286723	Fee-for-Service	1568924975	1568924975	1	1	PATEL, TULSI P MD	4/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
286779	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	11/7/2018	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286786	Fee-for-Service	1306921580	1306921580	1	1	PATTISON, THOMAS S MD	4/1/2002	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	72662	25	Physical Medicine and Rehabilitation	0	In state provider	None	3939 J ST	STE 200	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
286798	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
286805	Fee-for-Service	1679569578	1679569578	1	1	PARSHAD, SULEKHA MD	9/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	52528	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
286807	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	10/29/2021	207L00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286816	Fee-for-Service	1154537058	1154537058	1	1	PRISCO, DOUGLAS L MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108810	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
286825	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	11/14/2020	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286846	Fee-for-Service	1285011148	1285011148	1	1	PATEL, HEMAL MD	10/8/2018	207R00000X	NA	Other	026	PHYSICIANS	148518	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
286855	Fee-for-Service	1346373222	1346373222	1	1	PROHEALTH PARTNERS	10/31/1995	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2888 LONG BEACH BLVD	STE 235	LONG BEACH	CA	90806	1562	19	06037	33.809706	-118.189343	Los Angeles County
286922	Fee-for-Service	1073606299	1073606299	1	15	PERMANENTE MEDICAL GROUP INC	10/18/2019	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
286930	Fee-for-Service	1467459214	1467459214	1	1	PACIFIC AMBULATORY	7/10/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY CENTER	707 S GARFIELD AVE	STE 101	ALHAMBRA	CA	91801	5860	19	06037	34.088688	-118.123106	Los Angeles County
286940	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
286943	Fee-for-Service	1982797239	1982797239	1	1	PATHWAY HEALTHCARE	10/27/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	190 S OAK AVE	BLDG 2, SUITE 1	OAKDALE	CA	95361	3528	50	06099	37.75958945	-120.8613916	Stanislaus County
286949	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	10/1/2021	207L00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
286956	Fee-for-Service	1154537058	1154537058	1	1	PRISCO, DOUGLAS L MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108810	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
286967	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/15/2020	207L00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
286993	Fee-for-Service	1346373222	1346373222	1	1	PROHEALTH PARTNERS	10/31/1995	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	2888 LONG BEACH BLVD	STE 235	LONG BEACH	CA	90806	1562	19	06037	33.809706	-118.189343	Los Angeles County
287028	Fee-for-Service	1396995502	1396995502	1	1	PAMBUKHCHIAN, KARINA MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101061	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
287031	Fee-for-Service	1891702734	1891702734	1	1	PATEL, NANDLAL MD	11/14/2024	207R00000X	NA	Other	026	PHYSICIANS	156676	41	Internal Medicine	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
287080	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287082	Fee-for-Service	1982797239	1982797239	1	1	PATHWAY HEALTHCARE	10/27/1995	363L00000X	NA	Nurse Practitioner	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	190 S OAK AVE	BLDG 2, SUITE 1	OAKDALE	CA	95361	3528	50	06099	37.75958945	-120.8613916	Stanislaus County
287087	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	6/1/2021	207L00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287107	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	10/31/2020	207L00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
287117	Fee-for-Service	1306830302	1306830302	1	1	PADDOCK, KAREN L MD	7/1/2001	207L00000X	NA	Other	026	PHYSICIANS	63575	None	None	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
287149	Fee-for-Service	1376596247	1376596247	1	1	PULVER,KERRY P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3123 MEDICAL DRIVE	None	CALDWELL	ID	83605	6972	00	None	43.65963	-116.658621	Canyon County
287166	Fee-for-Service	1053355545	1053355545	1	1	PEZANOSKI, JONATHAN P MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	10619 PROFESSIONAL CIR	None	RENO	NV	89521	5831	00	None	39.42779657	-119.7542429	Washoe County
287176	Fee-for-Service	1508266768	1508266768	1	1	PAVILION ON PICO HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE, LP	5916 WEST PICO BLVD	None	LOS ANGELES	CA	90035	2615	19	06037	34.05179823	-118.3682615	Los Angeles County
287201	Fee-for-Service	1588656268	1588656268	1	7	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	680 SONOMA MOUNTAIN PWKY	None	PETALUMA	CA	94954	8553	49	06097	38.268783	-122.634432	Sonoma County
287216	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287224	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	4/23/2021	207L00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287227	Fee-for-Service	1700854544	1700854544	1	1	PARKER, MALCOLM B MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	38119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 W E ST	None	TEHACHAPI	CA	93561	1607	15	06029	35.13009994	-118.4488237	Kern County
287231	Fee-for-Service	1467949693	1467949693	1	1	PASSIAK, BRITTANY C MD	8/14/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
287236	Fee-for-Service	1295050482	1295050482	1	1	PASCA, ANCA M MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123138	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
287242	Fee-for-Service	1821396227	1821396227	1	1	PALM PHARMACY INC	5/16/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	254 E HARVARD BLVD	None	SANTA PAULA	CA	93060	3372	56	06111	34.34748271	-119.0680997	Ventura County
287244	Fee-for-Service	1073606299	1073606299	1	35	PERMANENTE MEDICAL GROUP INC	9/20/2020	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	180 WESTGATE	302	WATSONVILLE	CA	95076	2469	44	06087	36.92251219	-121.7930016	Santa Cruz County
287271	Fee-for-Service	1134530462	1134530462	1	1	PINA, CESAR R NP	8/27/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
287298	Fee-for-Service	1881166296	1881166296	1	1	PES-EBS.INC.	5/16/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2060 CHICAGO AVE	A-9	RIVERSIDE	CA	92507	2081	33	06065	33.992568	-117.3483325	Riverside County
287331	Fee-for-Service	1316472764	1316472764	1	1	PACKER, JONATHAN DO	6/15/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	21007	None	None	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
287333	Fee-for-Service	1518997709	1518997709	1	1	PAJA, ISAIAS D JR MD	1/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65363	08	Family Practice	0	In state provider	None	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	19	06037	34.0565363	-118.2728437	Los Angeles County
287337	Fee-for-Service	1588656268	1588656268	1	7	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	680 SONOMA MOUNTAIN PWKY	None	PETALUMA	CA	94954	8553	49	06097	38.268783	-122.634432	Sonoma County
287353	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	4/24/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287359	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	3/26/2021	207L00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287363	Fee-for-Service	1700854544	1700854544	1	1	PARKER, MALCOLM B MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	38119	01	General Practice	0	In state provider	None	115 W E ST	None	TEHACHAPI	CA	93561	1607	15	06029	35.13009994	-118.4488237	Kern County
287370	Fee-for-Service	1578577664	1578577664	1	1	PERER, ELISE SHARON MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77355	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
287391	Fee-for-Service	1053548776	1053548776	1	1	PAVLOVSKY, MORDECHAI MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128814	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
287395	Fee-for-Service	1083221220	1083221220	1	1	POWELL, TIASSA L CRNA	3/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
287420	Fee-for-Service	1659759512	1659759512	1	1	PANDYA, SHALIN DO	2/24/2019	207RA0201X	NA	Other	026	PHYSICIANS	16270	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
287429	Fee-for-Service	1821268293	1821268293	1	1	POOJA KHANDELWAL M.D.	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
287436	Fee-for-Service	1225652480	1225652480	1	1	PANTAPALANGKOOR, PAUL MD	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
287451	Fee-for-Service	1265019780	1265019780	1	1	PEREZ, RICHARD K MD	4/15/2025	207L00000X	NA	Other	026	PHYSICIANS	192379	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287452	Fee-for-Service	1407482490	1407482490	1	1	PHAN, JAMES V MD	7/21/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186177	None	None	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
287478	Fee-for-Service	1518423672	1518423672	1	1	PACIFIC RITZ SURGERY CENTER,	7/28/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	16311 VENTURA BLVD	570	ENCINO	CA	91436	4314	19	06037	34.15706864	-118.4885978	Los Angeles County
287484	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287492	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	3/12/2021	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287493	Fee-for-Service	1598140956	1598140956	1	1	PIRKO, SARAH L AU	2/2/2022	231H00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
287579	Fee-for-Service	1023156296	1023156296	1	1	PETERS, ANNE L MD	1/2/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25136	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 506	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
287614	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	10/18/2019	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287619	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	6/13/2021	207L00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287635	Fee-for-Service	1467508382	1467508382	1	1	PETERSON, JOHANN M MD	6/25/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97701	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
287648	Fee-for-Service	1548342728	1548342728	1	1	PRIMARY AND MULTI SPECIALTY	9/24/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CLINICS OF ANAHEIM INC	1006 W LA PALMA AVE	None	ANAHEIM	CA	92801	3650	30	06059	33.84713552	-117.9305145	Orange County
287658	Fee-for-Service	1043716939	1043716939	1	1	PAI, DARSHANA MD	11/3/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174381	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
287660	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	3/31/2020	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
287681	Fee-for-Service	1619083045	1619083045	1	1	PATEL, JAINA	7/6/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9545 RESEDA BLVD	STE. 3 & 4	NORTHRIDGE	CA	91324	2312	19	06037	34.24381621	-118.5361155	Los Angeles County
287710	Fee-for-Service	1346590098	1346590098	1	1	PARK, SANGDO MD A	10/9/2012	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	107642	20	Orthopedic Surgery	0	In state provider	PROFESSIONAL CORPORATION	2105 BEVERLY BLVD	SUITE 223	LOS ANGELES	CA	90057	2280	19	06037	34.06682861	-118.2706286	Los Angeles County
287723	Fee-for-Service	1013073766	1013073766	1	1	PHAN, DOUGLAS M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51181	04	Otology, Laryngology, Rhinology	0	In state provider	None	135 N JACKSON AVE	STE 102	SAN JOSE	CA	95116	1917	43	06085	37.36164758	-121.8466827	Santa Clara County
287741	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287748	Fee-for-Service	1073606299	1073606299	1	36	PERMANENTE MEDICAL GROUP INC	7/30/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	288 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.23829776	-121.800455	Santa Clara County
287771	Fee-for-Service	1811230139	1811230139	1	1	PARK, CAROLINE MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119942	None	None	0	In state provider	None	4650 W. SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287776	Fee-for-Service	1548342728	1548342728	1	1	PRIMARY AND MULTI SPECIALTY	9/24/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CLINICS OF ANAHEIM INC	1006 W LA PALMA AVE	None	ANAHEIM	CA	92801	3650	30	06059	33.84713552	-117.9305145	Orange County
287784	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	4/18/2017	103G00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
287790	Fee-for-Service	1093240285	1093240285	1	1	PROTON DOCTORS PROFESSIONAL	8/31/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	9730 SUMMERS RIDGE RD	None	SAN DIEGO	CA	92121	3101	37	06073	32.89408843	-117.1706972	San Diego County
287821	Fee-for-Service	1427276757	1427276757	1	1	PATEL, ASHIT G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	875 OAK ST SE	STE 5080	SALEM	OR	97301	0000	00	None	44.933598	-123.0339735	Marion County
287852	Fee-for-Service	1013073766	1013073766	1	1	PHAN, DOUGLAS M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51181	84	Surgery-Head and Neck	0	In state provider	None	135 N JACKSON AVE	STE 102	SAN JOSE	CA	95116	1917	43	06085	37.36164758	-121.8466827	Santa Clara County
287866	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
287892	Fee-for-Service	1811315492	1811315492	1	1	PATEL, NIRAJ R MD	9/28/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145669	08	Family Practice	0	In state provider	None	3581 PALMER DR	STE 602	CAMERON PARK	CA	95682	8238	09	06017	38.66109103	-120.9649544	El Dorado County
287902	Fee-for-Service	1548342728	1548342728	1	1	PRIMARY AND MULTI SPECIALTY	9/24/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CLINICS OF ANAHEIM INC	1006 W LA PALMA AVE	None	ANAHEIM	CA	92801	3650	30	06059	33.84713552	-117.9305145	Orange County
287911	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
287914	Fee-for-Service	1972732931	1972732931	1	1	PERUMAL, DEEPA MD	11/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133102	08	Family Practice	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
287924	Fee-for-Service	1215004189	1215004189	1	1	PAPPU, ANURADHA R MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50361	10	Gastroenterology (M.D. only)	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
287929	Fee-for-Service	1245210582	1245210582	1	1	PROCTOR, JON A MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87835	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
287951	Fee-for-Service	1518052547	1518052547	1	1	PATEL, RAMESH A MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141295	01	General Practice	0	In state provider	None	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2245	15	06029	35.36875951	-119.0959206	Kern County
287974	Fee-for-Service	1700808649	1700808649	1	1	PACIFIC PHARMACY, INC	11/8/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA AVE	STE G10	SAN GABRIEL	CA	91776	1147	19	06037	34.10120583	-118.1065375	Los Angeles County
287993	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	5/2/2019	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
288025	Fee-for-Service	1841587748	1841587748	1	1	PARIKH, NEIL A MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129539	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
288034	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	4/19/2005	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288116	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	1/28/2019	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
288123	Fee-for-Service	1205099074	1205099074	1	1	PHAM-THOMAS, NANCY MD	5/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112865	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
288140	Fee-for-Service	1407041700	1407041700	1	1	PALLAIS, MARCELA LCSW	10/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
288152	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288169	Fee-for-Service	1114001104	1114001104	1	1	POMPA, DAVID J MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65203	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
288233	Fee-for-Service	1073606299	1073606299	1	14	PERMANENTE MEDICAL GROUP INC	11/8/2018	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
288235	Fee-for-Service	1386728376	1386728376	1	1	PRUSINER, PAUL E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40360	18	Ophthalmology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
288249	Fee-for-Service	1790949402	1790949402	1	1	PARRINELLA, REBECCA R	12/17/2019	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	68 COOMBS ST.	A-4	NAPA	CA	94559	3956	28	06055	38.28705321	-122.2871753	Napa County
288271	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	5/18/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
288285	Fee-for-Service	1114001104	1114001104	1	1	POMPA, DAVID J MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65203	10	Gastroenterology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
288286	Fee-for-Service	1003596545	1003596545	1	1	POWER, BRID LCSW	2/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	251 COHASSET	None	CHICO	CA	95926	2241	04	06007	39.75090044	-121.8522609	Butte County
288292	Fee-for-Service	1467735001	1467735001	1	1	PIERNAS, JANINE K LMFT	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
288306	Fee-for-Service	1104067578	1104067578	1	1	PARAMOUNT PROFESSIONALS, INC	2/9/2015	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16484 VICTOR STREET	None	VICTORVILLE	CA	92395	3918	36	06071	34.5217475	-117.3044025	San Bernardino County
288347	Fee-for-Service	1154943801	1154943801	1	1	PATEL, NISARGI S MD	9/26/2023	207R00000X	NA	Other	026	PHYSICIANS	184783	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
288354	Fee-for-Service	1275843575	1275843575	1	1	PILLAI, MANJU G MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121909	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
288355	Fee-for-Service	1346328960	1346328960	1	1	PINORIS, ANASTASIA MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62168	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
288367	Fee-for-Service	1861429060	1861429060	1	1	POUSMAN, ROBERT M DO	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9252	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
288383	Fee-for-Service	1588656268	1588656268	1	4	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	333 CASA GRANDE RD	None	PETALUMA	CA	94954	5706	49	06097	38.24186165	-122.5972973	Sonoma County
288388	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
288395	Fee-for-Service	1174749956	1174749956	1	1	PINYAVAT, ALAN MD	12/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135359	41	Internal Medicine	0	In state provider	None	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
288420	Fee-for-Service	1073504791	1073504791	1	1	PEDDADA, ABHINAND V MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47818	30	Radiology	0	In state provider	None	15400 NATIONAL AVE	STE 100	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
288426	Fee-for-Service	1407891658	1407891658	1	1	PAK, EUGENE MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138763	25	Physical Medicine and Rehabilitation	0	In state provider	None	11406 LOMA LINDA DR	STE 300	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
288445	Fee-for-Service	1710964630	1710964630	1	1	PERRY, KITTI J	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1830 WHALESHIP RD.	None	BODEGA BAY	CA	94923	0003	49	06097	38.33532767	-123.0614127	Sonoma County
288451	Fee-for-Service	1124435896	1124435896	1	1	PORTILLO, TANIA M MD	5/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141013	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
288458	Fee-for-Service	1558627497	1558627497	1	1	POSTEN, JOHN P DO	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13067	01	General Practice	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
288476	Fee-for-Service	1568785004	1568785004	1	1	PAREKH, CHINTAN A MD	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98702	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288483	Fee-for-Service	1598314478	1598314478	1	1	PRATT, ALISON L LMFT	2/1/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
288501	Fee-for-Service	1588656268	1588656268	1	4	PETALUMA HEALTH CTR, INC	6/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	333 CASA GRANDE RD	None	PETALUMA	CA	94954	5706	49	06097	38.24186165	-122.5972973	Sonoma County
288504	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	11/18/2016	103G00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288519	Fee-for-Service	1114052743	1114052743	1	1	POONIA, MOHINDER S MD INC	5/11/1981	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36683	41	Internal Medicine	0	In state provider	None	7035 N CHESTNUT ST	STE 102	FRESNO	CA	93720	0352	10	06019	36.8379852	-119.7362481	Fresno County
288537	Fee-for-Service	1073504791	1073504791	1	1	PEDDADA, ABHINAND V MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47818	78	Neoplastic Diseases/Oncology	0	In state provider	None	15400 NATIONAL AVE	STE 100	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
288601	Fee-for-Service	1043416498	1043416498	1	1	PAREKH, NIRAJ V MD	12/31/2009	390200000X	NA	Other	026	PHYSICIANS	106262	08	Family Practice	0	In state provider	None	28078 BAXTER RD	STE 110	MURRIETA	CA	92563	1402	33	06065	33.615	-117.1670265	Riverside County
288619	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288650	Fee-for-Service	1073504791	1073504791	1	1	PEDDADA, ABHINAND V MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47818	01	General Practice	0	In state provider	None	15400 NATIONAL AVE	STE 100	LOS GATOS	CA	95032	2433	43	06085	37.24429169	-121.9493834	Santa Clara County
288666	Fee-for-Service	1790312494	1790312494	1	1	PATEL, MONIL V MD	7/3/2023	390200000X	NA	Other	026	PHYSICIANS	186670	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288712	Fee-for-Service	1043416498	1043416498	1	1	PAREKH, NIRAJ V MD	12/31/2009	390200000X	NA	Other	026	PHYSICIANS	106262	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	28078 BAXTER RD	STE 110	MURRIETA	CA	92563	1402	33	06065	33.615	-117.1670265	Riverside County
288728	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	1/12/2017	103G00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288739	Fee-for-Service	1184791196	1184791196	1	1	PATEL, SUNILKUMAR J MD	6/30/1992	207RH0000X	NA	Hematology	026	PHYSICIANS	52005	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
288772	Fee-for-Service	1972933497	1972933497	1	1	PROHEALTH PARTNERS, A MEDICA	4/29/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L GROUP, INC.	801 TUSTIN	201	SANTA ANA	CA	92705	3612	30	06059	33.752286	-117.8341735	Orange County
288780	Fee-for-Service	1477127975	1477127975	1	1	PHILLIPS, MICHAEL	7/14/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1160 N VENTURA RD	None	OXNARD	CA	93030	3802	56	06111	34.2133887	-119.1943554	Ventura County
288834	Fee-for-Service	1184684797	1184684797	1	1	PORTEUS, MATTHEW H MD	10/1/2001	2080P0207X	NA	Hematology	026	PHYSICIANS	85749	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
288837	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	4/18/2017	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288847	Fee-for-Service	1184791196	1184791196	1	1	PATEL, SUNILKUMAR J MD	6/30/1992	207RH0000X	NA	Hematology	026	PHYSICIANS	52005	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
288871	Fee-for-Service	1306089313	1306089313	1	1	PAUL ROMO, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
288886	Fee-for-Service	1710189543	1710189543	1	1	PARAJULI, RITESH MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142584	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
288933	Fee-for-Service	1891344917	1891344917	1	1	PYAE, SHWE NP	6/11/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 BRYANT	None	PALO ALTO	CA	94301	2711	43	06085	37.44253348	-122.1562279	Santa Clara County
288943	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	11/28/2016	103G00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
288955	Fee-for-Service	1457786451	1457786451	1	1	PEREIRA, MICHELLE LCSW	9/2/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
288973	Fee-for-Service	1598783789	1598783789	1	1	PARKER, PETER J MD	6/13/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44924	03	Allergy	0	In state provider	None	1100-06 1/2 W GLEN OAKS	None	GLENDALE	CA	91202	2606	19	06037	34.15926579	-118.2562523	Los Angeles County
288984	Fee-for-Service	1700803285	1700803285	1	1	PLANNED PARENTHOOD	8/21/1987	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA CENTRAL COAST	743 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3921	40	06079	35.27698063	-120.6618385	San Luis Obispo County
288995	Fee-for-Service	1710189543	1710189543	1	1	PARAJULI, RITESH MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142584	68	Hematology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
289013	Fee-for-Service	1326168600	1326168600	1	1	PAPAMATHEAKIS, DEMOSTHENES G	9/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101188	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289016	Fee-for-Service	1700545902	1700545902	1	1	PETERSON, MICHELLE LCSW	2/11/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119345	-	NOT APPLICABLE	0	In state provider	None	11512 B AVE	None	AUBURN	CA	95603	2605	31	06061	38.93969517	-121.1046397	Placer County
289024	Fee-for-Service	1952672032	1952672032	1	1	PRACTICA INC	12/23/2013	261Q00000X	NA	Other	026	PHYSICIANS	97645	02	General Surgery	0	In state provider	None	4910 VAN NUYS BLVD	206	SHERMAN OAKS	CA	91403	1766	19	06037	34.15979697	-118.4486826	Los Angeles County
289036	Fee-for-Service	1073661989	1073661989	1	1	PARK, STEVE C MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60930	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
289049	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	1/30/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289143	Fee-for-Service	1306920640	1306920640	1	1	PRATHIKANTI, SRIDHAR MD	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52202	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
289151	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	2/26/2013	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289178	Fee-for-Service	1578838520	1578838520	1	6	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	990 KLAMATH LANE	SUITE 17	YUBA CITY	CA	95993	8979	51	06101	39.13992431	-121.6517328	Sutter County
289200	Fee-for-Service	1548558067	1548558067	1	1	POOLI, AYDIN MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142512	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
289209	Fee-for-Service	1194416628	1194416628	1	1	PERSONALIZED PEDIATRIC LABOR	4/23/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ATORIES LLC	1744 BERKELEY ST	None	SANTA MONICA	CA	90404	4105	19	06037	34.03262617	-118.4640763	Los Angeles County
289251	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	3/25/2020	193200000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289258	Fee-for-Service	1750912119	1750912119	1	1	PEREZ, MARIA M CRNA	4/15/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
289271	Fee-for-Service	1497705537	1497705537	1	1	PATHOLOGY SCIENCES MED	1/1/1995	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
289277	Fee-for-Service	1578838520	1578838520	1	6	PACIFIC COAST MEDICAL CENTER	3/25/2014	305S00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	990 KLAMATH LANE	SUITE 17	YUBA CITY	CA	95993	8979	51	06101	39.13992431	-121.6517328	Sutter County
289294	Fee-for-Service	1922539006	1922539006	1	1	PERRY, STEPHEN MD	11/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170641	None	None	0	In state provider	None	131 STONY CIR	1600	SANTA ROSA	CA	95401	9520	49	06097	38.439477	-122.7451095	Sonoma County
289306	Fee-for-Service	1043658388	1043658388	1	1	PIECES GROUP LP	11/3/2013	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3731 TOURNAMENT DRIVE	None	PALMDALE	CA	93551	5638	19	06037	34.6232316	-118.1967454	Los Angeles County
289323	Fee-for-Service	1669209714	1669209714	1	1	PALLAN, ELYSSE LCSW	10/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
289346	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	11/7/2018	193200000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289348	Fee-for-Service	1174204440	1174204440	1	1	PLASCENCIA, BRANDY G CRNA	1/8/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
289359	Fee-for-Service	1578723805	1578723805	1	1	PARK, JEOUNG P PSYD	8/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1357 W SHAW AVE	STE 104	FRESNO	CA	93711	3619	10	06019	36.80824094	-119.8162512	Fresno County
289362	Fee-for-Service	1497705537	1497705537	1	1	PATHOLOGY SCIENCES MED	5/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
289400	Fee-for-Service	1205932605	1205932605	2	1	PEOPLES CARE HOME HEALTH INC	10/22/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12611 HIDDENCREEK WAY	SUITE JK	CERRITOS	CA	90703	2156	19	06037	33.88499597	-118.0628892	Los Angeles County
289421	Fee-for-Service	1407315997	1407315997	1	1	PHARMACY AT THE COURTS LLC	4/27/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8237 ROCHESTER AVE	120	RANCHO CUCAMONGA	CA	91730	0717	36	06071	34.103952	-117.5435325	San Bernardino County
289440	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289484	Fee-for-Service	1649370164	1649370164	1	1	POTH, PHILLIP W MD	3/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135333	41	Internal Medicine	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
289503	Fee-for-Service	1578725123	1578725123	1	1	PAN, JONATHAN Z MD	8/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121840	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
289526	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	10/8/2018	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289604	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	6/15/2010	207R00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289644	Fee-for-Service	1811036619	1811036619	1	1	PARK, JINHA M MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	80100	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289651	Fee-for-Service	1528039039	1528039039	1	1	PHOENIXVILLE HOSPITAL	5/21/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	140 NUTT ROAD	None	PHOENIXVILLE	PA	19460	3906	00	None	40.124025	-75.5153415	Chester County
289672	Fee-for-Service	1891011078	1891011078	1	1	PODSADA, KIMBERLY C NP	12/18/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
289683	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	1/12/2017	193200000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289698	Fee-for-Service	1538188198	1538188198	1	1	PHILLIPS, WILLIAM H MD	3/26/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	52644	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 330	PLEASANTON	CA	94588	5804	01	06001	37.69214859	-121.8796532	Alameda County
289699	Fee-for-Service	1023032133	1023032133	1	1	PATEL, KAUSHAL MD	6/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79162	02	General Surgery	0	In state provider	None	100 MEDICAL PLAZA #755	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
289719	Fee-for-Service	1760626758	1760626758	1	1	PACIFIC HOSPITALISTS INC	2/17/2010	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7143 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4905	19	06037	33.97427787	-118.2224599	Los Angeles County
289721	Fee-for-Service	1558312629	1558312629	1	1	PALATNIK, MIKHAIL MD	6/11/2009	207R00000X	NA	Other	026	PHYSICIANS	51374	41	Internal Medicine	0	In state provider	None	4811 CHIPPENDALE DR	STE 605	SACRAMENTO	CA	95841	2553	34	06067	38.663046	-121.352472	Sacramento County
289727	Fee-for-Service	1528039039	1528039039	1	1	PHOENIXVILLE HOSPITAL	5/21/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMPANY LLC	140 NUTT ROAD	None	PHOENIXVILLE	PA	19460	3906	00	None	40.124025	-75.5153415	Chester County
289738	Fee-for-Service	1285739334	1285739334	1	1	PINNELL, SEAN P MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70007	None	None	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
289760	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	5/2/2019	103G00000X	NA	Other	062	GROUP RESPIRATORY CARE PRACTITIONERS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289795	Fee-for-Service	1558312629	1558312629	1	1	PALATNIK, MIKHAIL MD	6/11/2009	207R00000X	NA	Other	026	PHYSICIANS	51374	01	General Practice	0	In state provider	None	4811 CHIPPENDALE DR	STE 605	SACRAMENTO	CA	95841	2553	34	06067	38.663046	-121.352472	Sacramento County
289803	Fee-for-Service	1134137243	1134137243	1	1	PUE, ALEXANDER F MD INC	2/16/1988	207L00000X	NA	Other	026	PHYSICIANS	22263	05	Anesthesiology	0	In state provider	None	5469 KEARNY VILLA RD	STE 302	SAN DIEGO	CA	92123	1159	37	06073	32.83298834	-117.1388725	San Diego County
289816	Fee-for-Service	1891173720	1891173720	1	2	PATEL, RISHI DO	1/24/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15503	-	NOT APPLICABLE	0	In state provider	None	5715 S BROADWAY AVE	None	LOS ANGELES	CA	90037	4131	19	06037	33.990273	-118.2783255	Los Angeles County
289830	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2015	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289843	Fee-for-Service	1720582539	1720582539	1	1	PHAM, NATHAN MD	8/23/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
289861	Fee-for-Service	1619016300	1619016300	1	1	PRONG, TZERLIN DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC PROF CORP	1722 DESIRE AVE	STE 205	ROWLAND HEIGHTS	CA	91748	2970	19	06037	33.98725948	-117.8963129	Los Angeles County
289872	Fee-for-Service	1306334586	1306334586	1	1	PEARSON, HADLEY MD	8/17/2023	207ND0900X	NA	Dermatology	026	PHYSICIANS	166795	None	None	0	In state provider	None	2255 YGNACIO VALLEY RD	STE B1	WALNUT CREEK	CA	94598	3335	07	06013	37.92242643	-122.0301696	Contra Costa County
289898	Fee-for-Service	1336302231	1336302231	1	1	PIFER, MATTHEW A MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124936	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
289899	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
289902	Fee-for-Service	1447861141	1447861141	1	1	PROGRESS HEALTH CARE INC	9/12/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 204	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
289938	Fee-for-Service	1245537612	1245537612	1	1	PRODIGY HEALTHCARE, INC	12/17/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	975 EAST ADAMS AVENUE	R1-5, O1-3	FOWLER	CA	93625	2702	10	06019	36.632682	-119.6677575	Fresno County
289948	Fee-for-Service	1649391954	1649391954	1	1	PATEL, HIREN Y MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10472	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
289964	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	12/30/2018	103G00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
289984	Fee-for-Service	1396405437	1396405437	1	1	POPAJ, CHRISTINE LMFT	12/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
290028	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	12/30/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
290043	Fee-for-Service	1164726709	1164726709	1	1	PANG, PANNY C W	10/17/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 S FIRST ST	STE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
290082	Fee-for-Service	1295254324	1295254324	1	1	PARK, SEONGHYEON	11/16/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	410 S MELROSE DR	200	VISTA	CA	92081	6642	37	06073	33.19049793	-117.2538503	San Diego County
290083	Fee-for-Service	1912393885	1912393885	1	1	PAUL, SUCHISMITA MD	12/5/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	162605	07	Dermatology	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
290086	Fee-for-Service	1710312277	1710312277	1	1	PALACIOS, MERCEDES P PHD	1/12/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
290092	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	6/3/2019	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
290115	Fee-for-Service	1316462484	1316462484	1	1	PEREZ-STABLE, KATHLYN P LCSW	10/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
290121	Fee-for-Service	1699726760	1699726760	1	1	PATEL, SUNIL K MD	12/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51068	01	General Practice	0	In state provider	None	5905 BROCKTON AVE	STE E	RIVERSIDE	CA	92506	1887	33	06065	33.96228646	-117.3959221	Riverside County
290139	Fee-for-Service	1932333457	1932333457	1	1	PATEL, PRASHANT S MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107712	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
290142	Fee-for-Service	1932125135	1932125135	1	1	PADAM, GURPREET K MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88960	41	Internal Medicine	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
290148	Fee-for-Service	1073606299	1073606299	1	7	PERMANENTE MEDICAL GROUP INC	2/17/2009	193200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP INC	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
290157	Fee-for-Service	1477587632	1477587632	1	1	PROVIDENCE HEALTH SYSTEM	5/1/1996	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
290169	Fee-for-Service	1306336490	1306336490	1	1	PATHIPATI, MYTHILI P MD	9/9/2024	163WG0100X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
290204	Fee-for-Service	1073606299	1073606299	1	1	PERMANENTE MEDICAL GROUP INC	9/11/2012	103G00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
290215	Fee-for-Service	1477587632	1477587632	1	1	PROVIDENCE HEALTH SYSTEM	5/1/1996	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
290222	Fee-for-Service	1306336490	1306336490	1	1	PATHIPATI, MYTHILI P MD	9/9/2024	163WG0100X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
290225	Fee-for-Service	1649257015	1649257015	1	1	PENA, MATTHEW T MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88230	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
290240	Fee-for-Service	1336201706	1336201706	1	1	PERSONS, MELISSA A	11/7/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
290257	Fee-for-Service	1487083705	1487083705	1	1	PRIM HOSPICE CARE INC.	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4413 RIVERSIDE DR	SUITE E	CHINO	CA	91710	3949	36	06071	34.01890606	-117.708813	San Bernardino County
290261	Fee-for-Service	1841848157	1841848157	1	1	PARK, LEANNA LMFT	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
290275	Fee-for-Service	1306336490	1306336490	1	1	PATHIPATI, MYTHILI P MD	9/9/2024	163WG0100X	NA	Other	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
290309	Fee-for-Service	1487083705	1487083705	1	1	PRIM HOSPICE CARE INC.	8/25/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4413 RIVERSIDE DR	SUITE E	CHINO	CA	91710	3949	36	06071	34.01890606	-117.708813	San Bernardino County
290319	Fee-for-Service	1497942064	1497942064	1	1	PULIDO, RICHARD N MD FCCP	6/14/2024	208M00000X	NA	Other	026	PHYSICIANS	105802	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
290358	Fee-for-Service	1275716250	1275716250	1	1	PARAJULISAPKOTA, SARITA NP	5/10/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
290438	Fee-for-Service	1760682058	1760682058	1	1	PUTLUR, PRADEEP MD	12/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55965	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW BLVD	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
290458	Fee-for-Service	1851327910	1851327910	1	1	PHAM, QUYNH T DO	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8668	08	Family Practice	0	In state provider	None	9191 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
290461	Fee-for-Service	1134163793	1134163793	1	1	PHAM, TUAN A MD	7/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62514	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	415 E HARDING WAY	None	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
290473	Fee-for-Service	1326089806	1326089806	1	1	PETALUMA VALLEY INTERNAL	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55098	41	Internal Medicine	0	In state provider	MEDICINE	1250 BROADWAY	None	SONOMA	CA	95476	7500	49	06097	38.27841777	-122.4598827	Sonoma County
290487	Fee-for-Service	1033955497	1033955497	1	1	PALMDALE INTENSIVIST INC	8/18/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
290567	Fee-for-Service	1073681433	1073681433	1	1	PROSISE, JOHN PHD	6/19/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2424 DWIGHT WY	STE 9	BERKELEY	CA	94704	2365	01	06001	37.86494873	-122.2595558	Alameda County
290572	Fee-for-Service	1124601372	1124601372	1	1	PATEL, RAJ A DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21408	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
290596	Fee-for-Service	1508041187	1508041187	1	1	PARK, MEYEON MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107145	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
290630	Fee-for-Service	1508041187	1508041187	1	1	PARK, MEYEON MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107145	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
290655	Fee-for-Service	1033265038	1033265038	1	1	PAUL, GEORGE MD	5/1/2013	207L00000X	NA	Other	026	PHYSICIANS	93035	05	Anesthesiology	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
290715	Fee-for-Service	1720467889	1720467889	1	1	PAYDAR, ASHLEY R M DO	1/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	14979	01	General Practice	0	In state provider	None	2210 DEL PASO RD	None	SACRAMENTO	CA	95834	9671	34	06067	38.655189	-121.5091575	Sacramento County
290730	Fee-for-Service	1427512714	1427512714	1	1	PHAN, TANYA CNP	11/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
290741	Fee-for-Service	1831712496	1831712496	1	2	PREMIUM HEALTH OC INC	6/26/2023	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	22 ODYSSEY	STE 240	IRVINE	CA	92618	7700	30	06059	33.66719598	-117.7642461	Orange County
290803	Fee-for-Service	1992018634	1992018634	1	1	POLLITT, JAN E LCSW	5/29/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24800 CHRISANTA DR	STE 220	MISSION VIEJO	CA	92691	4838	30	06059	33.60239643	-117.6735464	Orange County
290819	Fee-for-Service	1356788772	1356788772	1	1	PRABHAKAR, RADHIKA MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132696	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
290866	Fee-for-Service	1548446602	1548446602	1	1	PURCOTT, KARI L MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98534	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
290911	Fee-for-Service	1811413032	1811413032	1	1	PHILLIPS, COLIN C PT	7/11/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON STREET	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
290912	Fee-for-Service	1609845171	1609845171	1	1	PLANNED PARENTHOOD/	9/19/1980	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ORANGE & SAN BERNARDINO	1520 NUTMEG PL	SUITE 101	COSTA MESA	CA	92626	2501	30	06059	33.68196448	-117.920322	Orange County
290926	Fee-for-Service	1598132185	1598132185	1	1	PAGKALINAWAN, MARIBEL M NP	6/26/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
290966	Fee-for-Service	1255891917	1255891917	1	1	PLASENCIA, VERIAH B MD	7/16/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176403	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
291001	Fee-for-Service	1356883805	1356883805	1	1	PETALUMAIDENCE OPCO, LLC	12/16/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	101 MONROE ST	None	PETALUMA	CA	94954	2328	49	06097	38.25630881	-122.62758	Sonoma County
291020	Fee-for-Service	1215160569	1215160569	1	1	PETRAKIS, ALEXIS C PSYD	3/2/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
291034	Fee-for-Service	1619981172	1619981172	1	1	PELLETT MADAN, REBECCA	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
291053	Fee-for-Service	1891766093	1891766093	1	1	PANGANIBAN, WALTER G MD	4/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	25837	08	Family Practice	0	In state provider	None	1429 W FREMONT ST	None	STOCKTON	CA	95203	2635	39	06077	37.95439432	-121.3112101	San Joaquin County
291067	Fee-for-Service	1356446835	1356446835	1	1	PANDIT, RAJUL P MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55744	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
291068	Fee-for-Service	1457333577	1457333577	1	1	PERLMAN, JONATHAN P MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61218	18	Ophthalmology	0	In state provider	None	610 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	57	06113	38.67351395	-121.7933438	Yolo County
291076	Fee-for-Service	1659433340	1659433340	1	1	POWELL, GEORGE MD	10/20/2022	207L00000X	NA	Other	026	PHYSICIANS	171011	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
291080	Fee-for-Service	1891140620	1891140620	1	1	PATEL, NEIL D MD	12/17/2018	1835P1300X	NA	Other	026	PHYSICIANS	154780	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
291089	Fee-for-Service	1457333577	1457333577	1	1	PERLMAN, JONATHAN P MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61218	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	610 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	57	06113	38.67351395	-121.7933438	Yolo County
291106	Fee-for-Service	1306371117	1306371117	1	1	PARK, SUNMIN MD	10/1/2020	208M00000X	NA	Other	026	PHYSICIANS	169853	41	Internal Medicine	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
291132	Fee-for-Service	1669865424	1669865424	1	1	PETERSON, ROBERT C DO	11/15/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	14381	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
291276	Fee-for-Service	1821601071	1821601071	1	1	PLUCKHAN, LAURA PSYD	4/4/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
291296	Fee-for-Service	1912944232	1912944232	1	1	PATRICK, DANIEL MD	8/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92101	42	Nuclear Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
291303	Fee-for-Service	1902409550	1902409550	1	1	PHARMEDQUEST PHARMACY SERVIC	6/18/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3590 E IMPERIAL HWY	101	LYNWOOD	CA	90262	2655	19	06037	33.93042906	-118.2056035	Los Angeles County
291311	Fee-for-Service	1174554935	1174554935	2	1	PONCE, GEORGE A MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	51194	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
291320	Fee-for-Service	1174179030	1174179030	1	1	PACIFIC OAK COMPOUNDING PHAR	11/21/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MACY, INC.	12 N 1ST AVE	None	ARCADIA	CA	91006	3205	19	06037	34.14041319	-118.0282852	Los Angeles County
291349	Fee-for-Service	1609926617	1609926617	1	1	PUMPHREY, EDWARD A MD INC	10/14/2016	207L00000X	NA	Other	026	PHYSICIANS	24667	05	Anesthesiology	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
291396	Fee-for-Service	1649681636	1649681636	1	1	PHUNG-HART, ELIZABETH DO	3/31/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	18158	None	None	0	In state provider	None	198 COHASSET RD	None	CHICO	CA	95926	2202	04	06007	39.75140931	-121.8541188	Butte County
291438	Fee-for-Service	1710518998	1710518998	1	1	PIZENO, MAYRA	9/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
291476	Fee-for-Service	1992011894	1992011894	1	1	PEREZ-VELASCO, DANIELA J DO	9/12/2023	207L00000X	NA	Other	026	PHYSICIANS	20861	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
291488	Fee-for-Service	1649633207	1649633207	1	1	PTASNIK, SARA MD	6/9/2021	207R00000X	NA	Other	026	PHYSICIANS	151567	None	None	0	In state provider	None	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
291491	Fee-for-Service	1013091040	1013091040	1	1	PROSSER, JANE M MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
291509	Non-Physician Medical Practitioner	None	1568828739	0	0	PATEL, PRATIKSHA NP	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291523	Non-Physician Medical Practitioner	None	1457976938	0	0	PADILLA-PHU, JERRICK K NP	10/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 S CENTRAL AVE	SUITE 240	GLENDALE	CA	91204	2570	00	06000	34.12709764	-118.2577911	Los Angeles County
291559	Non-Physician Medical Practitioner	None	1598002537	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	6/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	689 TANK FARM RD STE 220	None	SAN LUIS OBISPO	CA	93401	7079	00	06000	35.24775907	-120.6444598	San Luis Obispo County
291579	Non-Physician Medical Practitioner	None	1568791390	0	0	PLANNED PARENTHOOD BASICS -BALDWIN HILLS/CRENSHAW	11/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3637 S LA BREA AVENUE	None	LOS ANGELES	CA	90016	0000	00	06000	34.01991	-118.355626	Los Angeles County
291594	Non-Physician Medical Practitioner	None	1659026367	0	0	PIERSON, DAVID J NP	8/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
291614	Non-Physician Medical Practitioner	None	1508317843	0	0	PANTHAKY, ANAITA J NP	2/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1821 CONTESSA	None	IRVINE	CA	92620	1735	00	06000	33.68831748	-117.7623987	Orange County
291673	Non-Physician Medical Practitioner	None	1891965448	0	0	POWERS, JEFFREY SCOTT	9/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 CRANE ST	None	MENLO PARK	CA	94025	4260	00	06000	37.45264069	-122.1878743	San Mateo County
291720	Non-Physician Medical Practitioner	None	1205846326	0	0	PEAK, SIHUOR PA-C	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S. RAYMOND AVE	None	PASADENA	CA	91105	3229	00	06000	34.13185488	-118.1487468	Los Angeles County
291747	Non-Physician Medical Practitioner	None	1235897281	0	0	PHAM, LOUIS NP	11/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 N MOUNTAIN AVE	STE A	UPLAND	CA	92307	8516	00	06000	34.10114204	-117.6702497	San Bernardino County
291768	Non-Physician Medical Practitioner	None	1588280374	0	0	PARKE, RICHARD J NP	12/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	00	06000	37.79071145	-122.4308506	San Francisco County
291810	Non-Physician Medical Practitioner	None	1548308752	0	0	PRICE, BRENT LOUIS	6/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2340 CLAY ST	FOURTH FLOOR	SAN FRANCISCO	CA	94115	1932	00	06000	37.79101969	-122.43208	San Francisco County
291817	Non-Physician Medical Practitioner	None	1831979863	0	0	PHAN, BRANDON NP	6/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	61 VICTORY LN	STE. A	LOS GATOS	CA	95030	5920	00	06000	37.22441264	-121.9836902	Santa Clara County
291833	Non-Physician Medical Practitioner	None	1417294455	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	4/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	217 W CENTRAL AVE STE G	None	LOMPOC	CA	93436	2830	00	06000	34.66084049	-120.460302	Santa Barbara County
291867	Non-Physician Medical Practitioner	None	1407338064	0	0	PATEL, MONALI B PA	5/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29525 CANWOOD ST	200	AGOURA HILLS	CA	91301	4233	00	06000	34.14724223	-118.7675471	Los Angeles County
291870	Non-Physician Medical Practitioner	None	1619005634	0	0	PERSHING, NANCY LUCILLE	10/4/1982	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	330 CAMPUS DR	None	HANFORD	CA	93230	4375	00	06000	36.32674062	-119.6636908	Kings County
291890	Non-Physician Medical Practitioner	None	1053657726	0	0	PAULY-ONEILL, SUSAN J NP	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39 MCNEAR DR	None	SAN RAFAEL	CA	94901	1545	00	06000	37.98960189	-122.4745471	Marin County
291913	Non-Physician Medical Practitioner	None	1225076433	0	0	PETTI, LORRAINE F	3/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	938 STANNAGE AVE	None	ALBANY	CA	94706	2006	00	06000	37.88895671	-122.296688	Alameda County
291919	Non-Physician Medical Practitioner	None	1285247049	0	0	PHAM, THANH PA	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	00	06000	33.52069117	-117.1653103	Riverside County
291930	Non-Physician Medical Practitioner	None	1821577222	0	0	PLANTAK, NATASHA S PA	3/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	00	06000	33.837354	-116.545572	Riverside County
291941	Non-Physician Medical Practitioner	None	1528217528	0	0	PEREZ, ESTHER PA-C	2/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	200	SALINAS	CA	93901	4483	00	06000	36.66552031	-121.6439174	Monterey County
291947	Non-Physician Medical Practitioner	None	1093976805	0	0	PREGNANCY COUNSELING CENTER	10/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	2622	00	06000	34.255791	-118.4675065	Los Angeles County
291988	Non-Physician Medical Practitioner	None	1942404827	0	0	PETTY, EMILY J PA	1/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
291990	Non-Physician Medical Practitioner	None	1760017479	0	0	PEREZ, FREDERICK NP	5/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
292038	Non-Physician Medical Practitioner	None	1396993713	0	0	PHAM, JENNIFER PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
292048	Non-Physician Medical Practitioner	None	1225065998	0	0	PALMER, HEATHER L	10/27/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	EMERGENCY DEPARTMENT	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
292056	Non-Physician Medical Practitioner	None	1619345899	0	0	PERALTA, EDGAR A PA-C	5/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292085	Non-Physician Medical Practitioner	None	1073892212	0	0	PATEL, AMI J	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	139 RAINBOW LN	None	REDLANDS	CA	92374	4805	00	06000	34.05695652	-117.1424675	San Bernardino County
292089	Non-Physician Medical Practitioner	None	1508446089	0	0	PORTER BERG, SKYE R NP	11/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
292106	Non-Physician Medical Practitioner	None	1649008772	0	0	PATEL, PRIYA N	8/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
292120	Non-Physician Medical Practitioner	None	1770099558	0	0	POLACH, ROCHELLE L NP	6/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
292136	Non-Physician Medical Practitioner	None	1073273777	0	0	POPESCU, CRISTIAN PA-C	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1792 TRIBUTE RD	200	SACRAMENTO	CA	95815	4305	00	06000	38.598219	-121.445964	Sacramento County
292137	Non-Physician Medical Practitioner	None	1275055329	0	0	PEKARCIK, HAYLEY S NP	8/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17810 PARK VISTA CT	None	RIVERSIDE	CA	92503	6593	00	06000	33.86263433	-117.4571171	Riverside County
292242	Non-Physician Medical Practitioner	None	1225220163	0	0	PINEROS, SANDRA L	7/14/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 E 3RD AVE	2613	SAN MATEO	CA	94401	2156	00	06000	37.57445226	-122.3091889	San Mateo County
292243	Non-Physician Medical Practitioner	None	1598756942	0	0	PEARSON, JAMES RICHARD	1/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	155 SOLANO ST	CORNING MEDICAL ASSOCIAT	CORNING	CA	96021	3511	00	06000	39.92779745	-122.1687508	Tehama County
292298	Non-Physician Medical Practitioner	None	1871998922	0	0	POPOVIC, JULIETA NP	2/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13151 YORBA AVE	APT 207	CHINO	CA	91710	4076	00	06000	34.014366	-117.7023135	San Bernardino County
292353	Non-Physician Medical Practitioner	None	1902521404	0	0	PROFF, ROSEMARY NP	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	00	06000	35.14690796	-118.4506925	Kern County
292378	Non-Physician Medical Practitioner	None	1346796661	0	0	PICOS, JULIE A	1/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 BUTTES VIEW LANE	None	AUBURN	CA	95603	7323	00	06000	38.91883881	-121.1625598	Placer County
292382	Non-Physician Medical Practitioner	None	1306285697	0	0	PALMA, LYNNE D NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
292397	Non-Physician Medical Practitioner	None	1932517539	0	0	PALOMO, MANUEL D PA	7/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
292412	Non-Physician Medical Practitioner	None	1497825087	0	0	PERES, STEVEN E	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	131 THORNDIKE WAY	None	FOLSOM	CA	95630	6561	00	06000	38.668005	-121.129614	Sacramento County
292443	Non-Physician Medical Practitioner	None	1629792304	0	0	PARK, ERIKA D NP	2/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
292445	Non-Physician Medical Practitioner	None	1093228926	0	0	PHILAVONG-DANH, MONEMALA	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10590 TOWN CENTER DR	170	RANCHO CUCAMONGA	CA	91730	0360	00	06000	34.11101693	-117.5740616	San Bernardino County
292452	Non-Physician Medical Practitioner	None	1316585730	0	0	PINI, KATELYN N PA	1/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
292455	Non-Physician Medical Practitioner	None	1659625622	0	0	PETERMANN, JEANETTE MARIE	2/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1036 EAST HUNTINGTON DRI	None	DUARTE	CA	91010	0000	00	06000	34.13947369	-117.9831619	Los Angeles County
292476	Non-Physician Medical Practitioner	None	1568584035	0	0	PARSON, JENA D	11/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY STREET	PALO ALTO MEDICAL FOUNDA	FREMONT	CA	94538	6104	00	06000	37.54866156	-121.9750739	Alameda County
292483	Non-Physician Medical Practitioner	None	1861731523	0	0	PLANNED PARENTHOOD MAR MONTE, INC.	7/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1682 7TH ST	None	OAKLAND	CA	94607	1351	00	06000	37.80663765	-122.3002667	Alameda County
292491	Non-Physician Medical Practitioner	None	1538920004	0	0	PATEL, VIKKIE S NP	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
292520	Non-Physician Medical Practitioner	None	1982464624	0	0	PRISICHENKO, MYKOLA PA-C	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH ST	SUITE 104	SANTA ANA	CA	92705	3916	00	06000	33.74826075	-117.8385386	Orange County
292532	Non-Physician Medical Practitioner	None	1760169569	0	0	PETERSON, KYLE NP	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	00	06000	33.73793948	-118.3036095	Los Angeles County
292550	Non-Physician Medical Practitioner	None	1184682999	0	0	PARK, SOOK J NP	12/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3852 YELLOWSTONE CIR	None	CHINO	CA	91710	5623	00	06000	33.98942316	-117.7189678	San Bernardino County
292588	Non-Physician Medical Practitioner	None	1154631687	0	0	PITCHFORD-MORRISON, CYNTHIA R NP	4/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	00	06000	33.84718298	-117.933758	Orange County
292606	Non-Physician Medical Practitioner	None	1164473187	0	0	PAGE, SAUNDRIA L	10/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41840 ENTERPRISE CIR N	None	TEMECULA	CA	92590	5654	00	06000	33.51730799	-117.1697125	Riverside County
292608	Non-Physician Medical Practitioner	None	1972809663	0	0	PREGERSON, HEATHER AIRD	8/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3156 VISTA WAY	SUITE 100	OCEANSIDE	CA	92056	3622	00	06000	33.18255249	-117.3250703	San Diego County
292618	Non-Physician Medical Practitioner	None	1922751981	0	0	PEREZ, ANA A PA-C	1/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
292619	Non-Physician Medical Practitioner	None	1083310999	0	0	PHAM, JAESON NP	4/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
292624	Non-Physician Medical Practitioner	None	1750625588	0	0	PENGHO, HONORINE P NP	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6850 SEPULVEDA BLVD	217	VAN NUYS	CA	91405	4444	00	06000	34.1955	-118.4661705	Los Angeles County
292625	Non-Physician Medical Practitioner	None	1760026181	0	0	PERRY, ROSALYN PA-C	11/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292634	Non-Physician Medical Practitioner	None	1245779016	0	0	PHAN, THU NP	11/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35410 DEL REY	None	DANA POINT	CA	92624	1814	00	06000	33.44949435	-117.6508774	Orange County
292665	Non-Physician Medical Practitioner	None	1205597507	0	0	PATINO TRIER, PAMELA L PA-C	3/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
292706	Non-Physician Medical Practitioner	None	1568541944	0	0	PARIS, HOLLY K PA-C	11/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
292725	Non-Physician Medical Practitioner	None	1326536590	0	0	PATEL, NISA K NP	7/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
292728	Non-Physician Medical Practitioner	None	1972662674	0	0	PORTIER-JONES, AUXSOPHENE L	5/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5105 ESCALON AVE	None	LOS ANGELES	CA	90043	1641	00	06000	33.99605299	-118.3449946	Los Angeles County
292732	Non-Physician Medical Practitioner	None	1649228925	0	0	PATEL, SHINA V	5/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13719 COLDWATER CT	None	CORONA	CA	92880	2810	00	06000	33.94826003	-117.5826046	Riverside County
292736	Non-Physician Medical Practitioner	None	1356809412	0	0	POPE, NATALIE E NP	3/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
292764	Non-Physician Medical Practitioner	None	1942943857	0	0	PAHLEVAN, SOGOL PA-C	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	00	06000	33.715035	-117.936993	Orange County
292765	Non-Physician Medical Practitioner	None	1437563152	0	0	PATYNOWSKI, NINA	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5437 KIETZKE LANE	None	RENO	NV	89511	1088	00	06000	39.46515231	-119.7902663	Washoe County
292790	Non-Physician Medical Practitioner	None	1457697674	0	0	PATEL, MADHUBHAI M	11/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 W ALBERTONI ST	None	GARDENA	CA	90248	3543	00	06000	33.87124242	-118.2764176	Los Angeles County
292813	Non-Physician Medical Practitioner	None	1730570243	0	0	PAEZ, CARMINA-LOU V NP	4/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10510 HALBRENT AVE	None	MISSION HILLS	CA	91345	2020	00	06000	34.26125824	-118.4659697	Los Angeles County
292826	Non-Physician Medical Practitioner	None	1861636177	0	0	PLANNED PARENTHOOD OF PASADENA, INC.	7/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 S GARFIELD AVE	SUITE 126	ALHAMBRA	CA	91801	3886	00	06000	34.09184212	-118.1245127	Los Angeles County
292830	Non-Physician Medical Practitioner	None	1679219356	0	0	PRANGER, COLIN PA-C	2/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
292839	Non-Physician Medical Practitioner	None	1548557499	0	0	PATRICK, MYCHAEL S PA	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
292850	Non-Physician Medical Practitioner	None	1528586245	0	0	PALM, KEVIN A	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1005 WILD OAK DR	None	HOLLISTER	CA	95023	9168	00	06000	36.81898492	-121.3719989	San Benito County
292876	Non-Physician Medical Practitioner	None	1720573439	0	0	PUDOL, MARILYN NP	4/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	00	06000	33.736257	-117.995535	Orange County
292877	Non-Physician Medical Practitioner	None	1093251753	0	0	PEREZ, VICTOR A S NP	4/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4617 SILVERCREST CT	None	ANTIOCH	CA	94531	7649	00	06000	37.97043719	-121.7637627	Contra Costa County
292884	Non-Physician Medical Practitioner	None	1710220439	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	5/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 PLAZA DR	SUITE 204	SANTA MARIA	CA	93454	6953	00	06000	34.93735341	-120.4286548	Santa Barbara County
292913	Non-Physician Medical Practitioner	None	1851819742	0	0	PATEL, MINAL A NP	2/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1154 E OAKMONT AVE	None	FRESNO	CA	93730	5925	00	06000	36.88970843	-119.7622998	Fresno County
292937	Non-Physician Medical Practitioner	None	1962866624	0	0	PATEL, MUNJAL K NP	8/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
292947	Non-Physician Medical Practitioner	None	1144686908	0	0	PIERCE, LOTTIE A	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9406 CUMMINGS RD	None	DURHAM	CA	95938	9602	00	06000	39.64615394	-121.7819682	Butte County
293015	Non-Physician Medical Practitioner	None	1184066649	0	0	POYTHRESS, RACHEL M	4/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7839 N CARNEGIE AVE	None	FRESNO	CA	93722	2334	00	06000	36.85065206	-119.8926254	Fresno County
293017	Non-Physician Medical Practitioner	None	1508212960	0	0	PRIFTAKIS, AMY	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
293026	Non-Physician Medical Practitioner	None	1619481447	0	0	PREDA, MARIA PA-C	11/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
293062	Non-Physician Medical Practitioner	None	1851019426	0	0	PIHLMANN, STEPHANIE J CNM	9/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
293085	Non-Physician Medical Practitioner	None	1568297943	0	0	PEREZ, CHRISTOPHER NP	12/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	00	06000	33.8601747	-118.148313	Los Angeles County
293131	Non-Physician Medical Practitioner	None	1033957253	0	0	PATEL, SHIVANI NP	10/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
293135	Non-Physician Medical Practitioner	None	1760861306	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	8/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5075 S BRADLEY RD	SUITE 131	SANTA MARIA	CA	93455	5077	00	06000	34.864155	-120.4187955	Santa Barbara County
293143	Non-Physician Medical Practitioner	None	1124474994	0	0	PEREZ, MELINDA A NP	5/31/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17505 CERRO VISTA DR	None	YORBA LINDA	CA	92886	3855	00	06000	33.88678591	-117.8293309	Orange County
293177	Non-Physician Medical Practitioner	None	1871092254	0	0	PASCUAL, ANDREW A NP	4/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
293182	Non-Physician Medical Practitioner	None	1538405915	0	0	PATEL, BINDI A	5/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	328 S CLOVERDALE AVE	APT 304	LOS ANGELES	CA	90036	6605	00	06000	34.068123	-118.346161	Los Angeles County
293186	Non-Physician Medical Practitioner	None	1841587037	0	0	PATEL, PRIYA P PA	7/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	00	06000	34.08060971	-117.9958001	Los Angeles County
293188	Non-Physician Medical Practitioner	None	1134625130	0	0	PONNURAJU, GIRIJA NP	8/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
293201	Non-Physician Medical Practitioner	None	1265969315	0	0	PINGOL, MICHAEL R	1/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5459 WILDSAGE PLACE	None	CHINO HILLS	CA	91709	8723	00	06000	33.96589398	-117.6857979	San Bernardino County
293206	Non-Physician Medical Practitioner	None	1417619818	0	0	PABAND, MASSOODA NP	10/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
293212	Non-Physician Medical Practitioner	None	1407368988	0	0	PALLARES, ANDREA C NP	11/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	# B10	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
293240	Non-Physician Medical Practitioner	None	1184963233	0	0	PILLAI, ANUPAMA R NP	4/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	637 N CAHUENGA BLVD	None	LOS ANGELES	CA	90004	1103	00	06000	34.08270899	-118.329072	Los Angeles County
293243	Non-Physician Medical Practitioner	None	1386078780	0	0	PACHECO, JENNIFER ELIZABETH	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	216 E PINE STREET	None	EXETER	CA	93221	1750	00	06000	36.2964192	-119.1405448	Tulare County
293265	Non-Physician Medical Practitioner	None	1336660141	0	0	PEDROZA, SARAH N PA-C	12/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 WEST LA VETA	STE 675	ORANGE	CA	92868	4308	00	06000	33.78028244	-117.8635552	Orange County
293293	Non-Physician Medical Practitioner	None	1831730944	0	0	PORTER, BRITTANY A PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	00	06000	32.8002375	-117.1546269	San Diego County
293300	Non-Physician Medical Practitioner	None	1215382874	0	0	PULIDO, NANCY NP	8/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
293304	Non-Physician Medical Practitioner	None	1275018210	0	0	PICKLER, PATTI J NP	11/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	805 LA VETA	STE 101	ORANGE	CA	98268	3901	00	06000	33.78064152	-117.8606475	Orange County
293322	Non-Physician Medical Practitioner	None	1326482068	0	0	PELAYO, TERRY L PA	5/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10185 VICTORIA DRIVE	None	REDDING	CA	96001	9409	00	06000	40.58373991	-122.4671774	Shasta County
293329	Non-Physician Medical Practitioner	None	1427073295	0	0	PIEROG, LINDA J NP	4/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	108 MONARCH BAY DRIVE	None	MONARCH BAY	CA	92629	3430	00	06000	33.48804729	-117.7316193	Orange County
293341	Non-Physician Medical Practitioner	None	1548681612	0	0	PELLEGRINI, ELIZABETH R PA-C	8/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	00	06000	33.84718298	-117.933758	Orange County
293352	Non-Physician Medical Practitioner	None	1598389124	0	0	PHILBIN, AMANDA PA	2/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4062 FLYING C RD	STE 41	CAMERON PARK	CA	95682	9664	00	06000	38.65476716	-120.9977643	El Dorado County
293358	Non-Physician Medical Practitioner	None	1679978274	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	6/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	715 TANK FARM RD	SUITE C	SAN LUIS OBISPO	CA	93401	7068	00	06000	35.24853234	-120.642458	San Luis Obispo County
293364	Non-Physician Medical Practitioner	None	1780248161	0	0	PADILLA, VERONICA PA-C	9/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
293396	Non-Physician Medical Practitioner	None	1023416948	0	0	PARIKH, NISHA S PA	4/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
293403	Non-Physician Medical Practitioner	None	1528691805	0	0	PAN, FRANCINE	12/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 S 1ST ST	None	ALHAMBRA	CA	91801	3893	00	06000	34.09192598	-118.1259775	Los Angeles County
293475	Non-Physician Medical Practitioner	None	1548713886	0	0	PATEL, APEXA PA-C	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
293534	Non-Physician Medical Practitioner	None	1104314327	0	0	PARKER, TAWANA	8/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293553	Non-Physician Medical Practitioner	None	1366193120	0	0	PHAM, ELIZABETH H NP	6/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10100 CULVER BLVD	STE E	CULVER CITY	CA	90232	3175	00	06000	34.01935201	-118.3979919	Los Angeles County
293555	Non-Physician Medical Practitioner	None	1700225174	0	0	POBLETE, RANDALL JOSEPH P PA	11/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
293565	Non-Physician Medical Practitioner	None	1639649239	0	0	PADILLA, KIMBERLY C NP	10/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
293630	Non-Physician Medical Practitioner	None	1558024570	0	0	PHAN, EUNICE JILL NP	6/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11420 WARNER AVE.	None	FOUNTAIN VALLEY	CA	92708	2529	00	06000	33.71633952	-117.929061	Orange County
293632	Non-Physician Medical Practitioner	None	1124749577	0	0	PEDRAM, MOJGAN PA-C	6/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
293638	Non-Physician Medical Practitioner	None	1295716629	0	0	PERALEZ, MARISELDA	7/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	387 CORRAL DE TIERRA RD	None	SALINAS	CA	93908	8917	00	06000	36.53028996	-121.7057176	Monterey County
293642	Non-Physician Medical Practitioner	None	1063514628	0	0	PETERSON, BRIDGET I	6/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	00	06000	34.22073847	-118.532988	Los Angeles County
293653	Non-Physician Medical Practitioner	None	1982232245	0	0	POSSANI, SADAF	6/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
293654	Non-Physician Medical Practitioner	None	1023106804	0	0	PITTMAN, THERESA V NP	9/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
293672	Non-Physician Medical Practitioner	None	1669776712	0	0	POSADAS, GRETA E	5/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3033 S BYRD CT	None	VISALIA	CA	93292	1744	00	06000	36.30205593	-119.2800456	Tulare County
293675	Non-Physician Medical Practitioner	None	1497229108	0	0	PARKER, KATELYN E PA-C	7/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
293679	Non-Physician Medical Practitioner	None	1629554936	0	0	PATTERSON, RAYSHA J NP	11/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
293686	Non-Physician Medical Practitioner	None	1619125200	0	0	POGUE, ANDREA	7/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1721 N WILMINGTON BLVD	None	WILMINGTON	CA	90744	1261	00	06000	33.79755756	-118.2753059	Los Angeles County
293721	Non-Physician Medical Practitioner	None	1235820283	0	0	PELAYO PALMER, KAREN J NP	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	00	06000	36.83939464	-119.6661479	Fresno County
293724	Non-Physician Medical Practitioner	None	1356018220	0	0	PEREZ, APRIL	6/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
293727	Non-Physician Medical Practitioner	None	1790902351	0	0	PERKINS, NATALIE A NP	4/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7602 VIOLA CT	None	FONTANA	CA	92336	3154	00	06000	34.11594389	-117.4695258	San Bernardino County
293747	Non-Physician Medical Practitioner	None	1306355839	0	0	PADDA, JASMINE NP	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
293760	Non-Physician Medical Practitioner	None	1417489717	0	0	PRICE, JESSICA M NP	5/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 SKYLINE DRIVE	None	MONTEREY	CA	93940	4110	00	06000	36.59323606	-121.9166669	Monterey County
293771	Non-Physician Medical Practitioner	None	1134374465	0	0	PONCE, CHERI L	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16352 S DEL REY AVE	None	KINGSBURG	CA	93631	9527	00	06000	36.49839166	-119.5930892	Fresno County
293781	Non-Physician Medical Practitioner	None	1427434455	0	0	PIERCE, BRITTANY A PA	1/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
293799	Non-Physician Medical Practitioner	None	1861859084	0	0	PEREZ, CRISTINA A NP	9/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2057 COMPTON AVE	STE 102	CORONA	CA	92881	3147	00	06000	33.84971564	-117.536168	Riverside County
293816	Non-Physician Medical Practitioner	None	1790705937	0	0	PHILLIPS, KIMBERLY R NP	12/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	363 SPANISH MOSS LN	None	ARROYO GRANDE	CA	93420	6613	00	06000	35.1328426	-120.5802978	San Luis Obispo County
293848	Non-Physician Medical Practitioner	None	1881460335	0	0	PATEL, SIMRAN PA	9/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
293850	Non-Physician Medical Practitioner	None	1093969115	0	0	PLANNED PARENTHOOD - LOS ANGELES S MARK TAPER FOR	10/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
293851	Non-Physician Medical Practitioner	None	1538799820	0	0	PHAM, DIANE Q NP	10/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	00	06000	33.67620851	-117.7948348	Orange County
293855	Non-Physician Medical Practitioner	None	1720267909	0	0	PROKOP, JANETTE	6/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
293924	Non-Physician Medical Practitioner	None	1760040422	0	0	PANGILINAN, LAWRENCE PA-C	5/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11436 GARVEY AVE	STE A, B	EL MONTE	CA	91732	3304	00	06000	34.06282769	-118.0281402	Los Angeles County
293931	Non-Physician Medical Practitioner	None	1356160493	0	0	POPE, IAN J PA-C	12/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
293971	Non-Physician Medical Practitioner	None	1114378114	0	0	PROAL, ASHLEY NP	1/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	00	06000	34.160805	-118.4487295	Los Angeles County
293973	Non-Physician Medical Practitioner	None	1114236064	0	0	PONDEXTER, DENIA E NP	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1387 WOODEN VALLEY ST	None	CHULA VISTA	CA	91913	2949	00	06000	32.62978084	-116.97384	San Diego County
294002	Non-Physician Medical Practitioner	None	1245013309	0	0	PHAM, KAREN PA-C	8/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 STONE BLVD	STE 190	WEST SACRAMENTO	CA	95691	4055	00	06000	38.56318049	-121.5379228	Yolo County
294018	Non-Physician Medical Practitioner	None	1699224170	0	0	PEARSON, PRESLEY PA	5/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18133 VENTURA BLVD	300 3RD FLOOR	TARZANA	CA	91356	3612	00	06000	34.1657808	-118.5283188	Los Angeles County
294019	Non-Physician Medical Practitioner	None	1194937920	0	0	POQUETTE, RITA M NP	1/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1630 BLAZING STAR DRIVE	None	HACIENDA HEIGHTS	CA	91745	3302	00	06000	34.00393677	-117.975894	Los Angeles County
294032	Non-Physician Medical Practitioner	None	1801268164	0	0	PORTER, CLIFFORD A	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8760 CENTER PARKWAY	APT 209	ELK GROVE	CA	95758	8442	00	06000	38.436741	-121.418613	Sacramento County
294044	Non-Physician Medical Practitioner	None	1225549439	0	0	PONCE, MAYRA S CNP	11/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2638 EAST FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	4708	00	06000	33.97407048	-118.2240182	Los Angeles County
294059	Non-Physician Medical Practitioner	None	1457808941	0	0	PATEL, RAVI S	1/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9802 STOCKDALE HWY	SUITE 105	BAKERSFIELD	CA	93311	3653	00	06000	35.3544067	-119.1113372	Kern County
294064	Non-Physician Medical Practitioner	None	1992014195	0	0	POGGIALI, LAURA B PA	6/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2068 JOHN JONES RD	None	DAVIS	CA	95616	9711	00	06000	38.56390812	-121.7690112	Yolo County
294111	Non-Physician Medical Practitioner	None	1558857359	0	0	PHAM, THUYVI T NP	11/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11382 MIDWICK PLACE	None	GARDEN GROVE	CA	92840	3462	00	06000	33.78281604	-117.9340866	Orange County
294114	Non-Physician Medical Practitioner	None	1497895775	0	0	PAULSEN, DONALD SCOTT	9/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3204 WYCLIFFE DR	None	MODESTO	CA	95355	4738	00	06000	37.6543255	-120.935493	Stanislaus County
294162	Non-Physician Medical Practitioner	None	1184731101	0	0	PATRICIA, FANN	6/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	0000	00	06000	34.129683	-117.970857	Los Angeles County
294175	Non-Physician Medical Practitioner	None	1992387088	0	0	PETERSON, PORSHA M NP	5/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	00	06000	34.52471945	-117.3042336	San Bernardino County
294242	Non-Physician Medical Practitioner	None	1679121750	0	0	PARNELL, TANIKA E NP	1/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
294289	Non-Physician Medical Practitioner	None	1245261494	0	0	PARKINSON, ROBERT D	5/10/1993	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 JASMINE ST	None	REDLAND	CA	92374	4920	00	06000	34.0693683	-117.1454012	San Bernardino County
294293	Non-Physician Medical Practitioner	None	1114141645	0	0	PILRAM, ALICE J NP	5/3/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	302 NIMITZ DR	UNIT B	SAN FRANCISCO	CA	94130	1524	00	06000	37.811403	-122.370984	San Francisco County
294309	Non-Physician Medical Practitioner	None	1558964767	0	0	PYDAH, SUNAYANA C PA	12/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
294329	Non-Physician Medical Practitioner	None	1285185397	0	0	PERIHAROS, ZACHARY	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	333 8TH STREET	None	BROOKLYN	NY	11215	3313	00	06000	40.669083	-73.984068	Kings County
294351	Non-Physician Medical Practitioner	None	1386791028	0	0	PELIO, DARREN A PA	3/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
294363	Non-Physician Medical Practitioner	None	1891245122	0	0	PHAM, RENEE PA-C	9/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
294365	Non-Physician Medical Practitioner	None	1548619034	0	0	PITTMAN, LATARSHA C NP	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	733 5TH ST	207	WEST SACRAMENTO	CA	95605	2692	00	06000	38.582856	-121.51188	Yolo County
294370	Non-Physician Medical Practitioner	None	1043594047	0	0	PABLA, SHARON K	6/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3016 GERMAN ST	None	FAIRFIELD	CA	94534	8320	00	06000	38.291028	-122.088003	Solano County
294387	Non-Physician Medical Practitioner	None	1255908265	0	0	PATEL, POOJA PA-C	8/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 E OCEAN AVE	STE B	LOMPOC	CA	93436	7096	00	06000	34.63888288	-120.4436487	Santa Barbara County
294392	Non-Physician Medical Practitioner	None	1184670762	0	0	PATHWAY MEDICAL GROUP, INC	6/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	#502-A	GARDEN GROVE	CA	92843	1901	00	06000	33.77450141	-117.9123364	Orange County
294424	Non-Physician Medical Practitioner	None	1578892626	0	0	PHELAN, DARCY	4/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	650 PARNASSUS AVE	MOFFITT HOSPITAL, BOX 01	SAN FRANCISCO	CA	94122	2621	00	06000	37.7627529	-122.4606191	San Francisco County
294433	Non-Physician Medical Practitioner	None	1083982995	0	0	PLONG, DONALD	1/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11215 LONG BEACH BLVD	None	LYNWOOD	CA	90262	4292	00	06000	33.92904942	-118.2112567	Los Angeles County
294458	Non-Physician Medical Practitioner	None	1457027211	0	0	PETRENKO, HANNAH L NP	10/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 N HARBOR BLVD	None	ANAHEIM	CA	92805	1810	00	06000	33.84310811	-117.92254	Orange County
294461	Non-Physician Medical Practitioner	None	1114703311	0	0	PANG, PAUL PA-C	12/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
294490	Non-Physician Medical Practitioner	None	1235568486	0	0	PUNG, NINA	12/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10168 DECIMA DR	None	WESTMINSTER	CA	92683	7048	00	06000	33.74094336	-117.9517494	Orange County
294510	Non-Physician Medical Practitioner	None	1124534920	0	0	PLASCHKE, SVITLANA NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
294512	Non-Physician Medical Practitioner	None	1659702611	0	0	POCOCK, KATHERINE R	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33203 BLUE FIN DRIVE	None	DANA POINT	CA	92629	1416	00	06000	33.48078353	-117.6873564	Orange County
294513	Non-Physician Medical Practitioner	None	1407202328	0	0	PIZZIFRED, TIFFINY S NP	10/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3432 MONO DR	None	RIVERSIDE	CA	92506	2117	00	06000	33.95522166	-117.3841683	Riverside County
294565	Non-Physician Medical Practitioner	None	1982787826	0	0	PENULIAR, ESTELEI A NP	8/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21817 FOLEY AVE	None	CARSON	CA	90745	3428	00	06000	33.829596	-118.255787	Los Angeles County
294570	Non-Physician Medical Practitioner	None	1902109580	0	0	PLANNED PARENTHOOD ANTELOPE VALLEY CLINIC	1/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	533 E PALMDALE BVLD	SUITE 533 A1	PALMDALE	CA	93550	2375	00	06000	34.5796702	-118.1198284	Los Angeles County
294592	Non-Physician Medical Practitioner	None	1578939013	0	0	PARR, BRANDI NP	7/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
294600	Non-Physician Medical Practitioner	None	1609112267	0	0	PARKYN, JESSICA S PA	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294624	Non-Physician Medical Practitioner	None	1982198263	0	0	PERRY, LINDSEY	12/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
294627	Non-Physician Medical Practitioner	None	1447370697	0	0	PHILLIPS, CHERI PA	2/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
294662	Non-Physician Medical Practitioner	None	1104133958	0	0	PENA, MICHELE	10/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLZ	SUITE 365-C1	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
294672	Non-Physician Medical Practitioner	None	1942361027	0	0	PAYNE, AMBER PA-C	2/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
294703	Non-Physician Medical Practitioner	None	1093393951	0	0	POLO, ANDREA M	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
294735	Non-Physician Medical Practitioner	None	1275196081	0	0	PIAMONTE, JEREMI JOHN L NP	8/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
294757	Non-Physician Medical Practitioner	None	1154455814	0	0	PALASKI, DEBORAH	5/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 AMGEN CENTER DR	OCCUPATIONAL HEALTH, BLD	THOUSAND OAKS	CA	91320	1730	00	06000	34.19176783	-118.9196187	Ventura County
294759	Non-Physician Medical Practitioner	None	1952771990	0	0	PARISH, ASHLEY M	11/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	943 E SYCAMORE AVE	None	TULARE	CA	93274	4428	00	06000	36.21036661	-119.3343889	Tulare County
294761	Non-Physician Medical Practitioner	None	1770533069	0	0	PFEFFER, ANDREA	10/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	None	OAKLAND	CA	94609	3425	00	06000	37.81892183	-122.2640154	Alameda County
294776	Non-Physician Medical Practitioner	None	1073672788	0	0	PATTERSON, JAMES P	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16017 WHITESPRING DR	None	WHITTIER	CA	90604	3751	00	06000	33.92282235	-117.990094	Los Angeles County
294793	Non-Physician Medical Practitioner	None	1134301716	0	0	PEREZ, FRANK J	8/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 W SAINT ANDREWS AVE	None	LA HABRA	CA	90631	2029	00	06000	33.9071915	-117.9502128	Orange County
294801	Non-Physician Medical Practitioner	None	1760196851	0	0	PACHECO, MITZY G NP	2/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1590 SOUTH IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	00	06000	32.77950118	-115.5697279	Imperial County
294810	Non-Physician Medical Practitioner	None	1427589738	0	0	PATEL, SACHI PA	12/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	106 LA CASA VIA	SUITE 140	WALNUT CREEK	CA	94598	3084	00	06000	37.91255783	-122.0428047	Contra Costa County
294834	Non-Physician Medical Practitioner	None	1003526187	0	0	PHAM, RENEE T NP	1/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	00	06000	33.91745451	-117.9133065	Orange County
294926	Non-Physician Medical Practitioner	None	1649788514	0	0	PALMER, TRICIA L	12/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
294934	Non-Physician Medical Practitioner	None	1316375744	0	0	PORTES, PEDRO NP	1/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	248 FARMINGTON CIR	None	ROSEVILLE	CA	95678	5905	00	06000	38.77464277	-121.3026332	Placer County
294940	Non-Physician Medical Practitioner	None	1205328317	0	0	POON, LALITA NP	6/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44-419 TOWN CENTER WAY	STE E	PALM DESERT	CA	92260	7100	00	06000	33.72583102	-116.398368	Riverside County
294943	Non-Physician Medical Practitioner	None	1417155920	0	0	POLEGA, KRISTIN	10/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	436 N BEDFORD DR	SUITE 103	BEVERLY HILLS	CA	90210	4310	00	06000	34.0685329	-118.4056227	Los Angeles County
294953	Non-Physician Medical Practitioner	None	1871620724	0	0	PURPORA, SHERRI L	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1177 N PARK AVE	None	POMONA	CA	91768	3028	00	06000	34.06950662	-117.7549507	Los Angeles County
294974	Non-Physician Medical Practitioner	None	1528297157	0	0	PAMELA, ANTIQUERA	7/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
294998	Non-Physician Medical Practitioner	None	1972176345	0	0	PORTE-GARCIA, MICHELLE V NP	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7115 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0361	00	06000	36.83977368	-119.7366985	Fresno County
295045	Non-Physician Medical Practitioner	None	1700631934	0	0	PATINO, CECILIA NP	10/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8628 RESEDA BLVD.	None	NORTHRIDGE	CA	91324	4032	00	06000	34.22722956	-118.5360495	Los Angeles County
295067	Non-Physician Medical Practitioner	None	1326870510	0	0	PETTEK, TAYLOR J	9/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295074	Non-Physician Medical Practitioner	None	1013319821	0	0	PISHEH, LEILA C NP	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8151 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2300	00	06000	38.461554	-121.4167635	Sacramento County
295106	Non-Physician Medical Practitioner	None	1225506397	0	0	PETERSON, LARISSA NP	5/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
295109	Non-Physician Medical Practitioner	None	1093706392	0	0	PAOLINETTI, LAURI ANN	1/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
295123	Non-Physician Medical Practitioner	None	1306958632	0	0	PATEL, NUTAN J	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 MOLINO AVE	SUITE 202	LONG BEACH	CA	90803	5784	00	06000	33.76718008	-118.1605782	Los Angeles County
295127	Non-Physician Medical Practitioner	None	1093866543	0	0	PICAZO, JUDY A NP	5/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7814 E MENTON AVE	None	ANAHEIM	CA	92808	1556	00	06000	33.85168076	-117.7431504	Orange County
295138	Non-Physician Medical Practitioner	None	1376852335	0	0	PRADO, ADELENE C NP	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SANTA MONICA BLVD	SUITE 550, 5TH FLOOR	SANTA MONICA	CA	90404	2023	00	06000	34.02901811	-118.4795396	Los Angeles County
295145	Non-Physician Medical Practitioner	None	1336852680	0	0	PHAM, THUY-VY D NP	1/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	00	06000	33.95782448	-117.3904065	Riverside County
295161	Non-Physician Medical Practitioner	None	1124566724	0	0	PADILLA, ROGGIELYZ Y NP	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23517 MAIN ST	SUITE 103	CARSON	CA	90745	5234	00	06000	33.81129174	-118.2756933	Los Angeles County
295197	Non-Physician Medical Practitioner	None	1205106200	0	0	PAPPADEMOS, MARGARETHE SATTVA	2/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 E PLAZA DRIVE	SUITE 200	SANTA MARIA	CA	93454	6954	00	06000	34.9373822	-120.4296004	Santa Barbara County
295212	Non-Physician Medical Practitioner	None	1962992693	0	0	PHAM, HELEN PA-C	5/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
295232	Non-Physician Medical Practitioner	None	1427501162	0	0	PATEL, ASHISH A NP	2/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
295278	Non-Physician Medical Practitioner	None	1205263456	0	0	PILLSBURY, NICOLE M	5/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	102 WALLACE HILL RD	None	TOWSEND	MA	01469	1159	00	06000	42.663024	-71.6688225	Middlesex County
295311	Non-Physician Medical Practitioner	None	1700214673	0	0	PAULLUS, JEFFREY R	1/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26532 DOMINGO DRIVE	None	MISSION VIEJO	CA	92692	4113	00	06000	33.577189	-117.646402	Orange County
295312	Non-Physician Medical Practitioner	None	1083952147	0	0	PENHALLURICK, TIFFANY R	1/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10927 RAGSDALE RD	None	LOMA LINDA	CA	92354	6546	00	06000	34.05528349	-117.2399905	San Bernardino County
295319	Non-Physician Medical Practitioner	None	1891937652	0	0	PAMPALONE, INGRID ZINA	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 LA CASA VIA	135	WALNUT CREEK	CA	94598	3091	00	06000	37.91229899	-122.0423696	Contra Costa County
295323	Non-Physician Medical Practitioner	None	1710512124	0	0	PATEL, MAMATABEN S NP	4/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27212 CALAROGA AVENUE	None	HAYWARD	CA	94545	4339	00	06000	37.63229023	-122.0896425	Alameda County
295365	Non-Physician Medical Practitioner	None	1396865333	0	0	PINEDA, HECTOR NARCISO	3/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15718 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	4352	00	06000	33.8904	-118.1600135	Los Angeles County
295393	Non-Physician Medical Practitioner	None	1407198658	0	0	PINEDA, CHRISTINA H NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
295396	Non-Physician Medical Practitioner	None	1821865171	0	0	PEREZ-RIOS, ERNESTO	8/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
295398	Non-Physician Medical Practitioner	None	1588780738	0	0	PHAM, CHRIS C	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24388 NAN CT	None	DIAMOND BAR	CA	91765	4387	00	06000	34.00498461	-117.7871618	Los Angeles County
295420	Non-Physician Medical Practitioner	None	1245682194	0	0	PAYNE, AUDREY E PA-C	12/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
295427	Non-Physician Medical Practitioner	None	1164054383	0	0	PERFECT, ZAHRA H NP	6/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	00	06000	34.39750589	-118.552072	Los Angeles County
295450	Non-Physician Medical Practitioner	None	1386934875	0	0	PEDIATRIC & FAMILY MEDICAL CENTER	6/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	3048	00	06000	34.03692236	-118.2655238	Los Angeles County
295452	Non-Physician Medical Practitioner	None	1265094684	0	0	PADDOCK, PATRICIA C NP	7/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	00	06000	39.71601447	-121.790817	Butte County
295465	Non-Physician Medical Practitioner	None	1811914906	0	0	PERLO, REBECCA B PA-C	8/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295477	Non-Physician Medical Practitioner	None	1336216696	0	0	PIERSON-BROWN, LEIGH NP	12/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
295479	Non-Physician Medical Practitioner	None	1881259406	0	0	PEREZ, VANESSA A NP	2/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
295500	Non-Physician Medical Practitioner	None	1164905956	0	0	PHAN, TRAM G NP	10/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	69844 HWY 111	STE A AND B	RANCHO MIRAGE	CA	92270	2849	00	06000	33.76988393	-116.4463473	Riverside County
295517	Non-Physician Medical Practitioner	None	1689991770	0	0	PERRY, TINA	7/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7075 N. MAPLE	STE. 102	FRESNO	CA	93720	0000	00	06000	36.83873854	-119.7453219	Fresno County
295593	Non-Physician Medical Practitioner	None	1376629493	0	0	PEREZ, KELLY PA-C	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	00	06000	35.356392	-119.092153	Kern County
295635	Non-Physician Medical Practitioner	None	1528399250	0	0	PEERY, DENNIS S PA-C	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	SUITE W201	PALM SPRINGS	CA	92262	4876	00	06000	33.839505	-116.5455735	Riverside County
295640	Non-Physician Medical Practitioner	None	1013003706	0	0	PETROSIAN, NOUNE PA	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5150 N 6TH ST	STE 100	FRESNO	CA	93710	7505	00	06000	36.81127498	-119.7632093	Fresno County
295680	Non-Physician Medical Practitioner	None	1871530931	0	0	PASTOR, FRANK	5/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
295719	Non-Physician Medical Practitioner	None	1528351814	0	0	PUCCINI, JOHN A PA-C	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
295720	Non-Physician Medical Practitioner	None	1073548079	0	0	PARIS, DAVID M	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5656 KELLEY ST	None	HOUSTON	TX	77026	1967	00	06000	29.810349	-95.310846	Harris County
295731	Non-Physician Medical Practitioner	None	1285132175	0	0	PLUVIOSE, GERDY M NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
295739	Non-Physician Medical Practitioner	None	1407036536	0	0	PERSON, RICHARD B	2/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	881 CAMINO DEL SOL	None	RIVERSIDE	CA	92508	6098	00	06000	33.91349151	-117.315792	Riverside County
295781	Non-Physician Medical Practitioner	None	1578097598	0	0	PALIGUTAN, ROGER NP	2/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	00	06000	35.36876049	-119.0948805	Kern County
295881	Non-Physician Medical Practitioner	None	1770294761	0	0	PARKER, OLIVIA M PA	10/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
295884	Non-Physician Medical Practitioner	None	1376144543	0	0	PERONEY, BRANDI M NP	12/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	00	06000	38.443806	-122.701374	Sonoma County
295920	Non-Physician Medical Practitioner	None	1386699437	0	0	PARKS, ELVIRA RUIZ	7/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	0000	00	06000	37.36217918	-121.8472051	Santa Clara County
295983	Non-Physician Medical Practitioner	None	1649728999	0	0	PEDERSEN, ASHZRA D NP	10/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4663 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3943	00	06000	37.04973619	-122.0157773	Santa Cruz County
295994	Non-Physician Medical Practitioner	None	1639145386	0	0	PRYOR, DONNA L PA	3/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1324 NELSON AVE	STE B	MODESTO	CA	95350	5374	00	06000	37.66254751	-120.9881942	Stanislaus County
296006	Non-Physician Medical Practitioner	None	1588606404	0	0	PRENTICE, HOLLY D PA-C	7/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
296017	Non-Physician Medical Practitioner	None	1215371307	0	0	PAVLIK, KATHERINE N	8/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	535 S LOS ROBLES	APT 8	PASADENA	CA	91101	3238	00	06000	34.13665361	-118.1413614	Los Angeles County
296019	Non-Physician Medical Practitioner	None	1174849905	0	0	PONCE, SARA R NP	5/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
296026	Non-Physician Medical Practitioner	None	1740380583	0	0	POKORNEY, SABINA	11/4/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	00	06000	38.74399612	-121.2349547	Placer County
296035	Non-Physician Medical Practitioner	None	1437664729	0	0	PRITTING, ROSANNA S NP	3/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 W LEGION ROAD	STE 105	BRAWLEY	CA	92227	7754	00	06000	32.95996012	-115.5538196	Imperial County
296036	Non-Physician Medical Practitioner	None	1972870095	0	0	PAK, DARIYA	9/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18080 IMPERIAL HWY	None	YORBA LINDA	CA	92886	3436	00	06000	33.89287302	-117.8194305	Orange County
296048	Non-Physician Medical Practitioner	None	1366770950	0	0	PISON, TISHA N NP	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18019 CECELIA PL	None	CERRITOS	CA	90703	8715	00	06000	33.86761552	-118.0494631	Los Angeles County
296050	Non-Physician Medical Practitioner	None	1619639788	0	0	POINT DU JOUR, HARRY	10/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
296056	Non-Physician Medical Practitioner	None	1700402773	0	0	POON, VINCENT PA	10/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296068	Non-Physician Medical Practitioner	None	1194895318	0	0	PIERCE, PATRICIA NICOLE	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3975 OLD REDWOOD HWY	MOB 5 - SUITE 152	SANTA ROSA	CA	95403	1719	00	06000	38.484045	-122.7376395	Sonoma County
296087	Non-Physician Medical Practitioner	None	1649239385	0	0	PATRIKEYEV, YEGOR V	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
296104	Non-Physician Medical Practitioner	None	1447647862	0	0	PINDER, ELAINE M NP	10/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8537 CUMULUS WAY	None	ORANGEVALE	CA	95662	3906	00	06000	38.681757	-121.2406875	Sacramento County
296116	Non-Physician Medical Practitioner	None	1184953127	0	0	PEREZ, RUTH NP	5/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
296122	Non-Physician Medical Practitioner	None	1801147707	0	0	PLANNED PARENTHOOD SHASTA DIABLO INC	3/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14671 OLYMPIC DR	None	CLEARLAKE	CA	95422	9516	00	06000	38.9618304	-122.6382453	Lake County
296141	Non-Physician Medical Practitioner	None	1356095269	0	0	PEZESHKIAN, MEAGAN M PA-C	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1211 W LA PALMA AVE	STE 505	ANAHEIM	CA	92801	2812	00	06000	33.84718298	-117.933758	Orange County
296144	Non-Physician Medical Practitioner	None	1063496651	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	3/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	00	06000	34.96327701	-120.4368111	Santa Barbara County
296146	Non-Physician Medical Practitioner	None	1720468804	0	0	PEDIATRIC AND FAMILY MEDICAL CENTER	7/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1513 S GRAND AVE	SUITE 220 & 250	LOS ANGELES	CA	90015	3070	00	06000	34.03596303	-118.266212	Los Angeles County
296164	Non-Physician Medical Practitioner	None	1235839168	0	0	PHELPS, HEATHER M NP	4/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
296166	Non-Physician Medical Practitioner	None	1194172361	0	0	PRIBAC, ANDREA NP	2/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296180	Non-Physician Medical Practitioner	None	1881164051	0	0	PARK, JULIA E PA-C	3/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
296188	Non-Physician Medical Practitioner	None	1912952086	0	0	PURVIS, TIFFANY A	9/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296211	Non-Physician Medical Practitioner	None	1730274374	0	0	PERLMAN, TAMARA LEE	6/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1871 SE TIFFANY AVE	SUITE 200	PORT SAINT LUCIE	FL	34952	7585	00	06000	27.29141618	-80.29435693	St. Lucie County
296212	Non-Physician Medical Practitioner	None	1073230793	0	0	PARNASO, WILMA V NP	8/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2455 SAND CREEK RD	STE 144	BRENTWOOD	CA	94513	7176	00	06000	37.94689155	-121.7370896	Contra Costa County
296213	Non-Physician Medical Practitioner	None	1770026684	0	0	POWELSON-ORR, GLENDA M NP	1/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4025 DARWIN AVE	None	BAKERSFIELD	CA	93306	2102	00	06000	35.40139646	-118.9475646	Kern County
296225	Non-Physician Medical Practitioner	None	1265080949	0	0	PADILLA ARECHIGA, MAYRA L NP	5/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4022 CHICAGO AVE	None	RIVERSIDE	CA	92507	5340	00	06000	33.97369354	-117.3484788	Riverside County
296228	Non-Physician Medical Practitioner	None	1942859798	0	0	PATRICK-CALVILLO, STEPHANIE A NP	4/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	00	06000	33.6526055	-117.910746	Orange County
296237	Non-Physician Medical Practitioner	None	1871062380	0	0	PYLE, LORNA A NP	12/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
296239	Non-Physician Medical Practitioner	None	1437591674	0	0	PAIK, SAMUEL	1/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5606 RIVER WAY DR	APT C	BUENA PARK	CA	90621	1763	00	06000	33.88104497	-117.9970004	Orange County
296243	Non-Physician Medical Practitioner	None	1518148873	0	0	PACE, TIMOTHY W	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3342 BOPEG RD	None	CANTONMENT	FL	32533	7014	00	06000	30.66301741	-87.35441012	Escambia County
296264	Non-Physician Medical Practitioner	None	1851024244	0	0	POTH, DANIELLE PA	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
296265	Non-Physician Medical Practitioner	None	1518486133	0	0	PAXSON, COURTNEY M	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	20113 W CARENDON AVE	None	BUCKEYE	AZ	85396	8415	00	06000	33.489216	-112.4924355	Maricopa County
296266	Non-Physician Medical Practitioner	None	1326360827	0	0	PASCUAL, JANHEEN TRIAS	3/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 BROADWAY ST	PAVILION A	REDWOOD CITY	CA	94063	3132	00	06000	37.48523183	-122.2025998	San Mateo County
296284	Non-Physician Medical Practitioner	None	1821311804	0	0	PARKER, ANDREA L	11/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4851 KOKOMO DR	APT 7211	SACRAMENTO	CA	95835	1845	00	06000	38.659707	-121.5252	Sacramento County
296332	Non-Physician Medical Practitioner	None	1053637942	0	0	PONGRACZ, BRIAN A NP	2/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
296333	Non-Physician Medical Practitioner	None	1164588026	0	0	P, BERNARDO D	9/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	JOHN DEMPSEY HOSPITAL	263 FARMINGTON AVENUE, M	FARMINGTON	CT	06030	0001	00	06000	41.73199512	-72.79046215	Capitol
296342	Non-Physician Medical Practitioner	None	1891196697	0	0	PARKER, DANITA PA-C	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
296350	Non-Physician Medical Practitioner	None	1619100278	0	0	PEREYRA, ASHLEY M	11/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7740 ATHERTON CT	None	RANCHO CUCAMONGA	CA	91730	2919	00	06000	34.11330568	-117.5929571	San Bernardino County
296360	Non-Physician Medical Practitioner	None	1306574603	0	0	PISANO, TAYLOR K	5/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	00	06000	36.97734512	-122.0204895	Santa Cruz County
296380	Non-Physician Medical Practitioner	None	1811454135	0	0	PENA, SUZANNE F NP	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 MERCY AVENUE	None	MERCED	CA	95340	8319	00	06000	37.33875148	-120.467457	Merced County
296393	Non-Physician Medical Practitioner	None	1689769671	0	0	PATLOVE, SILAS M	6/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	424 AVON STREET	APT 3	OAKLAND	CA	94618	1069	00	06000	37.83754763	-122.2585071	Alameda County
296396	Non-Physician Medical Practitioner	None	1699907428	0	0	POON, KITTY I K NP	11/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12453 NEWPORT COURT	None	SARATOGA	CA	95070	3328	00	06000	37.28754085	-122.0177391	Santa Clara County
296421	Non-Physician Medical Practitioner	None	1053468959	0	0	PIERSON, LINDA M	10/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	520 MEDICAL CENTER DRIVE	STE 200	MEDFORD	OR	97504	4314	00	06000	42.318801	-122.831728	Jackson County
296494	Non-Physician Medical Practitioner	None	1538248034	0	0	PARSON, MARGOLO NP	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	00	06000	38.56097929	-121.7800614	Yolo County
296506	Non-Physician Medical Practitioner	None	1750598603	0	0	PEARSON, DENISE RENEE	12/31/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6969 MEADOW WOOD TRL	None	REDDING	CA	96001	5339	00	06000	40.5146645	-122.370441	Shasta County
296541	Non-Physician Medical Practitioner	None	1417037912	0	0	PASQUARELLO, DIANA L	7/19/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 E 2ND AVE	None	ESCONDIDO	CA	92025	4212	00	06000	33.12175817	-117.0787555	San Diego County
296549	Non-Physician Medical Practitioner	None	1679024731	0	0	POSADAS, JOSETTE A	7/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14161 AGAVE STREET	None	MORENO VALLEY	CA	92553	4477	00	06000	33.91485568	-117.2236184	Riverside County
296562	Non-Physician Medical Practitioner	None	1396386124	0	0	PATEL, MEERA NP	1/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
296566	Non-Physician Medical Practitioner	None	1891959300	0	0	PORTILLO, EILDA	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1688 AZALEA ST	None	KINGSBURG	CA	93631	1342	00	06000	36.5345445	-119.5492995	Fresno County
296569	Non-Physician Medical Practitioner	None	1760902696	0	0	PACE, BRADLEY B	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1505 42ND AVE	NUMBER 26	CAPITOLA	CA	95010	3022	00	06000	36.97266161	-121.9623485	Santa Cruz County
296632	Non-Physician Medical Practitioner	None	1750723011	0	0	PIERSANTE, TRACY L NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5044 MAMMOTH AVENUE	None	SHERMAN OAKS	CA	91423	1322	00	06000	34.16250759	-118.4324144	Los Angeles County
296642	Non-Physician Medical Practitioner	None	1528213543	0	0	POWELL, HILARY R	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
296645	Non-Physician Medical Practitioner	None	1538543046	0	0	PAYAN-HERNANDEZ, CARMEN R NP	9/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13 W GRAND AVE	None	ALHAMBRA	CA	91801	2465	00	06000	34.09879664	-118.130227	Los Angeles County
296649	Non-Physician Medical Practitioner	None	1679123111	0	0	PRESMANES, EMILY K PA-C	1/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	00	06000	34.0653985	-118.3769177	Los Angeles County
296685	Non-Physician Medical Practitioner	None	1912568684	0	0	PADILLA, MARIAN B PA-C	9/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	00	06000	36.98692657	-121.9685264	Santa Cruz County
296725	Non-Physician Medical Practitioner	None	1306387055	0	0	PATRONETE, SARAH M NP	5/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3472 AMARILLO AVE	None	SIMI VALLEY	CA	93063	1206	00	06000	34.29792059	-118.7057214	Ventura County
296765	Non-Physician Medical Practitioner	None	1710352083	0	0	PERRY, DANIEL PA-C	6/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 N MILLER ST	STE C	SANTA MARIA	CA	93454	4557	00	06000	34.95397114	-120.4314387	Santa Barbara County
296825	Non-Physician Medical Practitioner	None	1699716548	0	0	PELE, CELINE THERESA	3/4/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2424 BOLIER AVENUE	None	MCKINLEYVILLE	CA	95519	3307	00	06000	40.94943901	-124.1201665	Humboldt County
296850	Non-Physician Medical Practitioner	None	1740965383	0	0	PROMPRADIT, ELI PA	7/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	00	06000	35.37519935	-119.0425415	Kern County
296876	Non-Physician Medical Practitioner	None	1962700682	0	0	PERRYMAN, SCOTT JACOB	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
296890	Non-Physician Medical Practitioner	None	1174759583	0	0	PLANNED PARENTHOOD LOS ANGELES-LAKEWOOD CENTER BAS	11/18/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5519 DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	00	06000	33.8471395	-118.1244195	Los Angeles County
296925	Non-Physician Medical Practitioner	None	1407969835	0	0	PROKSEL, MARI S	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1024 MAGGIE LANE	None	NIPOMO	CA	93444	6662	00	06000	35.03408567	-120.5401763	San Luis Obispo County
296966	Non-Physician Medical Practitioner	None	1447208665	0	0	PRICE, HEATHER PA	11/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 GREENLEY RD	None	SONORA	CA	95370	4685	00	06000	37.97749352	-120.3700335	Tuolumne County
296984	Non-Physician Medical Practitioner	None	1134875180	0	0	PATEL, MANSI NP	9/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
296987	Non-Physician Medical Practitioner	None	1629603667	0	0	PRAKASH, AVINESH NP	1/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
297013	Non-Physician Medical Practitioner	None	1801949524	0	0	PUZON, DONNA MARIA	8/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	00	06000	37.67984327	-122.4730264	San Mateo County
297034	Non-Physician Medical Practitioner	None	1225413636	0	0	PERRY, LAUREN N NP	8/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	174 N CAROLINA AVE	None	CLOVIS	CA	93611	7029	00	06000	36.83333001	-119.6646216	Fresno County
297078	Non-Physician Medical Practitioner	None	1629181524	0	0	PEACOCK, CHRISTA M NP	11/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1025 MALLET CT	APT 2	MENLO PARK	CA	94025	5152	00	06000	37.4454512	-122.1830523	San Mateo County
297098	Non-Physician Medical Practitioner	None	1710422274	0	0	PEANASKY, KRISTEN E	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1183 POLK AVE	None	SUNNYVALE	CA	94086	7338	00	06000	37.37784303	-122.0540544	Santa Clara County
297100	Non-Physician Medical Practitioner	None	1003159526	0	0	PONG, TIFFANY	6/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	3RD FLOOR, SUITE 311	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
297103	Non-Physician Medical Practitioner	None	1780691816	0	0	PELLERIN, MICHELLE	1/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3631 BREAKWATER DRIVE	None	LAKE HAVASU CITY	AZ	86406	6453	00	06000	34.487181	-114.277626	Mohave County
297114	Non-Physician Medical Practitioner	None	1508173584	0	0	PETERS, MIRANDA C	1/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 OTIS AVE	None	WOODSIDE	CA	94062	3532	00	06000	37.43729614	-122.2565981	San Mateo County
297120	Non-Physician Medical Practitioner	None	1790975969	0	0	PERISHO, KARLA M NP	4/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	00	06000	33.33904622	-118.3307237	Los Angeles County
297122	Non-Physician Medical Practitioner	None	1851932594	0	0	POLLACK, SOPHIE F PA-C	1/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
297137	Non-Physician Medical Practitioner	None	1730644527	0	0	PHAM, EMILY PA	11/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
297188	Non-Physician Medical Practitioner	None	1659916195	0	0	PASCHALL, KEVIN L PA-C	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
297195	Non-Physician Medical Practitioner	None	1710471289	0	0	PEDLEY, BRETT M	10/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10894 TOWNSHIP ROAD	None	BROWNS VALLEY	CA	95918	9621	00	06000	39.2759873	-121.3523302	Yuba County
297206	Non-Physician Medical Practitioner	None	1144775719	0	0	PARKER, KIZZY M NP	9/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
297217	Non-Physician Medical Practitioner	None	1629019310	0	0	PAPA, STEPHEN FRANCIS	5/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2155 W ORANGE GROVE RD	None	TUCSON	AZ	85741	3118	00	06000	32.322537	-111.0133845	Pima County
297221	Non-Physician Medical Practitioner	None	1437910346	0	0	PATEL, DIVYA	4/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	00	06000	37.66975543	-120.9724048	Stanislaus County
297239	Non-Physician Medical Practitioner	None	1992002570	0	0	PENNINGTON, MACKENZIE L	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4253 REDLINE DR	None	LAKEWOOD	CA	90713	3332	00	06000	33.83540459	-118.0954334	Los Angeles County
297241	Non-Physician Medical Practitioner	None	1033914916	0	0	PATEL, SARINA PA	4/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
297248	Non-Physician Medical Practitioner	None	1265213375	0	0	PETERS, COSETTE	10/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
297268	Non-Physician Medical Practitioner	None	1053734061	0	0	PERALEJO, ANGELICA M	10/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10555 N PIERPONT CIRCLE	None	FRESNO	CA	93730	4534	00	06000	36.88431613	-119.7507163	Fresno County
297296	Non-Physician Medical Practitioner	None	1629788302	0	0	PATEL, NEELAM PA-C	6/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
297299	Non-Physician Medical Practitioner	None	1285306043	0	0	PIPER, SHEY M PA-C	11/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11815 EDUCATION ST	None	AUBURN	CA	95602	2410	00	06000	38.94431878	-121.1009419	Placer County
297309	Non-Physician Medical Practitioner	None	1386378842	0	0	PEZZINI, SCOTT	10/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
297321	Non-Physician Medical Practitioner	None	1518906494	0	0	PINKS, JANINE	1/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
297349	Non-Physician Medical Practitioner	None	1902544729	0	0	PATTON, EMMA K PA	10/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
297368	Non-Physician Medical Practitioner	None	1497421747	0	0	PENG, PETER P PA-C	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
297377	Non-Physician Medical Practitioner	None	1265099030	0	0	PHILLIPS, CHRISTOPHER A NP	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	00	06000	38.56097929	-121.7800614	Yolo County
297460	Non-Physician Medical Practitioner	None	1407322373	0	0	POYNTZ, ERICA M NP	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	878 EL CAPITAN WAY	None	SAN LUIS OBISPO	CA	93401	7943	00	06000	35.24734412	-120.6401104	San Luis Obispo County
297467	Non-Physician Medical Practitioner	None	1891142170	0	0	PRESTON, KRISTINA L PA-C	8/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	00	06000	33.66214655	-117.6532809	Orange County
297471	Non-Physician Medical Practitioner	None	1285820985	0	0	PRASLIN, TEOBALDO	4/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3410 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	00	06000	34.02760053	-118.2006123	Los Angeles County
297492	Non-Physician Medical Practitioner	None	1225119621	0	0	PETERSON, BRIAN JARED	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6645 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	00	06000	32.7772577	-117.0575222	San Diego County
297494	Non-Physician Medical Practitioner	None	1922497510	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	8/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 BAYVIEW HEIGHTS DR	SUITE G	LOS OSOS	CA	93402	3921	00	06000	35.31038553	-120.8334714	San Luis Obispo County
297561	Non-Physician Medical Practitioner	None	1871182626	0	0	PHILLIPS, MORGEN D PA-C	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
297590	Non-Physician Medical Practitioner	None	1679030274	0	0	PASHLEY, ALEXANDRA N PA-C	6/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
297603	Non-Physician Medical Practitioner	None	1790202778	0	0	PAILLE, REMY A NP	3/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	00	06000	36.962588	-122.0439201	Santa Cruz County
297667	Non-Physician Medical Practitioner	None	1942960851	0	0	PAL, PREETI NP	5/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3933 COFFEE RD	STE A	BAKERSFIELD	CA	93308	5024	00	06000	35.395335	-119.092336	Kern County
297672	Non-Physician Medical Practitioner	None	1679036644	0	0	POLLEY, INDYANA PA-C	8/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
297681	Non-Physician Medical Practitioner	None	1023759842	0	0	PIMENTEL, SABRINA M PA	8/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
297689	Non-Physician Medical Practitioner	None	1134492051	0	0	PALOMIQUE, JUVELYN	12/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	SUITE 1060 WEST	LOS ANGELES	CA	90048	6101	00	06000	34.07361928	-118.3803143	Los Angeles County
297712	Non-Physician Medical Practitioner	None	1417211426	0	0	POMONA COMMUNITY HEALTH CENTER	6/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
297745	Non-Physician Medical Practitioner	None	1447729736	0	0	PFEIFFER, JOSHUA J PA-C	10/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
297761	Non-Physician Medical Practitioner	None	1740235977	0	0	PARK, MICHAEL C	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23371 LA COSTA COURT	None	AUBURN	CA	95602	8352	00	06000	39.04226185	-121.0703101	Nevada County
297763	Non-Physician Medical Practitioner	None	1891011078	0	0	PODSADA, KIMBERLY	6/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9000	00	06000	32.7537975	-117.1658298	San Diego County
297774	Non-Physician Medical Practitioner	None	1447725114	0	0	PAPPAS, CHLOE N PA	2/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
297781	Non-Physician Medical Practitioner	None	1346616745	0	0	PARK, MICHELLE M NP	8/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3121 KNIGHTS BRIDGE ROAD	None	SAN JOSE	CA	95132	1734	00	06000	37.40748478	-121.8607039	Santa Clara County
297789	Non-Physician Medical Practitioner	None	1346363330	0	0	PAIROT, KETSADA NP	5/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
297791	Non-Physician Medical Practitioner	None	1144370792	0	0	POTRA-CIONCA, FLORICA	6/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1125 N MAGNOLIA AVE	None	ANAHEIM	CA	92801	2638	00	06000	33.847875	-117.9761765	Orange County
297796	Non-Physician Medical Practitioner	None	1770664674	0	0	PATANE, MICHAEL G PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
297802	Non-Physician Medical Practitioner	None	1679990618	0	0	PUNSALAN, LORELEI D NP	4/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8907 CONEY ISLAND DR	None	BAKERSFIELD	CA	93311	8800	00	06000	35.30193426	-119.101807	Kern County
297828	Non-Physician Medical Practitioner	None	1336117480	0	0	PEBBLES, MAISA A	9/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
297875	Non-Physician Medical Practitioner	None	1376795914	0	0	PILKINGTON, STEPHANIE NP	9/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	198 COHASSET RD	None	CHICO	CA	95926	2202	00	06000	39.75140931	-121.8541188	Butte County
297883	Non-Physician Medical Practitioner	None	1194052456	0	0	PHELPS, TISHA Y	9/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	807 STONERIDGE CIR	None	FAIRFIELD	CA	94534	7404	00	06000	38.18874588	-122.1387187	Solano County
297901	Non-Physician Medical Practitioner	None	1457902017	0	0	PURI, PARUL NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
297942	Non-Physician Medical Practitioner	None	1053719492	0	0	PREVAL, MARIE C NP	7/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4400 THE WOODS DRIVE	APT 2033	SAN JOSE	CA	95136	3844	00	06000	37.27527296	-121.8375801	Santa Clara County
297952	Non-Physician Medical Practitioner	None	1841952355	0	0	PROKOPCHUK, PAVEL NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	00	06000	39.22820863	-121.0465856	Nevada County
297964	Non-Physician Medical Practitioner	None	1548263932	0	0	PRECIADO, RICHARD	11/24/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 E MERCED AVE	None	WEST COVINA	CA	91790	5023	00	06000	34.05463589	-117.9377705	Los Angeles County
297980	Non-Physician Medical Practitioner	None	1821061680	0	0	POPOVA, YELENA M	11/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5244 SWINDON RD	None	ROCKLIN	CA	95765	5114	00	06000	38.82062272	-121.257578	Placer County
297993	Non-Physician Medical Practitioner	None	1083025993	0	0	PAYNE, DANA O	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1317 CARLTON AVE	None	MENLO PARK	CA	94025	1503	00	06000	37.47673828	-122.1539204	San Mateo County
298032	Non-Physician Medical Practitioner	None	1497812655	0	0	PRESTON, LEANNE M	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
298067	Non-Physician Medical Practitioner	None	1548918071	0	0	PEWTHERS, HALLIE A PA	6/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
298101	Non-Physician Medical Practitioner	None	1356664890	0	0	PONCE, TANIA M PA	11/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
298104	Non-Physician Medical Practitioner	None	1255100053	0	0	PUGH, EVAN M PA	9/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
298121	Non-Physician Medical Practitioner	None	1952810632	0	0	PHAN, ANDREW K PA	7/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	00	06000	33.698367	-117.9194115	Orange County
298144	Non-Physician Medical Practitioner	None	1821544974	0	0	PASCUAL, RON NP	10/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 SKYLINE DRIVE	None	MONTEREY	CA	93940	4110	00	06000	36.59323606	-121.9166669	Monterey County
298168	Non-Physician Medical Practitioner	None	1174827943	0	0	PELPHREY, MICHALYN D NP	2/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3069 ADIRONDACK CT	None	WESTLAKE VILLAGE	CA	91362	3502	00	06000	34.17001548	-118.82488	Ventura County
298184	Non-Physician Medical Practitioner	None	1326713991	0	0	PYLE, SARAH L PA-C	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
298202	Non-Physician Medical Practitioner	None	1528658374	0	0	PIERCE, KRISTEN D CNM	5/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
298238	Non-Physician Medical Practitioner	None	1497122360	0	0	PASSANISI, CHERYL A NP	10/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11 ATHLONE CT	None	MENLO PARK	CA	94025	1913	00	06000	37.47737532	-122.1874211	San Mateo County
298254	Non-Physician Medical Practitioner	None	1548714181	0	0	PARK, ALLEN J	1/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1030 S STEWARD STREET	W2082	MESA	AZ	85202	4448	00	06000	33.395823	-111.860622	Maricopa County
298255	Non-Physician Medical Practitioner	None	1134781305	0	0	PARK, AMANDA E NP	4/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
298271	Non-Physician Medical Practitioner	None	1649050444	0	0	PEREZ, VICTORIA PA	12/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	00	06000	34.58364037	-118.1441012	Los Angeles County
298292	Non-Physician Medical Practitioner	None	1629734777	0	0	PARAZO, ALEXIS V NP	1/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
298318	Non-Physician Medical Practitioner	None	1548883002	0	0	PADFIELD, KARMEN NP	7/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12677 HESPERIA ROAD	SUITE 130	VICTORVILLE	CA	92395	7735	00	06000	34.48148078	-117.2906175	San Bernardino County
298322	Non-Physician Medical Practitioner	None	1124353065	0	0	PILKERTON, JASON A	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
298337	Non-Physician Medical Practitioner	None	1306463526	0	0	PARKINSON, KAITLYN A PA-C	10/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1835 S LA CIENEGA BLVD	STE 205 & 215	LOS ANGELES	CA	90035	4651	00	06000	34.04410366	-118.3768223	Los Angeles County
298353	Non-Physician Medical Practitioner	None	1518259936	0	0	PIDDING, APRYL D NP	4/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	166 RODNEY AVE	None	ENCINITAS	CA	92024	2902	00	06000	33.04720872	-117.2516908	San Diego County
298403	Non-Physician Medical Practitioner	None	1699045252	0	0	PASSEHL CAPACI, CHAUNDRA R NP	7/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
298408	Non-Physician Medical Practitioner	None	1457868267	0	0	PATWA, MANORAMA R NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4122 BELL COMMON	None	FREMONT	CA	94536	6900	00	06000	37.54911639	-121.992821	Alameda County
298460	Non-Physician Medical Practitioner	None	1538370903	0	0	PANSE, NANCY Y	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12729 GEORGE CT	None	RANCHO CUCAMONGA	CA	91739	1682	00	06000	34.12775845	-117.5272762	San Bernardino County
298469	Non-Physician Medical Practitioner	None	1285129049	0	0	PELTZ, TANYA PA	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 SOUTH GRAND AVE	None	GLENDORA	CA	91741	4218	00	06000	34.132842	-117.872523	Los Angeles County
298488	Non-Physician Medical Practitioner	None	1538780416	0	0	PARKER, BRIANA M PA	1/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
298494	Non-Physician Medical Practitioner	None	1417930272	0	0	PEREZ, ROSSY ALICIA	10/4/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 TROTH ST	None	JURUPA VALLEY	CA	91752	2204	00	06000	33.986772	-117.5167655	Riverside County
298498	Non-Physician Medical Practitioner	None	1124611843	0	0	PATEL, MINAL	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
298525	Non-Physician Medical Practitioner	None	1184265092	0	0	PERRY, ANDREW E PA	8/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	00	06000	34.08060971	-117.9958001	Los Angeles County
298532	Non-Physician Medical Practitioner	None	1326754516	0	0	PATRICIO, JAYSON S	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298541	Non-Physician Medical Practitioner	None	1114080801	0	0	PARK, SUNYOUNG PA-C	9/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25115 MADISON	None	MURRIETA	CA	92562	8967	00	06000	33.55794428	-117.2011541	Riverside County
298556	Non-Physician Medical Practitioner	None	1669415949	0	0	PAINE, DANIEL Y	7/31/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19605 LANVIEW LANE	None	SANTA CLARITA	CA	91350	3209	00	06000	34.44308549	-118.4784813	Los Angeles County
298570	Non-Physician Medical Practitioner	None	1790447019	0	0	PANNU, GURSHAKTI S PA	11/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
298580	Non-Physician Medical Practitioner	None	1720385453	0	0	PRATHER, JESSICA MICHELLE	3/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9508 STOCKDALE HWY STE 1	None	BAKERSFIELD	CA	93311	3623	00	06000	35.35453237	-119.1086014	Kern County
298659	Non-Physician Medical Practitioner	None	1528845542	0	0	POCZWARDOWSKI, PIOTR PA	4/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7257 FRESNO	FIRST FLOOR	FRESNO	CA	93720	2950	00	06000	36.84225164	-119.7833937	Fresno County
298697	Non-Physician Medical Practitioner	None	1568574713	0	0	PILLOR, EVELYN NP	7/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	120 GRANADA DR	APT 11	MOUNTAIN VIEW	CA	94043	4595	00	06000	37.39946611	-122.0859078	Santa Clara County
298700	Non-Physician Medical Practitioner	None	1013487883	0	0	PERKINS, AUSTIN J	2/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6180 OLD VILLAGE RD	None	YORBA LINDA	CA	92887	6704	00	06000	33.87226034	-117.7265338	Orange County
298715	Non-Physician Medical Practitioner	None	1891167086	0	0	PYPER, CHRISTOPHER	10/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1324 ADDISON ST	APT 4	BERKELEY	CA	94702	1730	00	06000	37.86900314	-122.2850644	Alameda County
298757	Non-Physician Medical Practitioner	None	1043486574	0	0	PETERSON, PATRICIA M	5/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	172 MAY AVENUE	None	MONROVIA	CA	91016	2228	00	06000	34.15390882	-117.997687	Los Angeles County
298759	Non-Physician Medical Practitioner	None	1760497267	0	0	PORRAS, MARTIN	3/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 LAWRENCE EXPY	DEPT. 104	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
298767	Non-Physician Medical Practitioner	None	1205219508	0	0	PATIO, CHRYSANTA D PA	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8470 PINEHOLLOW CIRCLE	None	DISCOVERY BAY	CA	94505	2673	00	06000	37.92923505	-121.6201242	Contra Costa County
298777	Non-Physician Medical Practitioner	None	1124047691	0	0	PHI, ELIZABETH NGOC-PHU	4/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2954 STATE ST	None	SANTA BARBARA	CA	93105	3418	00	06000	34.44041067	-119.7266539	Santa Barbara County
298820	Non-Physician Medical Practitioner	None	1518496256	0	0	POPAL, SINA	2/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	957 S RIDGECREST CIRCLE	None	ANAHEIM	CA	92807	4502	00	06000	33.841305	-117.746189	Orange County
298835	Non-Physician Medical Practitioner	None	1538167861	0	0	PHILLIPS, SUSANNE J NP	6/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
298839	Non-Physician Medical Practitioner	None	1013568781	0	0	PALAFOX, ADBNI NP	6/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2559 W ROSAMOND BLVD	STE D	ROSAMOND	CA	93560	6267	00	06000	34.86420508	-118.1771868	Kern County
298866	Non-Physician Medical Practitioner	None	1407986292	0	0	PURCELL, FAY PA-C	7/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
298879	Non-Physician Medical Practitioner	None	1528685054	0	0	PUCK, TORRENCE PA-C	2/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11100 WARNER AVE	STE 310	FOUNTAIN VALLEY	CA	92708	4009	00	06000	33.716291	-117.9355051	Orange County
298895	Non-Physician Medical Practitioner	None	1487387924	0	0	PRECHTL, KAITLIN PA	8/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
298933	Non-Physician Medical Practitioner	None	1023790128	0	0	PROVENCE, ERIKA NP	8/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31625 DE PORTOLA RD	SUITE 101	TEMECULA	CA	92592	2770	00	06000	33.48359715	-117.1048345	Riverside County
298964	Non-Physician Medical Practitioner	None	1487734091	0	0	PETERSEN, SUZANNE C	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	419 EDGEWOOD RD	None	SAN MATEO	CA	94402	1117	00	06000	37.56207974	-122.3520532	San Mateo County
298965	Non-Physician Medical Practitioner	None	1356991657	0	0	PATEL, PRIYANK PA-C	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
298973	Non-Physician Medical Practitioner	None	1013920354	0	0	PIETROWSKI, DALE J	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17248 BARNESTON CT	None	GRANADA HILLS	CA	91344	2443	00	06000	34.28505365	-118.5102943	Los Angeles County
298979	Non-Physician Medical Practitioner	None	1235545542	0	0	PERRONE, ELIZABETH A PA	9/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
298983	Non-Physician Medical Practitioner	None	1265481907	0	0	PODGORSKI, TERESA A	7/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14409 CHOCO RD	None	APPLE VALLEY	CA	92307	5559	00	06000	34.51320825	-117.2341516	San Bernardino County
298987	Non-Physician Medical Practitioner	None	1144791716	0	0	PARKER, MARGARET NP	4/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
298994	Non-Physician Medical Practitioner	None	1144547738	0	0	PAULSON, KRISTIN L	11/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13344 WHITEWATER DRIVE	None	POWAY	CA	92064	5226	00	06000	32.9579082	-117.0096637	San Diego County
298996	Non-Physician Medical Practitioner	None	1134692692	0	0	PERRIER, MONIQUE M PA	5/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25405 HANCOCK AVE.	STE. 108	MURRIETA	CA	92563	5978	00	06000	33.5580833	-117.1850127	Riverside County
299002	Non-Physician Medical Practitioner	None	1306250709	0	0	POV-BRANTLE, PHALLA M NP	9/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2413 WHITMORE AVE	None	CLOVIS	CA	93619	9252	00	06000	36.80483134	-119.6543072	Fresno County
299031	Non-Physician Medical Practitioner	None	1972294098	0	0	PALACIO, EMERI	6/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
299052	Non-Physician Medical Practitioner	None	1952315426	0	0	PARK, YULIE J	12/21/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	00	06000	33.9670722	-118.3439911	Los Angeles County
299072	Non-Physician Medical Practitioner	None	1699281493	0	0	PRESCOTT, BRIANNE E PA	12/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2540 EAST ST	None	CONCORD	CA	94520	1906	00	06000	37.98292379	-122.0341876	Contra Costa County
299084	Non-Physician Medical Practitioner	None	1518361435	0	0	PLANNED PARENTHOOD OF THE PACIFIC SOUTHWEST	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1463 S 4TH ST	None	EL CENTRO	CA	92243	4749	00	06000	32.78037178	-115.5523224	Imperial County
299113	Non-Physician Medical Practitioner	None	1326647413	0	0	PAGANELLI, RACHEL E PA-C	11/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	705 W. LA VETA AVE	SUITE 111	ORANGE	CA	92868	4447	00	06000	33.78062272	-117.8600738	Orange County
299125	Non-Physician Medical Practitioner	None	1457998122	0	0	PADFIELD, NELLY M NP	12/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
299142	Non-Physician Medical Practitioner	None	1003668138	0	0	PERTTULA, KENT NP	7/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	00	06000	34.58364037	-118.1441012	Los Angeles County
299154	Non-Physician Medical Practitioner	None	1285058727	0	0	PISIGAN, DOMINIC L NP	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1065 CANYON SPRING AVE	None	DIAMOND BAR	CA	91765	2306	00	06000	34.00275228	-117.8052328	Los Angeles County
299187	Non-Physician Medical Practitioner	None	1508196379	0	0	PARKER, EMESE C	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	181 ANDRIEUX ST	SUITE 108	SONOMA	CA	95476	6932	00	06000	38.28809911	-122.4613026	Sonoma County
299201	Non-Physician Medical Practitioner	None	1790258788	0	0	PETERMAN, KYLIE B PA	6/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
299203	Non-Physician Medical Practitioner	None	1619023157	0	0	PIERRE-MICHEL, SOLANGE NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	11615 N 39TH DR	None	PHOENIX	AZ	85029	3002	00	06000	33.591726	-112.1432985	Maricopa County
299216	Non-Physician Medical Practitioner	None	1902493117	0	0	POWER, DEIRDRE G NP	3/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	110 TAMPICO DRIVE	SUITE 210	WALNUT CREEK	CA	94598	2512	00	06000	37.91113845	-122.0458263	Contra Costa County
299222	Non-Physician Medical Practitioner	None	1609286418	0	0	PLANNED PARENTHOOD SHASTA	8/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 HARPST STREET	None	ARCATA	CA	95521	8222	00	06000	40.87420204	-124.0791833	Humboldt County
299225	Non-Physician Medical Practitioner	None	1689961302	0	0	PEOPLE'S COMMUNITY CLINIC	5/24/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4139 VERDUGO RD	SUITE A	LOS ANGELES	CA	90065	3820	00	06000	34.1261475	-118.2319835	Los Angeles County
299245	Non-Physician Medical Practitioner	None	1659427060	0	0	PLUTA, CATHERINE MARY	10/1/1994	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	00	06000	38.00418494	-121.8432075	Contra Costa County
299253	Non-Physician Medical Practitioner	None	1811752546	0	0	PRASAI, KALPANA NP	9/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	00	06000	37.53249631	-121.9198141	Alameda County
299292	Non-Physician Medical Practitioner	None	1568651743	0	0	PATEL, RESHMA	3/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1323 SOUTH CARMELINA AVE	APT 101	LOS ANGELES	CA	90025	1947	00	06000	34.04021743	-118.4678973	Los Angeles County
299304	Non-Physician Medical Practitioner	None	1295184893	0	0	PINEDA, KELLY L	6/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1884 OLVERA DRIVE	None	WOODLAND	CA	95776	9384	00	06000	38.66856516	-121.7343222	Yolo County
299311	Non-Physician Medical Practitioner	None	1376973776	0	0	PETERS, NATALIE C NP	6/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 GROVE ST	None	SAN FRANCISCO	CA	94117	1236	00	06000	37.775018	-122.444813	San Francisco County
299347	Non-Physician Medical Practitioner	None	1043576077	0	0	PAPAZIAN, TALAR S NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11051 HASKELL AVENUE	None	GRANADA HILLS	CA	91344	5429	00	06000	34.2714881	-118.4760021	Los Angeles County
299371	Non-Physician Medical Practitioner	None	1982101598	0	0	PRATT, KARA R PA-C	6/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	00	06000	36.83745149	-119.6604315	Fresno County
299383	Non-Physician Medical Practitioner	None	1619600194	0	0	PHAN, JAMIE	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	00	06000	34.09027878	-118.1450083	Los Angeles County
299388	Non-Physician Medical Practitioner	None	1427374446	0	0	PAGELS, KELLY F PA	12/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	06000	33.38982	-111.8760885	Maricopa County
299411	Non-Physician Medical Practitioner	None	1114354040	0	0	PAYEA, THOMAS A	10/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5229 FROST AVE	None	CARLSBAD	CA	92008	3840	00	06000	33.14550985	-117.2919759	San Diego County
299417	Non-Physician Medical Practitioner	None	1831653609	0	0	PIPKIN, DANIEL S PA-C	4/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1435 S VERMONT AVE	SUITE 100	LOS ANGELES	CA	90006	4554	00	06000	34.045335	-118.2916355	Los Angeles County
299449	Non-Physician Medical Practitioner	None	1427741180	0	0	PHILLIPS, AARON PA	7/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	00	06000	33.9598857	-118.2783041	Los Angeles County
299456	Non-Physician Medical Practitioner	None	1780148619	0	0	PRODAN, OKSANA NP	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	00	06000	37.5239043	-122.2667778	San Mateo County
299474	Non-Physician Medical Practitioner	None	1194489690	0	0	PIRES, MARLENE A NP	2/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299481	Non-Physician Medical Practitioner	None	1568645000	0	0	PERCIVAL-PACININ, SUZANNE M	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15860 ELCONA PLACE	None	VICTORVILLE	CA	92395	4850	00	06000	34.50338543	-117.3183015	San Bernardino County
299486	Non-Physician Medical Practitioner	None	1255403994	0	0	PAN, JEANNE P	12/5/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
299505	Non-Physician Medical Practitioner	None	1699312470	0	0	PHUNG, ANH Q PA-C	6/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	00	06000	37.39572142	-122.1051204	Santa Clara County
299513	Non-Physician Medical Practitioner	None	1043272552	0	0	PATEL, SHOHBA R	1/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2613 REMBRANDT PLACE	None	MODESTO	CA	95356	0378	00	06000	37.69610681	-121.0444396	Stanislaus County
299551	Non-Physician Medical Practitioner	None	1235380502	0	0	POULIN, DANIELLE J NP	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13322 MALENA DRIVE	None	SANTA ANA	CA	92705	1921	00	06000	33.76890793	-117.8232967	Orange County
299562	Non-Physician Medical Practitioner	None	1841916145	0	0	PUCCI, NICOYA N CNM	11/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1423 MAGNOLIA	None	CHICO	CA	95926	3226	00	06000	39.74063551	-121.8499048	Butte County
299576	Non-Physician Medical Practitioner	None	1831422336	0	0	PARKER, LISA M NP	11/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	134 JERVIS MIMS RD	None	HATTIESBURG	MS	39401	8864	00	06000	31.2522305	-89.32725487	Forrest County
299594	Non-Physician Medical Practitioner	None	1134512551	0	0	PHAM, HONG AN NP	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9351 LILY AVE	None	FOUNTAIN VALLEY	CA	92708	2263	00	06000	33.7201665	-117.9660465	Orange County
299596	Non-Physician Medical Practitioner	None	1053893057	0	0	PARKER, NATALIA NP	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	00	06000	34.2064445	-118.8824085	Ventura County
299619	Non-Physician Medical Practitioner	None	1669870739	0	0	PETALUMA HEALTH CENTER INC	6/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	00	06000	38.35358835	-122.7073105	Sonoma County
299631	Non-Physician Medical Practitioner	None	1467707406	0	0	PLOWMAN, SHAWN P	10/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	228 AVENIDA ARAGON	APT B	SAN CLEMENTE	CA	92672	5632	00	06000	33.42829327	-117.6259225	Orange County
299658	Non-Physician Medical Practitioner	None	1295935799	0	0	PENINSULA HEALTHCARE CONNECTION	8/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33 ENCINA AVE	None	PALO ALTO	CA	94301	2300	00	06000	37.43913037	-122.1608344	Santa Clara County
299685	Non-Physician Medical Practitioner	None	1235428830	0	0	PAUL, DIANE S NP	5/23/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3612 HERON LAKES CT	None	STOCKTON	CA	95219	1760	00	06000	37.98118116	-121.3602167	San Joaquin County
299714	Non-Physician Medical Practitioner	None	1730290834	0	0	POPE, EMILY A F NP	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5880 MOUNTAIN HAWK DR	None	SANTA ROSA	CA	95409	4356	00	06000	38.46690602	-122.6352469	Sonoma County
299727	Non-Physician Medical Practitioner	None	1013019934	0	0	PREPAS, ROBERTA P CNM	2/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	740 OAK ST	None	LAGUNA BEACH	CA	92651	2922	00	06000	33.53685463	-117.7711724	Orange County
299763	Non-Physician Medical Practitioner	None	1093061970	0	0	PARK, HELENA S NP	4/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1968 BAXTER LN	None	UPLAND	CA	91786	9481	00	06000	34.10156048	-117.689013	San Bernardino County
299819	Non-Physician Medical Practitioner	None	1386088151	0	0	POWELL, MELISSA C NP	3/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	70 GREENHOUSE	None	IRVINE	CA	92603	0158	00	06000	33.62212012	-117.8220991	Orange County
299825	Non-Physician Medical Practitioner	None	1417459611	0	0	PERRY, GLORIA M	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8919 CRIPPLE CREEK AVE	None	BAKERSFIELD	CA	93312	5074	00	06000	35.4253335	-119.1019849	Kern County
299843	Non-Physician Medical Practitioner	None	1073787875	0	0	POSCH, MEGHAN A NP	6/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
299882	Non-Physician Medical Practitioner	None	1033781141	0	0	PAUL, ARUP PA	9/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	00	06000	33.56635084	-117.1823956	Riverside County
299884	Non-Physician Medical Practitioner	None	1073230769	0	0	PIERCE, MIRANDA	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 N 3RD ST	None	LOMPOC	CA	93436	7002	00	06000	34.64013944	-120.4451768	Santa Barbara County
299892	Non-Physician Medical Practitioner	None	1194247072	0	0	PATEL, DEEP NP	8/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
299905	Non-Physician Medical Practitioner	None	1578214789	0	0	PORTER, GABRIEL NP	6/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
299945	Non-Physician Medical Practitioner	None	1235876244	0	0	PARTOVY, NICOLE S PA-C	11/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
299960	Non-Physician Medical Practitioner	None	1083965651	0	0	PETERSON, SHALENA	9/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
299970	Non-Physician Medical Practitioner	None	1538300132	0	0	PURCELL, MARGRETA	8/14/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	FLOOR 2	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
299982	Non-Physician Medical Practitioner	None	1659130664	0	0	PEDIGO, KORINAH NP	9/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
299995	Non-Physician Medical Practitioner	None	1629012398	0	0	PRICE, KAREN JEANETTE	1/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
300002	Non-Physician Medical Practitioner	None	1447232616	0	0	PANIAGUA-CASTRO, LIZETTE	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15243 VANOWEN ST	SUITE 306	VAN NUYS	CA	91405	3649	00	06000	34.19394848	-118.4654115	Los Angeles County
300016	Non-Physician Medical Practitioner	None	1053047803	0	0	PERKINS, CARISSA NP	12/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SUMMIT ST	2ND FLOOR	OAKLAND	CA	94609	3410	00	06000	37.82018974	-122.2643221	Alameda County
300020	Non-Physician Medical Practitioner	None	1922525302	0	0	POLLACK, TALIA L	1/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 NORTH CRESCENT DRIVE	APT 206	BEVERLY HILLS	CA	90210	5402	00	06000	34.06804124	-118.3966329	Los Angeles County
300066	Non-Physician Medical Practitioner	None	1669705430	0	0	POOLE, CASSIE S	9/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4203 HILARIA WY	None	NEWPORT BEACH	CA	92663	3612	00	06000	33.62793289	-117.9293258	Orange County
300073	Non-Physician Medical Practitioner	None	1427593953	0	0	PAUL-RICHIEZ, DARLING	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4276 54TH	C	SAN DIEGO	CA	92115	6011	00	06000	32.75444691	-117.0788921	San Diego County
300081	Non-Physician Medical Practitioner	None	1891736732	0	0	PARODI, TERESA ELAINE	9/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 COMMERCIAL XING	None	SANTA CRUZ	CA	95065	1702	00	06000	36.98796413	-121.9825327	Santa Cruz County
300099	Non-Physician Medical Practitioner	None	1033786991	0	0	PAREPALLI, AKHILA PA-C	12/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	06000	43.383456	-124.2330435	Coos County
300116	Non-Physician Medical Practitioner	None	1992037550	0	0	PATEL, KRISHNA	9/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1441 N BECKLEY AVE	None	DALLAS	TX	75203	0000	00	06000	32.76063	-96.8257485	Dallas County
300140	Non-Physician Medical Practitioner	None	1982264156	0	0	PARKER, JACQUELINE E NP	6/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	650 HOWE AVE	SUITE 600	SACRAMENTO	CA	95825	4731	00	06000	38.577294	-121.4146395	Sacramento County
300152	Non-Physician Medical Practitioner	None	1578674891	0	0	PADOVA, KARLA K	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 COVINA AVENUE	None	LONG BEACH	CA	90803	1906	00	06000	33.76447746	-118.1286271	Los Angeles County
300211	Non-Physician Medical Practitioner	None	1770660904	0	0	PHUONG, NARIN	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2851 E 57TH ST	None	LONG BEACH	CA	90805	5117	00	06000	33.85937079	-118.15803	Los Angeles County
300217	Non-Physician Medical Practitioner	None	1942850888	0	0	POLONCHAK, JILLIAN A NP	12/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
300222	Non-Physician Medical Practitioner	None	1831744432	0	0	PERSON, NANOULI G NP	8/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2244	00	06000	35.36875951	-119.0959206	Kern County
300235	Non-Physician Medical Practitioner	None	1396365599	0	0	PALLIS, KATIELEE PA	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
300237	Non-Physician Medical Practitioner	None	1841316007	0	0	PICKETT, DOUGLAS R	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8726 GLENIRA AVE	None	LA MESA	CA	91941	5408	00	06000	32.76556051	-117.008352	San Diego County
300276	Non-Physician Medical Practitioner	None	1013220359	0	0	PETROFSKY, MARY	11/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DRIVE	ROOM H0105, MAIL CODE 52	STANFORD	CA	94305	5221	00	06000	37.43304542	-122.1759654	Santa Clara County
300278	Non-Physician Medical Practitioner	None	1952813826	0	0	PARK, SUE J NP	3/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	00	06000	37.36269	-118.407312	Inyo County
300287	Non-Physician Medical Practitioner	None	1265558498	0	0	PELUSO, THOMAS M	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	962 ALEJO VISTA	None	PALM SPRINGS	CA	92262	6169	00	06000	33.82986663	-116.5373001	Riverside County
300293	Non-Physician Medical Practitioner	None	1568606309	0	0	PELLETIER, JACQUELINE ELIZABETH	5/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
300335	Non-Physician Medical Practitioner	None	1699409383	0	0	PERKINS, ELIZABETH R PA	8/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 S SOTO ST	None	HUNTINGTON PARK	CA	90255	9993	00	06000	33.990444	-118.2193965	Los Angeles County
300336	Non-Physician Medical Practitioner	None	1487882015	0	0	PASCALE, ERIN MARIE	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	5569	00	06000	34.070841	-117.580734	San Bernardino County
300360	Non-Physician Medical Practitioner	None	1275557506	0	0	PEREZ, GUILLERMO	4/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	467 EL CAMINO REAL	None	GREENFIELD	CA	93927	4915	00	06000	36.32573265	-121.2475971	Monterey County
300361	Non-Physician Medical Practitioner	None	1396167680	0	0	PEREZ, LESLIE ANN D NP	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12719 LINCOLNSHIRE DR	None	BAKERSFIELD	CA	93311	9587	00	06000	35.32587158	-119.1446823	Kern County
300382	Non-Physician Medical Practitioner	None	1881099786	0	0	POKROY, DENISE K NP	1/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5732 CAMPO WALK	None	LONG BEACH	CA	90803	5035	00	06000	33.75602826	-118.1224232	Los Angeles County
300396	Non-Physician Medical Practitioner	None	1790162410	0	0	PARMAR, REENA PA-C	6/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 N SUNRISE AVE	STE 1205	ROSEVILLE	CA	95661	2926	00	06000	38.74746043	-121.2655348	Placer County
300408	Non-Physician Medical Practitioner	None	1326599002	0	0	PITTMAN, LILIANA NP	8/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
300433	Non-Physician Medical Practitioner	None	1164886040	0	0	PEACH TREE HEALTHCARE	7/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3810 ROSIN CT	SUITE 100	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
300474	Non-Physician Medical Practitioner	None	1902437155	0	0	PERKINS, JARVIS PA	2/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8706 IMPERIAL HWY	SUITE A1	DOWNEY	CA	90242	3906	00	06000	33.91802345	-118.1407927	Los Angeles County
300541	Non-Physician Medical Practitioner	None	1588062145	0	0	PLUMETTAZ, JOANNA J PA-C	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 TRANCAS ST	SUITE 256	NAPA	CA	94558	2921	00	06000	38.32316569	-122.2981938	Napa County
300558	Non-Physician Medical Practitioner	None	1346507928	0	0	PLANNED PARENTHOOD LOS ANGELES STOLLER-FILER	11/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11722 WILMINGTON AVE	SUITE A3	LOS ANGELES	CA	90059	2543	00	06000	33.9267675	-118.2390104	Los Angeles County
300585	Non-Physician Medical Practitioner	None	1104307958	0	0	PUNSALAN, ALICIA H NP	4/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6121 N THESTA ST	STE 303	FRESNO	CA	93710	5294	00	06000	36.82493955	-119.783139	Fresno County
300588	Non-Physician Medical Practitioner	None	1164668786	0	0	PREMIER FAMILY MEDICINE ASSOCIATES, INC	2/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1601 MONTE VISTA AVE	SUITE 100	CLAREMONT	CA	91711	2914	00	06000	34.112259	-117.698539	Los Angeles County
300603	Non-Physician Medical Practitioner	None	1306584453	0	0	POCASANGRE, IRENE M NP	6/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5757 WILSHIRE BLVD	PR 2	LOS ANGELES	CA	90036	3689	00	06000	34.0624504	-118.3534253	Los Angeles County
300619	Non-Physician Medical Practitioner	None	1386172468	0	0	PARCH, JONATHAN R	9/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 S DE LACEY AVE	STE 304	PASADENA	CA	91105	4144	00	06000	34.14423345	-118.1523719	Los Angeles County
300639	Non-Physician Medical Practitioner	None	1629147731	0	0	PETERSON, GARY	10/20/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	00	06000	33.1814285	-117.3093613	San Diego County
300650	Non-Physician Medical Practitioner	None	1902155898	0	0	PRYCHUN, KAREN PA	12/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
300656	Non-Physician Medical Practitioner	None	1255733713	0	0	PYLYPIV, TARAS PA-C	12/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
300667	Non-Physician Medical Practitioner	None	1174923684	0	0	PLANNED PARENTHOOD MAR MONTE, INC.	12/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1032 A STREET	None	HAYWARD	CA	94541	4106	00	06000	37.67439519	-122.0831733	Alameda County
300675	Non-Physician Medical Practitioner	None	1154847986	0	0	PAYNE, ADAM M NP	7/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
300686	Non-Physician Medical Practitioner	None	1982990560	0	0	PETROVICH, RASHIDA D A NP	10/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6163 GIRVIN DR	None	OAKLAND	CA	94611	2444	00	06000	37.82699646	-122.1968329	Alameda County
300695	Non-Physician Medical Practitioner	None	1215119250	0	0	PRATT, RONALD JAMES	9/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 S ARCHIBALD AVE STE	None	ONTARIO	CA	91761	8503	00	06000	34.038603	-117.5935995	San Bernardino County
300697	Non-Physician Medical Practitioner	None	1861786139	0	0	PAVLEY, JENNIFER L	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 JIM BOWIE RD	None	AGOURA HILLS	CA	91301	3608	00	06000	34.13413033	-118.7202224	Los Angeles County
300784	Non-Physician Medical Practitioner	None	1366833923	0	0	PIROIZ, ANTHONY	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4595 LA VERNA AVE	None	SANTA MARIA	CA	93455	0000	00	06000	34.8706949	-120.4333316	Santa Barbara County
300787	Non-Physician Medical Practitioner	None	1396872537	0	0	PEREZ, DIANA NP	10/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15012 MINNEHAHA ST	None	MISSION HILLS	CA	91345	2521	00	06000	34.2600165	-118.4592398	Los Angeles County
300792	Non-Physician Medical Practitioner	None	1083773725	0	0	POON, LAWRENCE W	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19 DUSK WAY	None	ALISO VIEJO	CA	92656	8024	00	06000	33.57148495	-117.7364207	Orange County
300924	Non-Physician Medical Practitioner	None	1467099283	0	0	PIGEON, RUTH L NP	6/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300949	Non-Physician Medical Practitioner	None	1437859485	0	0	PALIGUTAN, JOCELYN A NP	2/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8305 BRIMHALL RD	STE 1601	BAKERSFIELD	CA	93312	2174	00	06000	35.36876049	-119.0948805	Kern County
300955	Non-Physician Medical Practitioner	None	1255067856	0	0	POLTE, KIERSTYN NP	9/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
300958	Non-Physician Medical Practitioner	None	1700182672	0	0	POUZAKOV, ALEXEI IVANOVICH	10/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
300970	Non-Physician Medical Practitioner	None	1881977965	0	0	PAREDES, LUCY	3/29/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	SUITE 713	GARDEN GROVE	CA	92843	1901	00	06000	33.77450141	-117.9123364	Orange County
300977	Non-Physician Medical Practitioner	None	1598713067	0	0	PATEL, SALONI	3/8/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 HAWTHORNE AVENUE	None	OAKLAND	CA	94609	3108	00	06000	37.819368	-122.263902	Alameda County
300982	Non-Physician Medical Practitioner	None	1124264437	0	0	PARANDA, AMANDA PA-C	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	00	06000	33.8420837	-117.9415765	Orange County
300987	Non-Physician Medical Practitioner	None	1033164249	0	0	PANATTONI, STEPHEN	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 E ROMIE LN	None	SALINAS	CA	93901	4029	00	06000	36.65983988	-121.6458041	Monterey County
301002	Non-Physician Medical Practitioner	None	1295215630	0	0	PATTON, MELANIE M NP	4/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 GREENLEY RD	None	SONORA	CA	95370	4685	00	06000	37.97749352	-120.3700335	Tuolumne County
301042	Non-Physician Medical Practitioner	None	1831647833	0	0	PUSCHENDORF, VANESSA R NP	2/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
301067	Non-Physician Medical Practitioner	None	1366481178	0	0	PORTER, PAMELA SUE	10/20/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9281 OFFICE PARK CIR	SUITE 120	ELK GROVE	CA	95758	8068	00	06000	38.418264	-121.39641	Sacramento County
301100	Non-Physician Medical Practitioner	None	1851361646	0	0	PENEV, IRINA E PA	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301132	Non-Physician Medical Practitioner	None	1407362692	0	0	PETERSON, MADISON PA-C	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	74090 EL PASEO	103	PALM DESERT	CA	92260	4135	00	06000	33.72028088	-116.3715055	Riverside County
301155	Non-Physician Medical Practitioner	None	1346753084	0	0	PELLA, CHRISTINA PA	10/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24241 HAWTHORNE BLVD	SUITE 201	TORRANCE	CA	90505	6504	00	06000	33.802578	-118.351229	Los Angeles County
301157	Non-Physician Medical Practitioner	None	1265006399	0	0	PHILLIPS, NICOLE NP	9/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	601 S WESTMORELAND AVE	None	LOS ANGELES	CA	90005	3999	00	06000	34.06348495	-118.28845	Los Angeles County
301185	Non-Physician Medical Practitioner	None	1720256647	0	0	PLANNED PARENTHOOD EAST LOS ANGELES	3/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5068 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3128	00	06000	34.02101146	-118.1603463	Los Angeles County
301202	Non-Physician Medical Practitioner	None	1689733305	0	0	PETERSON, ANGELA G	4/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8237 WEST BLVD	None	INGLEWOOD	CA	90305	1618	00	06000	33.963255	-118.3347575	Los Angeles County
301220	Non-Physician Medical Practitioner	None	1649937749	0	0	PAUL, BRITANI CNM	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9041 MAGNOLIA AVE	STE 305	RIVERSIDE	CA	92503	3957	00	06000	33.92541585	-117.4378266	Riverside County
301235	Non-Physician Medical Practitioner	None	1356063291	0	0	PETERSON, HANNAH L NP	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	00	06000	38.67049812	-121.7238394	Yolo County
301237	Non-Physician Medical Practitioner	None	1669982708	0	0	PERINOVIC, STEVEN A PA	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1535 RIVER PARK	None	SACRAMENTO	CA	95815	4601	00	06000	38.600334	-121.4361675	Sacramento County
301242	Non-Physician Medical Practitioner	None	1477325751	0	0	PERSAUD, STEPHEN D NP	2/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
301245	Non-Physician Medical Practitioner	None	1851692560	0	0	PLANNED PARENTHOOD: SHASTA-DIABLO, INC.	4/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 VALENCIA ST	None	SAN FRANCISCO	CA	94110	5013	00	06000	37.74617273	-122.4201514	San Francisco County
301258	Non-Physician Medical Practitioner	None	1477095149	0	0	PUATU, SHEILA MARIE	2/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14135 FRANCISQUITO AVE	STE 106	BALDWIN PARK	CA	91706	5010	00	06000	34.06372409	-117.9674972	Los Angeles County
301260	Non-Physician Medical Practitioner	None	1184683682	0	0	PEYTON, KRISTA JOY L	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
301265	Non-Physician Medical Practitioner	None	1306578083	0	0	PARMAR, HEMALY	2/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	00	06000	38.572803	-121.4685	Sacramento County
301283	Non-Physician Medical Practitioner	None	1295495844	0	0	PETERS, KRISTEN A NP	8/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
301293	Non-Physician Medical Practitioner	None	1689167751	0	0	PALMER, JACQUELINE N CNP	12/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2270 E PALMDALE BLVD	STE K	PALMDALE	CA	93550	4933	00	06000	34.58009827	-118.0881861	Los Angeles County
301294	Non-Physician Medical Practitioner	None	1447332366	0	0	PECK, DARLENE RENEE	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
301295	Non-Physician Medical Practitioner	None	1073352449	0	0	PEREZ, CZARINABELLE PA-C	2/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2626 N CALIFORNIA ST	STE B	STOCKTON	CA	95204	5500	00	06000	37.97724966	-121.2917368	San Joaquin County
301328	Non-Physician Medical Practitioner	None	1912651522	0	0	PEREL, MCKENNA PA	5/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
301375	Non-Physician Medical Practitioner	None	1124855275	0	0	PHU, STEPHANIE PA	2/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	00	06000	32.74986289	-117.1599343	San Diego County
301383	Non-Physician Medical Practitioner	None	1447605381	0	0	PARIS, AMBER NP	12/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
301409	Non-Physician Medical Practitioner	None	1265789721	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 E CHURCH ST	SUITE 202	SANTA MARIA	CA	93454	5909	00	06000	34.95209265	-120.4147348	Santa Barbara County
301431	Non-Physician Medical Practitioner	None	1841060530	0	0	PASCHE, ELISA NP	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 HARDY ST	None	INGLEWOOD	CA	90301	4011	00	06000	33.94909549	-118.3481595	Los Angeles County
301444	Non-Physician Medical Practitioner	None	1225198781	0	0	POWELL, LESLIE M NP	5/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
301450	Non-Physician Medical Practitioner	None	1457846560	0	0	PEANASKY, ANNE K PA-C	6/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
301457	Non-Physician Medical Practitioner	None	1760827026	0	0	PACELLA, GLORIA J NP	8/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301464	Non-Physician Medical Practitioner	None	1891302659	0	0	PARIKH, JOLLY NP	12/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
301466	Non-Physician Medical Practitioner	None	1437184439	0	0	PANNIER, TODD J	10/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
301484	Non-Physician Medical Practitioner	None	1245687052	0	0	PENA, CARLOS J	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	134 ELM ST	None	WOODLAND	CA	95695	3230	00	06000	38.68152082	-121.7758701	Yolo County
301508	Non-Physician Medical Practitioner	None	1043467020	0	0	PUTCHIO, SARAH L NP	5/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1820 S EL CAMINO REAL	A206	ENCINITAS	CA	92024	4917	00	06000	33.02476946	-117.2556033	San Diego County
301510	Non-Physician Medical Practitioner	None	1831224575	0	0	PAVLISKO, KATIE	12/8/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8737 BEVERLY BLVD STE 30	None	WEST HOLLYWOOD	CA	90048	1839	00	06000	34.07687959	-118.381876	Los Angeles County
301514	Non-Physician Medical Practitioner	None	1386119881	0	0	PAVLOVA, POLINA NP	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
301517	Non-Physician Medical Practitioner	None	1316462385	0	0	POSSEMATO, KYLE NP	5/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4617 FREEPORT BLVD	SUITE B	SACRAMENTO	CA	95822	2015	00	06000	38.533311	-121.4939295	Sacramento County
301549	Non-Physician Medical Practitioner	None	1508190588	0	0	PROKOP, CRISTINA E NP	1/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	917 HELEN LANE	None	BROOKINGS	OR	97415	9698	00	06000	42.06318547	-124.2896203	Curry County
301563	Non-Physician Medical Practitioner	None	1114221389	0	0	PIEPRZYCA, JOSEPH A	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3218 HONOLULU AVE	APT 3	LA CRESCENTA	CA	91214	3377	00	06000	34.22094222	-118.2495045	Los Angeles County
301573	Non-Physician Medical Practitioner	None	1770357972	0	0	POWERS, SEAN PA	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 N COLLEGE DR	101	SANTA MARIA	CA	93454	4614	00	06000	34.954461	-120.424836	Santa Barbara County
301586	Non-Physician Medical Practitioner	None	1457429540	0	0	PABON, JANEL	12/22/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DOUGLAS BLVD	2ND FLOOR	ROSEVILLE	CA	95661	3866	00	06000	38.74399612	-121.2349547	Placer County
301607	Non-Physician Medical Practitioner	None	1548591365	0	0	PETERS, JENNIFER L	4/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	235 W 6TH ST	None	RENO	NV	89503	4548	00	06000	39.53165987	-119.8181899	Washoe County
301623	Non-Physician Medical Practitioner	None	1154993012	0	0	PHAM, JULIA NP	1/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1035 JEFFERSON BLVD	1	WEST SACRAMENTO	CA	95691	3343	00	06000	38.57339903	-121.523861	Yolo County
301687	Non-Physician Medical Practitioner	None	1932163441	0	0	PARRILLA, RENEE	1/27/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 W ROWLAND ST	None	COVINA	CA	91723	2943	00	06000	34.078949	-117.8963031	Los Angeles County
301691	Non-Physician Medical Practitioner	None	1568908879	0	0	PETERS, JENNIFER K NP	9/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1449 CARDIFF DR	None	GARDNERVILLE	NV	89410	4839	00	06000	38.94127091	-119.7334254	Douglas County
301703	Non-Physician Medical Practitioner	None	1376678250	0	0	PARK, SUN MIN	2/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDRENS WAY	STE 410	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
301710	Non-Physician Medical Practitioner	None	1043753353	0	0	POTTS, CANDITA T NP	10/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3848 W 226TH ST	UNIT 124	TORRANCE	CA	90505	3624	00	06000	33.82327185	-118.3527055	Los Angeles County
301716	Non-Physician Medical Practitioner	None	1922482108	0	0	PARDO, ROBERTO C NP	12/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	00	06000	36.83752653	-119.7776433	Fresno County
301727	Non-Physician Medical Practitioner	None	1841562733	0	0	PORTNOY, PAMELA S NP	5/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
301729	Non-Physician Medical Practitioner	None	1457860074	0	0	PANTOJA, DANICA-ELLA M NP	3/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10251 SORRENTO VISTA PAR	SUITE 280	SAN DIEGO	CA	92121	3776	00	06000	32.89524013	-117.2142063	San Diego County
301730	Non-Physician Medical Practitioner	None	1699222620	0	0	PRIETO, ALEJANDRA J NP	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12015 ALTA CARMEL COURT	UNIT 309	SAN DIEGO	CA	92128	3836	00	06000	32.993073	-117.074376	San Diego County
301736	Non-Physician Medical Practitioner	None	1104546969	0	0	PHAN, THEODORE T PA-C	12/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
301746	Non-Physician Medical Practitioner	None	1447607148	0	0	PRUDENCIO, SABRINA NP	3/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 N RIVERSIDE AVE	None	RIALTO	CA	92376	5924	00	06000	34.10384154	-117.370545	San Bernardino County
301765	Non-Physician Medical Practitioner	None	1407044175	0	0	PLANNED PARENTHOOD SHASTA DIABLO	6/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2935 BECHELLI LN	None	REDDING	CA	96002	1905	00	06000	40.56452304	-122.3626362	Shasta County
301768	Non-Physician Medical Practitioner	None	1245250455	0	0	PIERSON, JEFFREY R	3/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19204 PERIMETER ROAD	None	GRASS VALLEY	CA	95949	7614	00	06000	39.05915023	-121.2066765	Nevada County
301801	Non-Physician Medical Practitioner	None	1760700892	0	0	PRETORIUS, KELLY ALLISON	8/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
301831	Non-Physician Medical Practitioner	None	1609304963	0	0	PARKER, REBECCA L NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 KELLS CIR	None	VACAVILLE	CA	95688	8569	00	06000	38.39372819	-121.9689559	Solano County
301858	Non-Physician Medical Practitioner	None	1447269766	0	0	PEQUENO, LENNIE PA	11/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 40TH STREET	None	BAKERSFIELD	CA	93301	1224	00	06000	35.39619932	-119.0074457	Kern County
301864	Non-Physician Medical Practitioner	None	1043339831	0	0	PAIVA, WENDY	8/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3920 EAGLE ROCK BLVD	SUITE A	LOS ANGELES	CA	90065	3606	00	06000	34.11936223	-118.230111	Los Angeles County
301914	Non-Physician Medical Practitioner	None	1811451826	0	0	PHAM, SANDY PA	1/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6719 ALVARADO ROAD	SUITE 200	SAN DIEGO	CA	92120	5256	00	06000	32.77684978	-117.055137	San Diego County
301938	Non-Physician Medical Practitioner	None	1306559653	0	0	PATEL, SONALI	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	00	06000	33.90273823	-118.2557598	Los Angeles County
301940	Non-Physician Medical Practitioner	None	1316221617	0	0	PLANNED PARENTHOOD MAR MONTE	6/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29 BAYWOOD AVE	None	SAN MATEO	CA	94402	1516	00	06000	37.56478204	-122.3289243	San Mateo County
301942	Non-Physician Medical Practitioner	None	1881329373	0	0	PARBO, ASHLEY A PA	11/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
301945	Non-Physician Medical Practitioner	None	1568860179	0	0	PELZ, MOLLY A	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4554 GUNDRY AVE	None	LONG BEACH	CA	90807	1817	00	06000	33.84089152	-118.1724621	Los Angeles County
301950	Non-Physician Medical Practitioner	None	1538357579	0	0	PETERS, CHRISTIANE ALISA	6/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3737 LONE TREE WAY	None	ANTIOCH	CA	94509	6065	00	06000	37.983654	-121.805622	Contra Costa County
301962	Non-Physician Medical Practitioner	None	1467425587	0	0	PLOURD, DONNA M NP	11/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
301976	Non-Physician Medical Practitioner	None	1225549082	0	0	PARK, LISA S NP	4/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 IDAHO AVE	APT 5	SANTA MONICA	CA	90403	2815	00	06000	34.02654657	-118.4990606	Los Angeles County
302005	Non-Physician Medical Practitioner	None	1871805127	0	0	PEAVY, SPRING M NP	5/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 N HARBOR BLVD	None	ANAHEIM	CA	92805	1810	00	06000	33.84310811	-117.92254	Orange County
302006	Non-Physician Medical Practitioner	None	1871262394	0	0	POLEVOI, DANIELLE E PA	5/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302040	Non-Physician Medical Practitioner	None	1760765846	0	0	POPE, CHAD P	11/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 STANLEY AVE	None	PACIFICA	CA	94044	3942	00	06000	37.59573929	-122.5112239	San Mateo County
302063	Non-Physician Medical Practitioner	None	1649696873	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	5/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	116 S PALISADE DR	SUITE 104	SANTA MARIA	CA	93454	8904	00	06000	34.9523869	-120.4120717	Santa Barbara County
302099	Non-Physician Medical Practitioner	None	1063816882	0	0	PARK, SEU NA NP	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7214 ANDREA ST	None	FONTANA	CA	92336	4413	00	06000	34.12287732	-117.4737622	San Bernardino County
302125	Non-Physician Medical Practitioner	None	1750795902	0	0	PASCO, JOANNE O NP	9/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	00	06000	34.02648965	-118.4867439	Los Angeles County
302134	Non-Physician Medical Practitioner	None	1659878882	0	0	PHAN, MY PHUONG T NP	10/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
302145	Non-Physician Medical Practitioner	None	1083128128	0	0	PHAM, CAITLIN C NP	1/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
302151	Non-Physician Medical Practitioner	None	1588716195	0	0	PAPAMICHAIL, SOTIRIS T	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3425 NOBLESSA WAY	None	RANCHO CORDOVA	CA	95670	6931	00	06000	38.578293	-121.274118	Sacramento County
302156	Non-Physician Medical Practitioner	None	1851408025	0	0	POWELL, MARIROSE	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3800 DALE RD	None	MODESTO	CA	95356	8627	00	06000	37.69395556	-121.0499498	Stanislaus County
302180	Non-Physician Medical Practitioner	None	1932153319	0	0	PHAM, JOHN D	5/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16 WHITNEY	None	IRVINE	CA	92620	3386	00	06000	33.70297261	-117.7641112	Orange County
302182	Non-Physician Medical Practitioner	None	1356159511	0	0	PERALTA, LESLYN D NP	2/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4013 BROCKTON AVE	None	RIVERSIDE	CA	92501	3440	00	06000	33.98177617	-117.3807605	Riverside County
302185	Non-Physician Medical Practitioner	None	1972137446	0	0	PHAN, TRACY NP	2/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	165 N CLARK ST	None	FRESNO	CA	93701	2108	00	06000	36.74454278	-119.786043	Fresno County
302188	Non-Physician Medical Practitioner	None	1578529830	0	0	PIDERMANN, BARBARA	4/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1090 3RD ST	None	SOUTH LAKE TAHOE	CA	96150	3485	00	06000	38.91492536	-119.9966528	El Dorado County
302255	Non-Physician Medical Practitioner	None	1417261165	0	0	PETRIK, ANNA PA	7/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6560 GREENBACK LN	None	CITRUS HEIGHTS	CA	95621	6237	00	06000	38.677716	-121.310793	Sacramento County
302257	Non-Physician Medical Practitioner	None	1700144334	0	0	POKOJNI, ISAAC	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
302278	Non-Physician Medical Practitioner	None	1629373030	0	0	PEREZ, JAIME D	3/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4556 UNIVERSITY AVENUE	None	RIVERSIDE	CA	92501	3038	00	06000	33.98677202	-117.3851796	Riverside County
302303	Non-Physician Medical Practitioner	None	1326786120	0	0	PHAM, CHRISTINE PA	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302307	Non-Physician Medical Practitioner	None	1568697795	0	0	PALLAN, ROSA MARIA	8/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3559 E GAGE AVE	None	BELL	CA	90201	1049	00	06000	33.9796373	-118.2015917	Los Angeles County
302322	Non-Physician Medical Practitioner	None	1730723677	0	0	PORTER, KATHRYN R PA-C	1/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W. 4TH ST	None	PERRIS	CA	92570	2010	00	06000	33.78233553	-117.2305035	Riverside County
302365	Non-Physician Medical Practitioner	None	1467763755	0	0	PEDREGO, VANESSA C	11/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1866 N ORANGE GROVE AVE	SUITE 201	POMONA	CA	91767	3031	00	06000	34.07771682	-117.7485431	Los Angeles County
302400	Non-Physician Medical Practitioner	None	1316584907	0	0	PEREIDA, CHRISTOPHER T NP	2/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
302405	Non-Physician Medical Practitioner	None	1164951422	0	0	PEARSON, BROOKE PA	2/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
302409	Non-Physician Medical Practitioner	None	1205973948	0	0	PICHA, JESSICA M CNM	4/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1535 VIA OTANO	None	OCEANSIDE	CA	92056	5631	00	06000	33.21952552	-117.2908118	San Diego County
302411	Non-Physician Medical Practitioner	None	1871167908	0	0	PELLETIER, SARA F PA	5/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
302413	Non-Physician Medical Practitioner	None	1528437340	0	0	PALT, RYAN D	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5626 DEER CREEK WAY	None	PASO ROBLES	CA	93446	9209	00	06000	35.68280735	-120.599552	San Luis Obispo County
302423	Non-Physician Medical Practitioner	None	1467755249	0	0	PARKER VALLEY EMERGENCY PHYSICIANS MEDICAL GROUP I	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TER	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
302429	Non-Physician Medical Practitioner	None	1528086782	0	0	PEREZ, VERONICA	9/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	SUITE 300	SACRAMENTO	CA	95816	5238	00	06000	38.570076	-121.4657145	Sacramento County
302442	Non-Physician Medical Practitioner	None	1861404329	0	0	PULLEN, ELINOR	6/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	679 S WESTLAKE AVE	None	LOS ANGELES	CA	90057	3505	00	06000	34.05635295	-118.2754139	Los Angeles County
302453	Non-Physician Medical Practitioner	None	1366624843	0	0	PEISTRUP, GREGORY L NP	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7423 DESERTSCAPE AVE	None	LAS VEGAS	NV	89178	8801	00	06000	36.00609778	-115.254234	Clark County
302464	Non-Physician Medical Practitioner	None	1508130311	0	0	PHAN, TUNG A PA	10/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
302490	Non-Physician Medical Practitioner	None	1235157967	0	0	PEACH TREE HEALTHCARE	6/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	724 5TH ST	None	MARYSVILLE	CA	95901	5646	00	06000	39.13984082	-121.5945596	Yuba County
302507	Non-Physician Medical Practitioner	None	1649232075	0	0	PORTILLA, CONCHITA ESTHER	10/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	PEDIATRICS ADMINISTRATIO	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
302512	Non-Physician Medical Practitioner	None	1437527876	0	0	PETROMILLI, EMILY T NP	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1688 MENDOCINO	None	CONCORD	CA	94521	1118	00	06000	37.97316917	-121.9901316	Contra Costa County
302516	Non-Physician Medical Practitioner	None	1316494719	0	0	PLANTON, CHARLENE G NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 JEFFERSN AVE	APT 818	REDWOOD CITY	CA	94063	1791	00	06000	37.489518	-122.2284275	San Mateo County
302561	Non-Physician Medical Practitioner	None	1578805842	0	0	PUSATERI, SCOTT T PA	3/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302573	Non-Physician Medical Practitioner	None	1679211510	0	0	PWU, JOCELYN PA	9/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
302587	Non-Physician Medical Practitioner	None	1861435067	0	0	PARKHURST, JANIS G	1/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	264 PROSPECT STREET	None	OAK VIEW	CA	93022	9421	00	06000	34.39789119	-119.3056939	Ventura County
302596	Non-Physician Medical Practitioner	None	1447626627	0	0	PARULAN, ETHEL C A NP	6/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20203 NORTHCOVE SQUARE	None	CUPERTINO	CA	95014	0505	00	06000	37.33528596	-122.0278359	Santa Clara County
302602	Non-Physician Medical Practitioner	None	1770885535	0	0	PLASCENCIA, KARLA E NP	10/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1035 39TH STREET	UNIT 10	SACRAMENTO	CA	95816	5548	00	06000	38.569167	-121.454415	Sacramento County
302605	Non-Physician Medical Practitioner	None	1144704933	0	0	PEDDYCORD, KRISTEN NP	3/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	06000	35.002656	-114.595893	Mohave County
302610	Non-Physician Medical Practitioner	None	1164963716	0	0	PRAKASH, REBECCA T S NP	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21137 LASSEN ST	UNIT 1	CHATSWORTH	CA	91311	6824	00	06000	34.2500195	-118.5939945	Los Angeles County
302636	Non-Physician Medical Practitioner	None	1518247436	0	0	PETER-TRUESDELL, JILLIAN NP	7/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13744 CAMINO DEL SUELO	None	SAN DIEGO	CA	92129	4430	00	06000	32.96728284	-117.1404856	San Diego County
302650	Non-Physician Medical Practitioner	None	1063797769	0	0	PAOLA, PORRECA	9/30/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10582 E 29TH DRIVE	None	DENVER	CO	80238	3549	00	06000	39.75881947	-104.865003	Denver County
302655	Non-Physician Medical Practitioner	None	1619196474	0	0	PERALTA, MIGUEL A	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4802 HAZELBROOK AVE	None	LONG BEACH	CA	90808	1027	00	06000	33.844869	-118.1392415	Los Angeles County
302674	Non-Physician Medical Practitioner	None	1336548239	0	0	PHAM, ARIANNA T P T	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	904 KNOLLFIELD WAY	None	SAN JOSE	CA	95136	1752	00	06000	37.26672718	-121.8688149	Santa Clara County
302697	Non-Physician Medical Practitioner	None	1720369945	0	0	POPOVICH, LAURA S NP	9/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S WINCHESTER BLVD	4104	SAN JOSE	CA	95128	2984	00	06000	37.31274	-121.950199	Santa Clara County
302716	Non-Physician Medical Practitioner	None	1356890347	0	0	POHL, NATALIE M PA	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
302738	Non-Physician Medical Practitioner	None	1811771520	0	0	PATEL, SHEEL	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302753	Non-Physician Medical Practitioner	None	1831377829	0	0	PERAFAN, JEANNE M	12/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	80633 PLUM LANE	None	INDIO	CA	92201	8497	00	06000	33.69581148	-116.2577469	Riverside County
302783	Non-Physician Medical Practitioner	None	1639682164	0	0	PHILLIPS, CALLIE PA-C	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
302791	Non-Physician Medical Practitioner	None	1477137693	0	0	PENN, EBONY	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302825	Non-Physician Medical Practitioner	None	1225895253	0	0	PEREZ-CURIEL, PAULINA PA	8/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44045 MARGARITA RD	STE 106	TEMECULA	CA	92592	2729	00	06000	33.48351542	-117.1027964	Riverside County
302838	Non-Physician Medical Practitioner	None	1598131211	0	0	PRIOR, TAMI L NP	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10576 SOMERSET DR	None	TRUCKEE	CA	96161	1220	00	06000	39.34721771	-120.091849	Nevada County
302851	Non-Physician Medical Practitioner	None	1356689871	0	0	PEDERSEN, ANDREA	5/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	747 52ND ST	ENDOCRINE 1ST FLOOR	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
302863	Non-Physician Medical Practitioner	None	1366144180	0	0	PHAM, NGOC T NP	6/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
302867	Non-Physician Medical Practitioner	None	1275974461	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	4/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 S PALISADE DR	SUITE 101	SANTA MARIA	CA	93454	8901	00	06000	34.95169604	-120.4120907	Santa Barbara County
302878	Non-Physician Medical Practitioner	None	1225428600	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	10/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	265 POSADA LN	SUITE B	TEMPLETON	CA	93465	4056	00	06000	35.55354235	-120.7214149	San Luis Obispo County
302882	Non-Physician Medical Practitioner	None	1447215314	0	0	PEREZ, KATHERINE NP	7/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	00	06000	38.572551	-121.4181585	Sacramento County
302889	Non-Physician Medical Practitioner	None	1558606756	0	0	PETERNELL, BRONWEN S	8/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6206 VIEW CREST DR	None	OAKLAND	CA	94619	1067	00	06000	37.7845338	-122.1657451	Alameda County
302890	Non-Physician Medical Practitioner	None	1912924754	0	0	PALSA, MEGAN	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 HAWTHORNE AVE	None	OAKLAND	CA	94609	3107	00	06000	37.82079728	-122.2633226	Alameda County
302917	Non-Physician Medical Practitioner	None	1346538592	0	0	PINEDA, JENNIFER T NP	8/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23517 MAIN ST	SUITE 103	CARSON	CA	90745	5234	00	06000	33.81129174	-118.2756933	Los Angeles County
302934	Non-Physician Medical Practitioner	None	1912307158	0	0	PORTO, ALEXANDER Y PA-C	2/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	00	06000	38.598876	-121.4502885	Sacramento County
302955	Non-Physician Medical Practitioner	None	1851870679	0	0	POANDL, ALISON C PA-C	10/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 SAN JOSE	None	SALINAS	CA	93901	3901	00	06000	36.6582359	-121.6463252	Monterey County
302986	Non-Physician Medical Practitioner	None	1679178297	0	0	PEDRAZA, CASSANDRA M NP	8/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	00	06000	34.06794352	-118.1229278	Los Angeles County
302997	Non-Physician Medical Practitioner	None	1477977973	0	0	PLANNED PARENTHOOD MAR MONTE INC.	6/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2907 EL CAMINO REAL	None	REDWOOD CITY	CA	94061	4003	00	06000	37.46906354	-122.2114417	San Mateo County
303013	Non-Physician Medical Practitioner	None	1568770725	0	0	PERALTA, LISETTE	10/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12832 ADAH LANE	None	POWAY	CA	92084	5850	00	06000	32.95266344	-117.0300256	San Diego County
303019	Non-Physician Medical Practitioner	None	1528007747	0	0	PRICE, RITA LAU	10/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8930 S SEPULVEDA BLVD	SUITE 114	LOS ANGELES	CA	90045	3606	00	06000	33.955128	-118.3961915	Los Angeles County
303022	Non-Physician Medical Practitioner	None	1619150752	0	0	PETERSON, BART J	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30363 PELICAN BAY	UNIT A	MURRIETA	CA	92563	8103	00	06000	33.54973615	-117.1310347	Riverside County
303026	Non-Physician Medical Practitioner	None	1427161488	0	0	PARK, DEALIE	6/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6815 NOBLE AVE	None	VAN NUYS	CA	91405	3796	00	06000	34.19440435	-118.461871	Los Angeles County
303032	Non-Physician Medical Practitioner	None	1013192228	0	0	PHAM, THU LAN T	2/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
303096	Non-Physician Medical Practitioner	None	1174245021	0	0	PETERSEN, ANNA NP	5/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1108 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3476	00	06000	38.912904	-119.998638	El Dorado County
303098	Non-Physician Medical Practitioner	None	1932454709	0	0	PATEL, SHEENA P PA	4/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
303099	Non-Physician Medical Practitioner	None	1508056854	0	0	PATTERSON, TRICIA	1/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	00	06000	40.57278686	-122.3958519	Shasta County
303148	Non-Physician Medical Practitioner	None	1336158328	0	0	PAGANO, TERRI D	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	349 FILLMORE STREET	APT 101	SAN FRANCISCO	CA	94117	3426	00	06000	37.77280484	-122.4305925	San Francisco County
303150	Non-Physician Medical Practitioner	None	1366584773	0	0	POSE, KATRINA A	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	875 BLAKE WILBUR DR	MAIL CODE 5820	PALO ALTO	CA	94304	2205	00	06000	37.43562782	-122.1766097	Santa Clara County
303162	Non-Physician Medical Practitioner	None	1174833263	0	0	PANLILIO, JAMES P	10/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15313 PASTRANA DR	None	LA MIRADA	CA	90638	3953	00	06000	33.90219761	-118.0058688	Los Angeles County
303166	Non-Physician Medical Practitioner	None	1346786647	0	0	PASCUAL, LEAH A RN	11/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9422 WYSTONE AVE	None	NORTHRIDGE	CA	91324	2836	00	06000	34.24188771	-118.5452789	Los Angeles County
303199	Non-Physician Medical Practitioner	None	1881307049	0	0	PENTON, ALYSSA PA	9/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13365 W WASHINGTON BLVD	None	CULVER CITY	CA	90066	5134	00	06000	33.99238471	-118.4439832	Los Angeles County
303221	Non-Physician Medical Practitioner	None	1033201298	0	0	PETERLIN, MARCUS M	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE RM A80	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
303258	Non-Physician Medical Practitioner	None	1215103098	0	0	PURI, MEESHA	3/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
303299	Non-Physician Medical Practitioner	None	1871359851	0	0	PEREZ, KELLY A NP	10/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
303304	Non-Physician Medical Practitioner	None	1740505262	0	0	PLANNED PARENTHOOD SHASTA DIABLO INC	7/16/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 EL CERRITO PLAZA	None	EL CERRITO	CA	94530	0000	00	06000	37.89921493	-122.2981973	Contra Costa County
303311	Non-Physician Medical Practitioner	None	1669848222	0	0	PASILLAS, DESIREE A	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3257 PONTIAC AVENUE	None	RIVERSIDE	CA	92509	4430	00	06000	34.00312068	-117.4035866	Riverside County
303328	Non-Physician Medical Practitioner	None	1285973388	0	0	PARKER, TRACY L	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1846 TEE BOX WY	None	HENDERSON	NV	89074	1736	00	06000	36.027972	-115.0678495	Clark County
303378	Non-Physician Medical Practitioner	None	1053980052	0	0	PENALOSA, YLIANA M NP	12/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	00	06000	33.8420837	-117.9415765	Orange County
303392	Non-Physician Medical Practitioner	None	1437422896	0	0	PARMAR, NISHA	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	258A 4TH AVE	None	SAN FRANCISCO	CA	94118	2468	00	06000	37.78389434	-122.462278	San Francisco County
303411	Non-Physician Medical Practitioner	None	1588267827	0	0	PARFREY, KATIE E NP	3/31/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	STE 707	LOS ANGELES	CA	90017	4807	00	06000	34.05362775	-118.2661889	Los Angeles County
303433	Non-Physician Medical Practitioner	None	1407925209	0	0	PETERS, REGINALD R	6/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16922 NANDINA AVE	None	RIVERSIDE	CA	92504	8826	00	06000	33.86532734	-117.3665602	Riverside County
303471	Non-Physician Medical Practitioner	None	1659396620	0	0	PRIMO, DANA PA	2/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	880 S ATLANTIC BLVD	SUITE 205	MONTEREY PARK	CA	91754	4782	00	06000	34.05038485	-118.1383456	Los Angeles County
303473	Non-Physician Medical Practitioner	None	1689042798	0	0	PANLILIO, ADRIENNE	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2515 W PICO BLVD	None	LOS ANGELES	CA	90006	4003	00	06000	34.04730048	-118.292283	Los Angeles County
303474	Non-Physician Medical Practitioner	None	1942459607	0	0	PARKS, PAT PA	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7111 FRESNO ST	STE 200	FRESNO	CA	93720	2965	00	06000	36.83951763	-119.7815709	Fresno County
303481	Non-Physician Medical Practitioner	None	1225426588	0	0	PLANNED PARENTHOOD MAR MONTE, INC.	5/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8480 ENTERPRISE WAY	None	OAKLAND	CA	94621	1318	00	06000	37.74207882	-122.1925503	Alameda County
303495	Non-Physician Medical Practitioner	None	1245738558	0	0	PIERCE, MORGAN B NP	10/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
303499	Non-Physician Medical Practitioner	None	1750443131	0	0	PETERSON, ALAN GUNNAR	5/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
303518	Non-Physician Medical Practitioner	None	1831773498	0	0	POPAL, HUMAYUN M NP	2/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1503 E MARCH LN	A	STOCKTON	CA	95210	5622	00	06000	38.00228434	-121.2903651	San Joaquin County
303532	Non-Physician Medical Practitioner	None	1679924724	0	0	PHAN, TRAM NP	9/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14971 BROOKHURST STREET	None	WESTMINSTER	CA	92683	6071	00	06000	33.74536854	-117.9549525	Orange County
303536	Non-Physician Medical Practitioner	None	1326144577	0	0	PANIAGUA, CALVIN F JR	9/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6677 APOLLOS GATE COURT	None	LAS VEGAS	NV	89142	3610	00	06000	36.13897851	-115.02729	Clark County
303543	Non-Physician Medical Practitioner	None	1750739173	0	0	PARRA, GLORIA NP	10/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	451 CLIFFWOOD AVE	None	BREA	CA	92821	3629	00	06000	33.92559	-117.889809	Orange County
303557	Non-Physician Medical Practitioner	None	1083108039	0	0	PAULSEN, PAULA M NP	7/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	00	06000	36.65837657	-121.6469645	Monterey County
303562	Non-Physician Medical Practitioner	None	1700937737	0	0	PERDUE, VELMA L	9/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10740 BENNETT DR	None	FONTANA	CA	92337	7549	00	06000	34.05869033	-117.4385573	San Bernardino County
303564	Non-Physician Medical Practitioner	None	1124073200	0	0	PUTNAM, MICHAEL J	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8 HUNTINGTON DRIVE	None	DALY CITY	CA	94015	3814	00	06000	37.6828564	-122.4853335	San Mateo County
303584	Non-Physician Medical Practitioner	None	1104223296	0	0	PERERA, MELANIE T	3/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	166 SALADA AVE	None	PACIFICA	CA	94044	2530	00	06000	37.63461851	-122.4908145	San Mateo County
303586	Non-Physician Medical Practitioner	None	1760879795	0	0	POON, DIANA C	6/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 DRIFTWOOD WAY	None	SAN LEANDRO	CA	94577	6513	00	06000	37.69263748	-122.1764164	Alameda County
303599	Non-Physician Medical Practitioner	None	1619457876	0	0	PINIZZOTTO, EMMA J PA-C	7/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3900 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5352	00	06000	37.8249684	-122.2542554	Alameda County
303625	Non-Physician Medical Practitioner	None	1760411920	0	0	PENATE, JOSE C	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
303713	Non-Physician Medical Practitioner	None	1396448866	0	0	PUNSAL, CELESTE	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303715	Non-Physician Medical Practitioner	None	1548278559	0	0	PATHARE, JODY R NP	8/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	387 E 21ST ST	None	COSTA MESA	CA	92627	2156	00	06000	33.64237085	-117.9017064	Orange County
303734	Non-Physician Medical Practitioner	None	1386663805	0	0	PETERSEN, DENISE K	12/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	#1617	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
303739	Non-Physician Medical Practitioner	None	1306593041	0	0	PHUN, KEVIN	3/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2418 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	3674	00	06000	34.0558524	-118.0905163	Los Angeles County
303742	Non-Physician Medical Practitioner	None	1932666815	0	0	PHAM, EMI PA	8/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5630 SANTA ANA CANYON	None	ANAHEIM	CA	92807	3122	00	06000	33.85124385	-117.7915652	Orange County
303757	Non-Physician Medical Practitioner	None	1457332504	0	0	PHAM, JOHNNY-AN T	3/3/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5443 E LANAI ST	None	LONG BEACH	CA	90808	3555	00	06000	33.81599293	-118.1259553	Los Angeles County
303817	Non-Physician Medical Practitioner	None	1467535328	0	0	PATEL, LOPA N NP	9/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	00	06000	37.24572659	-121.957997	Santa Clara County
303835	Non-Physician Medical Practitioner	None	1871275123	0	0	PANDHER, MANPREET NP	4/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	00	06000	35.356392	-119.092153	Kern County
303841	Non-Physician Medical Practitioner	None	1326310640	0	0	PAULHUS, PATRICIA A NP	10/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28535 CRAIG AVENUE	None	MENIFEE	CA	92584	8577	00	06000	33.66319177	-117.1619675	Riverside County
303885	Non-Physician Medical Practitioner	None	1174383053	0	0	PECHACEK-AQUINO, FRANCIS MATTHEW PA-C	7/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	06000	36.21499805	-115.2504953	Clark County
303886	Non-Physician Medical Practitioner	None	1205187804	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	6/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 S PALISADE DR	SUITE 201	SANTA MARIA	CA	93454	8902	00	06000	34.95143521	-120.412098	Santa Barbara County
303897	Non-Physician Medical Practitioner	None	1871694166	0	0	POTTER, SUSAN B	1/9/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2220 VIA LINDA COURT	None	CARMICHAEL	CA	95608	5058	00	06000	38.605329	-121.3440255	Sacramento County
303905	Non-Physician Medical Practitioner	None	1578928321	0	0	PHAN, THANHTRUC H NP	6/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	00	06000	32.781195	-117.0070695	San Diego County
303910	Non-Physician Medical Practitioner	None	1306427786	0	0	PINE, KATRINA L PA	9/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303916	Non-Physician Medical Practitioner	None	1770617755	0	0	PONCE, DUNIA L NP	2/8/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20954 HALLDALE AVE	None	TORRANCE	CA	90501	2337	00	06000	33.83817107	-118.3017024	Los Angeles County
303929	Non-Physician Medical Practitioner	None	1245947308	0	0	PAKDAMANIAN, KAYVON	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18200 YORBA LINDA BLVD	101-102	YORBA LINDA	CA	92886	4006	00	06000	33.88842824	-117.8154698	Orange County
303946	Non-Physician Medical Practitioner	None	1801361571	0	0	PEARCY, JAYMIE D	11/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8329 STORY RIDGE WAY	None	ANTELOPE	CA	95843	5235	00	06000	38.72205	-121.369599	Sacramento County
303948	Non-Physician Medical Practitioner	None	1689829210	0	0	PADILLA, LUCIA	12/30/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20700 SAN JOSE HILLS	None	WALNUT	CA	91789	1331	00	06000	34.04547002	-117.8506336	Los Angeles County
303972	Non-Physician Medical Practitioner	None	1861611386	0	0	PAK, PATRICK	8/7/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1307 W 6TH ST	SUITE 113	CORONA	CA	92882	3294	00	06000	33.87790309	-117.589666	Riverside County
303978	Non-Physician Medical Practitioner	None	1548296650	0	0	PETRIKAS, REGINA M	8/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4305 TORRANCE BLVD STE 1	None	TORRANCE	CA	90503	4400	00	06000	33.83759546	-118.359342	Los Angeles County
303979	Non-Physician Medical Practitioner	None	1588175988	0	0	PRICE-GIBSON, TAJ N NP	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	320 S. AVENUE 60	None	LOS ANGELES	CA	90042	4204	00	06000	34.10875623	-118.187108	Los Angeles County
303985	Non-Physician Medical Practitioner	None	1811352909	0	0	PETERS, KAITLYN A	9/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1539 REDWOOD AVE	None	REDWOOD CITY	CA	94061	2136	00	06000	37.46752988	-122.2341694	San Mateo County
303988	Non-Physician Medical Practitioner	None	1760723910	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	00	06000	34.95203385	-120.4131707	Santa Barbara County
304018	Non-Physician Medical Practitioner	None	1639841869	0	0	PEREZ-ANDRADE, MADELINE C PA	5/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	00	06000	34.44257521	-119.7584538	Santa Barbara County
304083	Non-Physician Medical Practitioner	None	1871033530	0	0	POWERS, JAMES J NP	5/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3551 Q ST	None	BAKERSFIELD	CA	93301	1657	00	06000	35.392059	-119.010556	Kern County
304091	Non-Physician Medical Practitioner	None	1396722138	0	0	PARSONS, JENNIFER K	8/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2668 S ADAMS ST	None	DENVER	CO	80210	6232	00	06000	39.668283	-104.9488405	Denver County
304093	Non-Physician Medical Practitioner	None	1356947253	0	0	PARSA, SEAN B PA-C	2/9/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	00	06000	33.837354	-116.545572	Riverside County
304105	Non-Physician Medical Practitioner	None	1407695257	0	0	PONCE BERNAL, LAURA NP	8/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9792 SIERRA AVE	None	FONTANA	CA	92335	6717	00	06000	34.0757348	-117.4357502	San Bernardino County
304107	Non-Physician Medical Practitioner	None	1770090508	0	0	PEOPLES, AMANDA L NP	11/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	00	06000	38.669886	-121.3127505	Sacramento County
304118	Non-Physician Medical Practitioner	None	1457977597	0	0	PATEL, WENDY S PA-C	8/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	00	06000	34.133598	-118.1534895	Los Angeles County
304130	Non-Physician Medical Practitioner	None	1205319290	0	0	PRUETT, CRISTINA R	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1207 LEAVENWORTH ST	None	SAN FRANCISCO	CA	94109	4010	00	06000	37.79238834	-122.4159992	San Francisco County
304133	Non-Physician Medical Practitioner	None	1205532553	0	0	PISHEV, CHRISTOPHER B PA-C	5/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
304162	Non-Physician Medical Practitioner	None	1366879306	0	0	PENG, MAYRA A PA	2/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
304174	Non-Physician Medical Practitioner	None	1134222169	0	0	POWELL, SHIRLEY L PA	3/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	00	06000	40.57119566	-122.4016582	Shasta County
304181	Non-Physician Medical Practitioner	None	1801658109	0	0	PEREZ, CEASAR NP	6/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
304214	Non-Physician Medical Practitioner	None	1376728253	0	0	PATEL, NIMA B	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	195 LONDON CT	None	SAN BRUNO	CA	94066	3905	00	06000	37.60898478	-122.4292831	San Mateo County
304221	Non-Physician Medical Practitioner	None	1760742225	0	0	PEREZ, MELANIE P B NP	4/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5263 COACH DR	None	EL SOBANTE	CA	94803	3865	00	06000	37.96689185	-122.258783	Contra Costa County
304263	Non-Physician Medical Practitioner	None	1639762289	0	0	PAGUIO, DARLENE PA	10/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23600 TELO AVE	STE 250	TORRANCE	CA	90505	4037	00	06000	33.81215054	-118.3384029	Los Angeles County
304284	Non-Physician Medical Practitioner	None	1265076996	0	0	PHAN, VICTORIA H NP	4/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
304290	Non-Physician Medical Practitioner	None	1518532795	0	0	PINEDA, ALEXANDRA G NP	3/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	00	06000	37.66383747	-122.4671404	San Mateo County
304302	Non-Physician Medical Practitioner	None	1043511744	0	0	PERALTA, JOYCE V NP	4/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23067 MISSION DRIVE	None	CARSON	CA	90745	4954	00	06000	33.81657552	-118.2655205	Los Angeles County
304304	Non-Physician Medical Practitioner	None	1487386017	0	0	PHAM, DOLLY NP	7/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13365 W WASHINGTON BLVD	None	CULVER CITY	CA	90066	5134	00	06000	33.99238471	-118.4439832	Los Angeles County
304309	Non-Physician Medical Practitioner	None	1538943758	0	0	PHILIPP, STEPHANIE NP	9/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
304358	Non-Physician Medical Practitioner	None	1578630240	0	0	PLUCKHAN, DEBORAH JEAN	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	00	06000	37.34234284	-121.9776787	Santa Clara County
304360	Non-Physician Medical Practitioner	None	1609423599	0	0	PHILPOTT, KAITLYN E PA-C	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	00	06000	34.04925	-118.2177405	Los Angeles County
304404	Non-Physician Medical Practitioner	None	1821431321	0	0	PUN, JOANN B NP	3/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST STREET	STE 400	SAN DIEGO	CA	92123	2753	00	06000	32.80027449	-117.153846	San Diego County
304417	Non-Physician Medical Practitioner	None	1437931920	0	0	PELAGIO, MICHELLE NP	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3006	00	06000	34.07803211	-117.74833	Los Angeles County
304429	Non-Physician Medical Practitioner	None	1972857498	0	0	PRAWAT, HANNAH R	11/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1045 3RD STREET	APT 302	SANTA MONICA	CA	90403	3708	00	06000	34.02012787	-118.5013318	Los Angeles County
304440	Non-Physician Medical Practitioner	None	1962960906	0	0	PENG, JESSIE L NP	12/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
304459	Non-Physician Medical Practitioner	None	1477744639	0	0	PEARSON, MARISA ALEXANDRA	9/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1136 E MONTECITO ST	None	SANTA BARBARA	CA	93103	2635	00	06000	34.42699433	-119.6800449	Santa Barbara County
304494	Non-Physician Medical Practitioner	None	1972048353	0	0	PENA-DONADY, MARIOLY NP	6/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5535 WESTLAWN AVE	APT 105	LOS ANGELES	CA	90066	7071	00	06000	33.98065708	-118.414754	Los Angeles County
304532	Non-Physician Medical Practitioner	None	1063132181	0	0	PHILIP, CAROLINE M NP	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
304574	Non-Physician Medical Practitioner	None	1982753117	0	0	PATTERSON, PATRICIA E PA	4/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
304578	Non-Physician Medical Practitioner	None	1376814202	0	0	POWELL, MELIKA K NP	4/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27522 ANTONIO PKWY	P3	LADERA RANCH	CA	92694	2166	00	06000	33.56343335	-117.6292292	Orange County
304606	Non-Physician Medical Practitioner	None	1407071087	0	0	PONSONES, GIL R NP	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 MARIN CENTER DRIVE	APT 46	SAN RAFAEL	CA	94903	2720	00	06000	38.00823187	-122.5405966	Marin County
304611	Non-Physician Medical Practitioner	None	1447672027	0	0	PETERS, VALERIE S NP	11/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32 STONE HARBOR	None	ALAMEDA	CA	94502	6525	00	06000	37.74078246	-122.2399603	Alameda County
304634	Non-Physician Medical Practitioner	None	1700197449	0	0	PRUNA, VERONICA	12/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 S BEACH BLVD STE B	None	LA HABRA	CA	90631	5180	00	06000	33.930531	-117.9677315	Orange County
304663	Non-Physician Medical Practitioner	None	1871830810	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 PEACH ST	SUITE B	SAN LUIS OBISPO	CA	93401	2837	00	06000	35.28647825	-120.6599674	San Luis Obispo County
304687	Non-Physician Medical Practitioner	None	1780981266	0	0	PELLECCHIA, KRISTYN G NP	10/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4845 TULA CT	None	SAN DIEGO	CA	92122	2844	00	06000	32.85711888	-117.1897988	San Diego County
304689	Non-Physician Medical Practitioner	None	1669846077	0	0	PANORINGAN, GENESSA M NP	8/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
304717	Non-Physician Medical Practitioner	None	1518224377	0	0	PANKOWSKI, THERESA	6/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	00	06000	37.25111017	-121.9465891	Santa Clara County
304735	Non-Physician Medical Practitioner	None	1174016455	0	0	PULTZ, CLAIRE M PA-C	7/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
304761	Non-Physician Medical Practitioner	None	1841825585	0	0	PATEL, BHUMI K PA-C	9/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33494 OAK GLEN RD	None	YUCAIPA	CA	92399	2057	00	06000	34.03255442	-117.0737219	San Bernardino County
304781	Non-Physician Medical Practitioner	None	1396163945	0	0	POKKAMTHANAM, SUNEENA S PA-C	8/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13682 ESTERO CIR	None	TUSTIN	CA	92870	4555	00	06000	33.74090587	-117.8172622	Orange County
304797	Non-Physician Medical Practitioner	None	1205499241	0	0	PATEL, KARISHMA S NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
304820	Non-Physician Medical Practitioner	None	1821006917	0	0	PFEIFF, CYNTHIA A	1/28/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	80 GRAND AVENUE	SUITE 300	OAKLAND	CA	94612	0000	00	06000	37.81147674	-122.2656076	Alameda County
304843	Non-Physician Medical Practitioner	None	1285725895	0	0	PETERSON, DEBRA DIANE	12/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 EAST 7TH AVE	SUITE D	CHICO	CA	95926	0000	00	06000	39.74473059	-121.8488381	Butte County
304863	Non-Physician Medical Practitioner	None	1811502545	0	0	PATEL, EKTA PA	10/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 RIVER PARK DR	STE 120	SACRAMENTO	CA	95815	4506	00	06000	38.597571	-121.4392905	Sacramento County
304865	Non-Physician Medical Practitioner	None	1366952020	0	0	PAKAWONGSE, LILLY NP	1/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2970 HILLTOP MALL ROAD	305	RICHMOND	CA	94806	1947	00	06000	37.97819764	-122.329244	Contra Costa County
304909	Non-Physician Medical Practitioner	None	1073767901	0	0	PATRICIA, TULLY	11/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
304945	Non-Physician Medical Practitioner	None	1881142438	0	0	PAN, SUWEN W NP	4/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	00	06000	33.68987636	-117.9542321	Orange County
304956	Non-Physician Medical Practitioner	None	1518427541	0	0	PROPHETE, LALLIANA D NP	6/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 WEST I ST	None	LOS BANOS	CA	95616	6201	00	06000	37.06346603	-120.8593647	Merced County
304977	Non-Physician Medical Practitioner	None	1457459547	0	0	PEREZ, LEONARDO	1/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1226 E MCFADDEN AVE	None	SANTA ANA	CA	92705	4106	00	06000	33.73357365	-117.8555408	Orange County
304988	Non-Physician Medical Practitioner	None	1124457015	0	0	PERAINO, TIFFANY PA	11/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	00	06000	33.87790309	-117.589666	Riverside County
305001	Non-Physician Medical Practitioner	None	1508648106	0	0	PATEL, JENNIE J PA-C	5/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	00	06000	33.85291987	-117.5664344	Riverside County
305039	Non-Physician Medical Practitioner	None	1649720517	0	0	PRATT, JAMES PA-C	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
305041	Non-Physician Medical Practitioner	None	1871964353	0	0	PUREWAL, STEPHANIE S	12/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	997 ANDERSON CIRCLE	None	WOODLAND	CA	95776	5100	00	06000	38.66484818	-121.7415892	Yolo County
305049	Non-Physician Medical Practitioner	None	1710024674	0	0	PILLER, JOSEPH V	1/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
305052	Non-Physician Medical Practitioner	None	1720419385	0	0	PHILLIPS, TODD S	2/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3151 SOARING GULLS DR	UNIT 1105	LAS VEGAS	NV	89128	7027	00	06000	36.21688657	-115.2742935	Clark County
305061	Non-Physician Medical Practitioner	None	1447444732	0	0	POHL, AMBER MICHELLE	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	685 PLACERVILLE DR	STE 314	PLACERVILLE	CA	95667	4231	00	06000	38.73153489	-120.8204326	El Dorado County
305074	Non-Physician Medical Practitioner	None	1518381961	0	0	PAI, YUNG-CHEN PA	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16404 COLIMA RD	None	HACIENDA HEIGHTS	CA	91745	5502	00	06000	33.98596755	-117.9536776	Los Angeles County
305076	Non-Physician Medical Practitioner	None	1336553767	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	6/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 POSADA LN	SUITE 202	TEMPLETON	CA	93465	4059	00	06000	35.55239522	-120.7215238	San Luis Obispo County
305122	Non-Physician Medical Practitioner	None	1184160186	0	0	PADILLA, DEANNA A NP	8/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
305127	Non-Physician Medical Practitioner	None	1225307317	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	6/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 E MAIN ST	SUITE 104-C	SANTA MARIA	CA	93454	4825	00	06000	34.95282793	-120.4100798	Santa Barbara County
305130	Non-Physician Medical Practitioner	None	1174064083	0	0	POMERANZ, MARCELLA NP	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	06000	36.19740597	-115.1207123	Clark County
305146	Non-Physician Medical Practitioner	None	1033851563	0	0	PINEDA, MARIA G NP	5/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
305147	Non-Physician Medical Practitioner	None	1922587450	0	0	PATZKE, SIERRA	11/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2801 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	06000	42.25271647	-121.787181	Klamath County
305175	Non-Physician Medical Practitioner	None	1972662039	0	0	PLANNED PARENTHOOD-NAPA	11/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
305192	Non-Physician Medical Practitioner	None	1285654038	0	0	PARTLOW, SHAUN PA	11/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	431 SANTA FE AVE	None	RICHMOND	CA	94801	3910	00	06000	37.92527757	-122.3882754	Contra Costa County
305196	Non-Physician Medical Practitioner	None	1619200128	0	0	PRATT, STACEY	3/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	00	06000	37.66383747	-122.4671404	San Mateo County
305210	Non-Physician Medical Practitioner	None	1841655768	0	0	PALMS, JO-ANN PA-C	11/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7590 MIRAMAR RD	STE C	SAN DIEGO	CA	92126	4232	00	06000	32.88443824	-117.1520684	San Diego County
305217	Non-Physician Medical Practitioner	None	1891160503	0	0	PATEL, CHIRAG V NP	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1830 ASHLAN AVE	None	CLOVIS	CA	93611	5297	00	06000	36.79388553	-119.6812305	Fresno County
305238	Non-Physician Medical Practitioner	None	1356789879	0	0	PRICE, SHAUNA W NP	8/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1195 PARQUE DR	None	CHICO	CA	95926	7339	00	06000	39.75804848	-121.827555	Butte County
305261	Non-Physician Medical Practitioner	None	1619361730	0	0	PEACH TREE HEALTHCARE	8/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 T STREET	None	SACRAMENTO	CA	95811	6822	00	06000	38.56595297	-121.4859736	Sacramento County
305263	Non-Physician Medical Practitioner	None	1902965676	0	0	PETRISON, LARISA	10/30/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305288	Non-Physician Medical Practitioner	None	1457012221	0	0	PYATKOVSKIY, STEPHANIE NP	5/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
305292	Non-Physician Medical Practitioner	None	1285063610	0	0	PATEL, FORUM P NP	9/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 OAKDALE RD	APT 69	MODESTO	CA	95355	2966	00	06000	37.67200156	-120.9576577	Stanislaus County
305295	Non-Physician Medical Practitioner	None	1649942467	0	0	PUCCI, JENNIFER W NP	10/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
305309	Non-Physician Medical Practitioner	None	1306356118	0	0	PARKER, TATSIANA PA	3/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
305321	Non-Physician Medical Practitioner	None	1447000138	0	0	PELIAS, KATHLEEN M NP	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 S A ST	STE 1	OXNARD	CA	93030	9252	00	06000	34.19225229	-119.178671	Ventura County
305332	Non-Physician Medical Practitioner	None	1962285825	0	0	PHAM, KARI	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
305375	Non-Physician Medical Practitioner	None	1932536745	0	0	PADEN, SYLVIA S NP	3/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1721 MONTARA AVE	None	SACRAMENTO	CA	95835	1228	00	06000	38.661282	-121.498128	Sacramento County
305433	Non-Physician Medical Practitioner	None	1982356481	0	0	PERDIGAO, ANTHONY J NP	2/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
305434	Non-Physician Medical Practitioner	None	1861017691	0	0	PASHALIDES, KATHRYN A PA	2/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
305442	Non-Physician Medical Practitioner	None	1144694068	0	0	PETERSON, NICOLE S PA-C	3/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W LUGONIA AVE	STE 310	REDLANDS	CA	92374	9704	00	06000	34.07027851	-117.218421	San Bernardino County
305444	Non-Physician Medical Practitioner	None	1972906998	0	0	PALUMBO, NICOLE PA	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12370 HESPERIA RD	SUITE 17	VICTORVILLE	CA	92395	7719	00	06000	34.47625382	-117.2913208	San Bernardino County
305453	Non-Physician Medical Practitioner	None	1043790397	0	0	PRATT, ASHLEY M NP	12/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	112 ARCHVIEW DR	None	BELLEVILLE	IL	62221	0422	00	06000	38.55209162	-89.91759592	St. Clair County
305457	Non-Physician Medical Practitioner	None	1487152534	0	0	PHAN, PHUNG N NP	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
305492	Non-Physician Medical Practitioner	None	1598706228	0	0	POST, JULIE A NP	4/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7318 N DANTE AVENUE	None	FRESNO	CA	93722	3468	00	06000	36.84166538	-119.8841603	Fresno County
305509	Non-Physician Medical Practitioner	None	1891089892	0	0	PIEROLA, CLAUDIA G PA-C	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12311 PACIFIC AVE	5	LOS ANGELES	CA	90066	4421	00	06000	34.00320695	-118.4320058	Los Angeles County
305513	Non-Physician Medical Practitioner	None	1417492950	0	0	PARK, CHRISTINE J PA-C	2/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
305515	Non-Physician Medical Practitioner	None	1093928491	0	0	POOLE, JOYCE J	8/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	707 DR MICHAEL DEBAKEY D	NEURO ASSOCIATES	LAKE CHARLES	LA	70601	5728	00	06000	30.21511352	-93.2308335	Calcasieu Parish
305521	Non-Physician Medical Practitioner	None	1265050546	0	0	PHAN, ANH PA	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1066 ATLANTIC AVE	SUITE B	LONG BEACH	CA	90813	3400	00	06000	33.78015	-118.1850225	Los Angeles County
305580	Non-Physician Medical Practitioner	None	1467708156	0	0	PURVIS, AMY J NP	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
305582	Non-Physician Medical Practitioner	None	1508253642	0	0	PICCOLA, JOSEPH R NP	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47 FIRWOOD	None	IRVINE	CA	92604	4633	00	06000	33.67775301	-117.7913548	Orange County
305614	Non-Physician Medical Practitioner	None	1225416472	0	0	PYLE, ALEXANDRA PA-C	5/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	00	06000	32.875668	-117.2139225	San Diego County
305620	Non-Physician Medical Practitioner	None	1114322518	0	0	PLANNED PARENTHOOD LOS ANGELES	8/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 N SAN VICENTE BLVD	None	WEST HOLLYWOOD	CA	90069	4505	00	06000	34.0855723	-118.3845783	Los Angeles County
305627	Non-Physician Medical Practitioner	None	1851345458	0	0	PUN, JANE C	6/19/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
305642	Non-Physician Medical Practitioner	None	1548931348	0	0	PAPPAS, MARINA S PA	4/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
305654	Non-Physician Medical Practitioner	None	1720735392	0	0	PIMSUPARP, CHUTCHATORN PA-C	3/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1610 W EDINGER AVE	STE B	SANTA ANA	CA	92704	4339	00	06000	33.72718149	-117.889506	Orange County
305682	Non-Physician Medical Practitioner	None	1891169207	0	0	PAREDES, BRYAN A NP	8/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	980 FALL CREEK CT	None	WALNUT	CA	91789	5032	00	06000	34.0305549	-117.8869102	Los Angeles County
305719	Non-Physician Medical Practitioner	None	1548426380	0	0	PICELLA, DAVID	10/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 S LEMON AVE	1295	WALNUT	CA	91789	2706	00	06000	34.01120195	-117.8599306	Los Angeles County
305731	Non-Physician Medical Practitioner	None	1053697367	0	0	PEREZ, NICOLE A NP	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26630 BARTON ROAD	APT 2123	REDLANDS	CA	92373	4330	00	06000	34.04822028	-117.2227851	San Bernardino County
305740	Non-Physician Medical Practitioner	None	1437493160	0	0	PUHLEV, ISKREN G NP	3/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4033 THIRD AVE	SUITE 400	SAN DIEGO	CA	92103	2140	00	06000	32.75053781	-117.1627168	San Diego County
305790	Non-Physician Medical Practitioner	None	1902134539	0	0	PERKINS, SANDRA V	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17510 MARIPOSA AVENUE	None	RIVERSIDE	CA	92504	6080	00	06000	33.87260466	-117.3567627	Riverside County
305794	Non-Physician Medical Practitioner	None	1942755137	0	0	PANDIT, PRITAM K NP	10/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26133 CITRON ST	None	LOMA LINDA	CA	92354	6576	00	06000	34.0509313	-117.2341848	San Bernardino County
305813	Non-Physician Medical Practitioner	None	1295287613	0	0	PATEL, CHANDNI M NP	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3455 SAN GREGORIO CT	None	MERCED	CA	95348	4816	00	06000	37.32704737	-120.49891	Merced County
305815	Non-Physician Medical Practitioner	None	1790202141	0	0	POWERS, JOSHUA PA-C	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
305826	Non-Physician Medical Practitioner	None	1447657804	0	0	PADDOCK, DIANA L	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2427 YUCCA HILL RD	None	ALPINE	CA	91901	3032	00	06000	32.81655796	-116.7805742	San Diego County
305841	Non-Physician Medical Practitioner	None	1891094611	0	0	PHAN, TRANG DOAN-MINH	4/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1083 GRAND CANYON	None	BREA	CA	92821	2620	00	06000	33.93511934	-117.8926006	Orange County
305867	Non-Physician Medical Practitioner	None	1629796438	0	0	PHAM, ANTHONY B NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
305899	Non-Physician Medical Practitioner	None	1346612744	0	0	PAZIAN, AMANDA PA-C	8/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305926	Non-Physician Medical Practitioner	None	1861080640	0	0	PECCHIA, ISABELLA PA	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
305969	Non-Physician Medical Practitioner	None	1457788663	0	0	PALMER, VIVIENNE N PA	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
305997	Non-Physician Medical Practitioner	None	1285491126	0	0	PATINO, CYNTHIA M NP	8/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31569 CANYON ESTATES DR	STE 225	LAKE ELSINORE	CA	92532	0470	00	06000	33.6671373	-117.3012532	Riverside County
306007	Non-Physician Medical Practitioner	None	1104337393	0	0	PALECEK, DAVID T	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	529 E EVERGLADE AVENUE	None	FRESNO	CA	93720	1608	00	06000	36.86483469	-119.7738166	Fresno County
306024	Non-Physician Medical Practitioner	None	1265880082	0	0	PAKTINAT, PRUSHA	11/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2449 FEDERAL AVE	None	LOS ANGELES	CA	90064	2914	00	06000	34.0312621	-118.4430408	Los Angeles County
306045	Non-Physician Medical Practitioner	None	1831724970	0	0	PAWIG, JOSEPH NP	8/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	00	06000	36.80840238	-119.8594473	Fresno County
306050	Non-Physician Medical Practitioner	None	1538162631	0	0	PARK, DANIEL	11/24/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	411 ORLENA AVE	None	LONG BEACH	CA	90814	1852	00	06000	33.771996	-118.130728	Los Angeles County
306052	Non-Physician Medical Practitioner	None	1588250690	0	0	PHAM, DANIEL J NP	4/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
306072	Non-Physician Medical Practitioner	None	1083790489	0	0	PORTUGAL, LUPE TARANGO	1/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 S LA VERNE AVE	None	LOS ANGELES	CA	90022	1932	00	06000	34.0327691	-118.1587846	Los Angeles County
306095	Non-Physician Medical Practitioner	None	1649787870	0	0	PAREKH, KHYATI PA	11/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 W 5TH ST	STE 209	SAN PEDRO	CA	90731	2752	00	06000	33.73971779	-118.2852574	Los Angeles County
306159	Non-Physician Medical Practitioner	None	1154548931	0	0	PECKHAM, JESSICA J NP	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1210 W LAMBERT RD	UNIT 58	LA HABRA	CA	90631	6633	00	06000	33.923745	-117.960933	Orange County
306173	Non-Physician Medical Practitioner	None	1265905947	0	0	PATEL, SHAYNA J PA	3/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
306210	Non-Physician Medical Practitioner	None	1063573251	0	0	PICCHI, ANDREA E	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
306231	Non-Physician Medical Practitioner	None	1841881778	0	0	PERHAM, KELLYN R PA-C	2/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	00	06000	33.67783408	-117.8720921	Orange County
306249	Non-Physician Medical Practitioner	None	1487013314	0	0	PARSONS, MELISSA NP	2/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
306250	Non-Physician Medical Practitioner	None	1306432281	0	0	PULSHA, CYNTHIA M CNM	10/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7724 CALIFORNIA AVE	None	RIVERSIDE	CA	92504	2509	00	06000	33.94557281	-117.4180549	Riverside County
306278	Non-Physician Medical Practitioner	None	1447705041	0	0	PLACENCIA, TANYA NP	3/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	00	06000	34.01035039	-118.109564	Los Angeles County
306290	Non-Physician Medical Practitioner	None	1275251175	0	0	POYOTTE, ANTHONETTE C NP	8/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	00	06000	37.66383747	-122.4671404	San Mateo County
306314	Non-Physician Medical Practitioner	None	1851948715	0	0	POUCHOULEN, MINERVA M PA	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
306322	Non-Physician Medical Practitioner	None	1942833066	0	0	PAUL, HEATHER L NP	7/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	00	06000	37.53249631	-121.9198141	Alameda County
306323	Non-Physician Medical Practitioner	None	1083205835	0	0	POWELL, FERRIS M NP	2/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2485 HIGH SCHOOL AVE	STE 311	CONCORD	CA	94520	1814	00	06000	37.98507961	-122.034189	Contra Costa County
306332	Non-Physician Medical Practitioner	None	1689011660	0	0	PRINCEWILL, GOODWILL C	7/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	478 NELSON STREET	None	TULARE	CA	93274	7538	00	06000	36.20604077	-119.3011983	Tulare County
306345	Non-Physician Medical Practitioner	None	1912655804	0	0	PHAN, MYLINH NP	4/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
306349	Non-Physician Medical Practitioner	None	1194884809	0	0	PULA, ANA P	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12412 SPLIT REIN DR	None	RANCHO CUCAMONGA	CA	91739	2414	00	06000	34.14863073	-117.5339884	San Bernardino County
306355	Non-Physician Medical Practitioner	None	1003512088	0	0	PACHECO, CYNTHIA L NP	3/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
306475	Non-Physician Medical Practitioner	None	1699121038	0	0	PRAY, CAITLIN L	7/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5960 LINDENHURST AVE	None	LOS ANGELES	CA	90036	3219	00	06000	34.06560471	-118.3575667	Los Angeles County
306520	Non-Physician Medical Practitioner	None	1245442482	0	0	PEREZ, ROXANE JULIET	7/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 N. ST COLLEGE BLVD	STUDENT HEALTH AND COUNS	FULLERTON	CA	92834	3069	00	06000	33.86442908	-117.8894431	Orange County
306538	Non-Physician Medical Practitioner	None	1770037723	0	0	PARADA, CRISTINA	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3540 MONAD RD	APT 9	BILLINGS	MT	59102	6072	00	06000	45.761238	-108.60534	Yellowstone County
306572	Non-Physician Medical Practitioner	None	1164945598	0	0	PAIGE, JACQUELYN K NP	10/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	94 W MANOR STREET	None	ALTADENA	CA	91001	4714	00	06000	34.19344475	-118.1500925	Los Angeles County
306588	Non-Physician Medical Practitioner	None	1922459635	0	0	PICAZO, RIGOBERTO R NP	8/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1130 MAIN SAIL CIRCLE	None	ROSEVILLE	CA	95661	7020	00	06000	38.72117745	-121.2701223	Placer County
306609	Non-Physician Medical Practitioner	None	1053000794	0	0	PANOPIO, ARSENIO D NP	6/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5311 HOPYARD RD	None	PLEASANTON	CA	94588	3307	00	06000	37.69896849	-121.9046448	Alameda County
306617	Non-Physician Medical Practitioner	None	1982827564	0	0	PARK, TIERRA D C	10/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	626 MONTEREY RD	None	SANTA MARIA	CA	93455	7447	00	06000	34.91084623	-120.4263775	Santa Barbara County
306644	Non-Physician Medical Practitioner	None	1457870727	0	0	PETRO, MATTHEW W	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4461 VALETA ST	UNIT D	SAN DIEGO	CA	92107	1258	00	06000	32.75069246	-117.2344035	San Diego County
306649	Non-Physician Medical Practitioner	None	1356749451	0	0	PERREAULT, MARK R PA	7/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
306663	Non-Physician Medical Practitioner	None	1831585272	0	0	PARSONS, MOLLY M NP	10/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27132 CALLE REAL	None	CAPISTRANO BEACH	CA	92624	1078	00	06000	33.46316665	-117.6565984	Orange County
306684	Non-Physician Medical Practitioner	None	1104174804	0	0	POPE, GWENDA L NP	3/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3541 PARKRIDGE LANE	None	PALMDALE	CA	93551	7545	00	06000	34.61008248	-118.1942097	Los Angeles County
306699	Non-Physician Medical Practitioner	None	1295146199	0	0	PUNSALAN, HOMER G	5/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8907 CONEY ISLAND DRIVE	None	BAKERSFIELD	CA	93311	8800	00	06000	35.30193426	-119.101807	Kern County
306714	Non-Physician Medical Practitioner	None	1699739482	0	0	PARKER, HILDA M NP	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 PARK PLACE	APT C	SAN MATEO	CA	94403	7111	00	06000	37.54470419	-122.2917595	San Mateo County
306719	Non-Physician Medical Practitioner	None	1770710709	0	0	PENINSULA PRIMARY CARE	9/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 THE CROSSROADS	None	CARMEL	CA	93923	8650	00	06000	36.53645751	-121.9089649	Monterey County
306741	Non-Physician Medical Practitioner	None	1407453541	0	0	PEREZ, STEPHEN B PA-C	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
306747	Non-Physician Medical Practitioner	None	1740530518	0	0	PIERRE-LOUIS, KERBY	2/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5307 SEPULVEDA BLVD	APT 307	SHERMAN OAKS	CA	91411	3448	00	06000	34.166961	-118.466187	Los Angeles County
306754	Non-Physician Medical Practitioner	None	1497941132	0	0	PETERSON, JENNIFER LYNN	8/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	SUITE 4212	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
306806	Non-Physician Medical Practitioner	None	1275072829	0	0	PARATHARA, EMILY C NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
306826	Non-Physician Medical Practitioner	None	1235235615	0	0	PAPPAS, CARA LEE	9/14/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1708 N MONROE ST	None	TALLAHASSEE	FL	32303	5535	00	06000	30.46346357	-84.28234266	Leon County
306843	Non-Physician Medical Practitioner	None	1023630373	0	0	PARRIS, AMY NP	2/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
306868	Non-Physician Medical Practitioner	None	1184809733	0	0	PATEL, RITA	7/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11235 ANDERSON ST	None	LOMA LINDA	CA	92354	2803	00	06000	34.04959815	-117.2610613	San Bernardino County
306872	Non-Physician Medical Practitioner	None	1720144405	0	0	PLACENTI, ANTOINETTE M	9/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2145 NILES ST	None	BAKERSFIELD	CA	93305	5007	00	06000	35.37652092	-118.9682408	Kern County
306914	Non-Physician Medical Practitioner	None	1053814681	0	0	PRICE, ASHTON NP	10/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
306952	Non-Physician Medical Practitioner	None	1003114414	0	0	PRITCHETT, DAVID PA-C	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
306959	Non-Physician Medical Practitioner	None	1396356796	0	0	PHELPS, KAITLIN A	1/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3095 OLD CONEJO RD	SUITE 200	NEWBURY PARK	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
306972	Non-Physician Medical Practitioner	None	1205086717	0	0	PYRON, JOSEPH M NP	3/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8100 CALIFORNIA CITY BLV	None	CALIFORNIA CITY	CA	93505	2648	00	06000	35.12573651	-117.983862	Kern County
307012	Non-Physician Medical Practitioner	None	1154045748	0	0	PATEL, MALISHA PA-C	3/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15325 FAIRFIELD RANCH RD	STE. 150	CHINO HILLS	CA	91709	8834	00	06000	33.9729714	-117.6918388	San Bernardino County
307015	Non-Physician Medical Practitioner	None	1467887646	0	0	POLLETT, ERIN S	7/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	00	06000	37.4924484	-122.2318516	San Mateo County
307034	Non-Physician Medical Practitioner	None	1639331267	0	0	PARDINO, AARIKA B PA-C	1/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 CHAMPAGNE CIR	None	RANCHO MIRAGE	CA	92270	2736	00	06000	33.79039477	-116.3972348	Riverside County
307048	Non-Physician Medical Practitioner	None	1902108541	0	0	PLANNED PARENTHOOD: SHASTA-DIABLO, INC.	4/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 CAMINO ALTO	None	MILL VALLEY	CA	94941	2246	00	06000	37.89756834	-122.5300877	Marin County
307072	Non-Physician Medical Practitioner	None	1861749277	0	0	PITTMAN, MARCI L PA	6/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	00	06000	34.44509477	-119.7186392	Santa Barbara County
307079	Non-Physician Medical Practitioner	None	1417373663	0	0	PARROTT, ALEXANDRA K	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2140 WOOLSEY ST	APT C	BERKELEY	CA	94705	1890	00	06000	37.85254407	-122.264413	Alameda County
307080	Non-Physician Medical Practitioner	None	1033221262	0	0	PEARSON, JOHN D	6/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2111 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57502348	-122.4048036	Shasta County
307114	Non-Physician Medical Practitioner	None	1538652128	0	0	PEFFER, MICHAEL B PA-C	8/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
307116	Non-Physician Medical Practitioner	None	1841905635	0	0	PETTIS, EMILY NP	4/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
307131	Non-Physician Medical Practitioner	None	1679982979	0	0	PASIA, SHIRLEY A	3/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5301 N VALENTINE AVE	APT 116	FRESNO	CA	93711	4098	00	06000	36.81306774	-119.8535228	Fresno County
307183	Non-Physician Medical Practitioner	None	1114107653	0	0	PRATHER, BROOKE S	8/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH STREET	None	SANTA BARBARA	CA	93101	0000	00	06000	34.41386476	-119.6993335	Santa Barbara County
307208	Non-Physician Medical Practitioner	None	1215645122	0	0	PACIS, JESUS NP	11/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1574 W BASE LINE ST	STE 107	SAN BERNARDINO	CA	92411	1736	00	06000	34.12134348	-117.321282	San Bernardino County
307213	Non-Physician Medical Practitioner	None	1376997312	0	0	PHAN, PHU-PHUC PA	7/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	530 N COLONIA DE LOS	CEDROS 58	LOS ANGELES	CA	90022	1315	00	06000	34.04299735	-118.1589585	Los Angeles County
307218	Non-Physician Medical Practitioner	None	1740067396	0	0	PEARSON, ANDREW PA	3/23/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	00	06000	33.03623896	-117.2837308	San Diego County
307248	Non-Physician Medical Practitioner	None	1932412525	0	0	PAE, TRACEY S	9/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST STE 21	None	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
307263	Non-Physician Medical Practitioner	None	1750921383	0	0	POLLOCK, MAX L NP	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	100	OAKLAND	CA	94609	3422	00	06000	37.81892183	-122.2640154	Alameda County
307267	Non-Physician Medical Practitioner	None	1740830520	0	0	POLOCHAK ARRAMBIDE, CANDICE M CNP	8/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
307289	Non-Physician Medical Practitioner	None	1871897678	0	0	POOLE, MICKOYAN N	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12664 MEMORIAL WAY	APT 1011	MORENO VALLEY	CA	92553	7561	00	06000	33.93395397	-117.2726569	Riverside County
307310	Non-Physician Medical Practitioner	None	1962796268	0	0	PLANNED PARENTHOOD SHASTA PACIFIC	9/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1165 S DORA ST	None	UKIAH	CA	95482	8325	00	06000	39.13602308	-123.2095502	Mendocino County
307339	Non-Physician Medical Practitioner	None	1235562380	0	0	PINGOL, MARIA CHRISTINA MAGAT	9/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1447 CEDARWOOD LN	SUITE A	PLEASANTON	CA	94566	6175	00	06000	37.67102566	-121.8742221	Alameda County
307398	Non-Physician Medical Practitioner	None	1427334424	0	0	PEREZ, MARILYN M PA-C	12/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 S WILLIS ST	None	VISALIA	CA	93291	6105	00	06000	36.327717	-119.2981005	Tulare County
307426	Non-Physician Medical Practitioner	None	1548631419	0	0	PERLMAN, SHARON E NP	5/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 MONDRAIAN	None	ALISO VIEJO	CA	92656	7074	00	06000	33.57740128	-117.7349355	Orange County
307428	Non-Physician Medical Practitioner	None	1457637340	0	0	PAPE, KEVIN A PA	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	00	06000	34.28644751	-118.721655	Ventura County
307435	Non-Physician Medical Practitioner	None	1922586437	0	0	PHAN, HOA NP	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11550 INDIAN HILLS RD	SUITE 330	MISSION HILLS	CA	91345	1203	00	06000	34.28024575	-118.4588775	Los Angeles County
307437	Non-Physician Medical Practitioner	None	1275140550	0	0	PASSALACQUA, LISA	12/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
307469	Non-Physician Medical Practitioner	None	1265868715	0	0	PETERSON, LAURA S NP	5/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11057 TOLLIVER WAY	None	ADELANTO	CA	92301	4042	00	06000	34.51832355	-117.4225635	San Bernardino County
307474	Non-Physician Medical Practitioner	None	1497950489	0	0	PALMA, MONICA	11/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 SAN BERNARDINO ST S	None	MONTCLAIR	CA	91763	2328	00	06000	34.07768363	-117.6968874	San Bernardino County
307485	Non-Physician Medical Practitioner	None	1265418826	0	0	PASQUINI, STEPHEN	4/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	467 EL CAMINO REAL	None	GREENFIELD	CA	93927	4915	00	06000	36.32573265	-121.2475971	Monterey County
307496	Non-Physician Medical Practitioner	None	1073919726	0	0	PORTER, TRISHA-LEIGH C	8/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	00	06000	37.4924484	-122.2318516	San Mateo County
307500	Non-Physician Medical Practitioner	None	1245079805	0	0	PINEDA, KINDA	9/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
307522	Non-Physician Medical Practitioner	None	1497094114	0	0	PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY	8/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	130 W ROUTE 66	SUITE 100	GLENDORA	CA	91740	6249	00	06000	34.12865951	-117.8651745	Los Angeles County
307532	Non-Physician Medical Practitioner	None	1679196133	0	0	PINASCO, MICAH NP	10/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	00	06000	36.83939464	-119.6661479	Fresno County
307548	Non-Physician Medical Practitioner	None	1538431432	0	0	PREVENTIVE CARE PATHWAYS	7/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5709 MARKET ST STE A	None	OAKLAND	CA	94608	2811	00	06000	37.84173278	-122.2745576	Alameda County
307568	Non-Physician Medical Practitioner	None	1992809115	0	0	PLASSE, ADRIENNE	8/27/1992	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3260 KERNER BLVD	None	SAN RAFAEL	CA	94901	4861	00	06000	37.96081282	-122.501833	Marin County
307583	Non-Physician Medical Practitioner	None	1730811316	0	0	PALOMARES, CINTHIA	9/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
307594	Non-Physician Medical Practitioner	None	1700208683	0	0	PARAKKAL, MEENA A NP	5/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
307637	Non-Physician Medical Practitioner	None	1528224573	0	0	PATAM, MARIENIDA B	10/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3101 LEGENDARIO	None	SAN CLEMENTE	CA	92673	3535	00	06000	33.47522533	-117.625391	Orange County
307640	Non-Physician Medical Practitioner	None	1205526639	0	0	PILLSBURY, SUMMER NP	9/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7830 CLAIREMONT MESA BLV	STE 100	SAN DIEGO	CA	92111	1619	00	06000	32.83285853	-117.1522755	San Diego County
307646	Non-Physician Medical Practitioner	None	1891022273	0	0	PALILEO, KRISTINE YVETTE B PA	11/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
307687	Non-Physician Medical Practitioner	None	1942522495	0	0	PLANCHARD, SARAH L	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4127 SARATOGA DR	None	REDDING	CA	96002	3769	00	06000	40.54786049	-122.3248967	Shasta County
307689	Non-Physician Medical Practitioner	None	1093166415	0	0	PATEL, SHITAL NP	9/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18200 YORBA LINDA BLVD	SUITE 250	YORBA LINDA	CA	92886	4044	00	06000	33.88842824	-117.8154698	Orange County
307691	Non-Physician Medical Practitioner	None	1164195053	0	0	PHELAN, KAITLIN M NP	9/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
307724	Non-Physician Medical Practitioner	None	1356755789	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	1/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 CASA ST	SUITE B	SAN LUIS OBISPO	CA	93405	1883	00	06000	35.29273885	-120.6647926	San Luis Obispo County
307741	Non-Physician Medical Practitioner	None	1881761120	0	0	POVEDA, STEPHANIE L	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10236 JACARANDA CT	None	RANCHO CUCAMONGA	CA	91737	1717	00	06000	34.15522952	-117.5815026	San Bernardino County
307749	Non-Physician Medical Practitioner	None	1295592293	0	0	PARK, CHRISTINA Y NP	4/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5630 SANTA ANA CANYON	None	ANAHEIM	CA	92807	3122	00	06000	33.85124385	-117.7915652	Orange County
307767	Non-Physician Medical Practitioner	None	1629314521	0	0	PATEL, DARSHANA V	2/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6749 RUBY CANYON DR	None	EASTVALE	CA	92880	3708	00	06000	33.9653124	-117.6010068	Riverside County
307777	Non-Physician Medical Practitioner	None	1225550809	0	0	PLIES, MELISSA C	11/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1601 CONCORDIA PLACE	None	LAS VEGAS	NV	89104	3308	00	06000	36.1521584	-115.1313625	Clark County
307795	Non-Physician Medical Practitioner	None	1528495884	0	0	PELESIC, BETINA NP	8/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6109 LAM BACK LN	None	SAN JOSE	CA	95119	1220	00	06000	37.239867	-121.7945175	Santa Clara County
307804	Non-Physician Medical Practitioner	None	1205219698	0	0	PASZEK, KARA A NP	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	570 MUIR PASS CT	None	SPARKS	NV	89436	1815	00	06000	39.59487807	-119.7341981	Washoe County
307813	Non-Physician Medical Practitioner	None	1124166772	0	0	PAPANTONIADIS, OURANIA Z	10/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11602 PINE ST	None	LOS ALAMITOS	CA	90720	4159	00	06000	33.79426354	-118.0702837	Orange County
307823	Non-Physician Medical Practitioner	None	1851661615	0	0	PRATT, ASHLEY E NP	8/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	948 CONTADERO PLACE	None	LAS VEGAS	NV	89138	4545	00	06000	36.15871497	-115.3615512	Clark County
307876	Non-Physician Medical Practitioner	None	1730162272	0	0	PENGEL, ANDREA MARGARETE SPRAGUE	1/9/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
307889	Non-Physician Medical Practitioner	None	1902930621	0	0	PARSLEY, DAWN S NP	4/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5030 CHARDONNAY	None	VISALIA	CA	93291	9095	00	06000	36.347157	-119.3472135	Tulare County
307932	Non-Physician Medical Practitioner	None	1215423363	0	0	PEYSAKHOVICH, ANYA PA	2/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21 TAMAL VISTA BLVD	103	CORTE MADERA	CA	94925	1130	00	06000	37.93173997	-122.5179353	Marin County
307941	Non-Physician Medical Practitioner	None	1194175752	0	0	PUESCHEL, ROBIN D NP	7/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	232 SANDCASTLE	None	ALISO VIEJO	CA	92656	3839	00	06000	33.56455192	-117.7227123	Orange County
307954	Non-Physician Medical Practitioner	None	1801521117	0	0	PARK, ANGELA G NP	1/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
307973	Non-Physician Medical Practitioner	None	1487971404	0	0	PABALAN, KAREN SUMMER	6/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1377 S GRAND AVE	None	GLENDORA	CA	91740	5047	00	06000	34.11435562	-117.8727587	Los Angeles County
307979	Non-Physician Medical Practitioner	None	1255573234	0	0	PATZ, HEATHER T	8/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	922 CALIFORNIA AVE	None	VENICE	CA	90291	3414	00	06000	33.99673233	-118.4612223	Los Angeles County
308020	Non-Physician Medical Practitioner	None	1598132185	0	0	PAGKALINAWAN, MARIBEL M NP	3/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6588 WHITEWOOD ST	None	SIMI VALLEY	CA	93063	3947	00	06000	34.27196558	-118.6608093	Ventura County
308025	Non-Physician Medical Practitioner	None	1053961268	0	0	PARTRIDGE, EILEEN W	3/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	00	06000	38.568393	-121.4658585	Sacramento County
308054	Non-Physician Medical Practitioner	None	1053952440	0	0	PATEL, DHARA	8/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 S MAIN ST	STE 108	CORONA	CA	92882	3401	00	06000	33.87190191	-117.5669613	Riverside County
308106	Non-Physician Medical Practitioner	None	1861949273	0	0	PREZA, SUSANA I NP	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8603 JELLICO AVE	None	NORTHRIDGE	CA	91325	3103	00	06000	34.226865	-118.5187395	Los Angeles County
308137	Non-Physician Medical Practitioner	None	1386743110	0	0	PELLECER, SILVIA	8/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W LUGONIA AVE	SUITE 120	REDLANDS	CA	92374	9703	00	06000	34.07027851	-117.218421	San Bernardino County
308143	Non-Physician Medical Practitioner	None	1326382441	0	0	PENA, DOLOR M NP	2/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6450 DOUGHERTY RD	APT 1611	DUBLIN	CA	94568	7736	00	06000	37.71102364	-121.9103764	Alameda County
308150	Non-Physician Medical Practitioner	None	1851809529	0	0	PYCARD, RANDA A NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
308190	Non-Physician Medical Practitioner	None	1316363542	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	5/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	116 S PALISADE DR	SUITE 104	SANTA MARIA	CA	93454	8904	00	06000	34.9523869	-120.4120717	Santa Barbara County
308252	Non-Physician Medical Practitioner	None	1396306148	0	0	PIERSON, JILLIAN PA	9/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308283	Non-Physician Medical Practitioner	None	1477962595	0	0	PHILLIPS, LASHUNDA K NP	9/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	671 IRONBARK CIRCLE	None	ORINDA	CA	94563	2410	00	06000	37.89299228	-122.1774285	Contra Costa County
308307	Non-Physician Medical Practitioner	None	1639407224	0	0	PATEL, MANISHA B	8/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	782 SAN ARDO DRIVE	None	BREA	CA	92821	7420	00	06000	33.93118567	-117.8597516	Orange County
308308	Non-Physician Medical Practitioner	None	1255046751	0	0	PARVIN, BROOKS W PA	4/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
308322	Non-Physician Medical Practitioner	None	1558690560	0	0	PETRIKOVIC, LAURA A PA	1/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308339	Non-Physician Medical Practitioner	None	1063178739	0	0	PIPER, STEVEN PA	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6160 LAUREL CANYON BLVD	STE 160	NORTH HOLLYWOOD	CA	91606	3287	00	06000	34.18258805	-118.3964946	Los Angeles County
308342	Non-Physician Medical Practitioner	None	1558915116	0	0	PASINI, MIA E NP	9/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1551 BISHOP ST	A 150	SAN LUIS OBISPO	CA	93401	4635	00	06000	35.27475609	-120.6454494	San Luis Obispo County
308350	Non-Physician Medical Practitioner	None	1841271913	0	0	PITTS, DUANE A	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21142 STEWARD RD	None	MADERA	CA	93638	7101	00	06000	37.05611095	-120.0157273	Madera County
308362	Non-Physician Medical Practitioner	None	1346517448	0	0	PIKE, CHRISTOPHER M PA	8/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
308379	Non-Physician Medical Practitioner	None	1538604822	0	0	PRAJAPATI, RAVISH PA	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
308389	Non-Physician Medical Practitioner	None	1982140075	0	0	POLLATH, TRACY A	3/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	951 LAS PALMAS ENTRADA	None	HENDERSON	NV	89012	5603	00	06000	36.0292617	-115.0277617	Clark County
308437	Non-Physician Medical Practitioner	None	1881824209	0	0	PAQUETTE, SEAN T	6/2/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6403 COYLE AVE STE 170	None	CARMICHAEL	CA	95608	0363	00	06000	38.668347	-121.3148745	Sacramento County
308459	Non-Physician Medical Practitioner	None	1972282069	0	0	PINOCCHIO, NICOLETTE NP	9/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	410 E YOSEMITE AVE	SUITE B	MERCED	CA	95340	8220	00	06000	37.33211247	-120.462489	Merced County
308473	Non-Physician Medical Practitioner	None	1760639488	0	0	PITTER, DALLAS N	6/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1625 CALLE GRANADA	None	DUARTE	CA	91010	2572	00	06000	34.14001847	-117.97011	Los Angeles County
308497	Non-Physician Medical Practitioner	None	1972059129	0	0	POWERS, PAMELA R NP	2/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	865 PEPPER DRIVE	None	EL CAJON	CA	92021	1103	00	06000	32.82376397	-116.9499153	San Diego County
308555	Non-Physician Medical Practitioner	None	1831668987	0	0	PHAN, CHRISTINA PA	9/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20642 JOHN DR	None	CASTRO VALLEY	CA	94546	5103	00	06000	37.69270814	-122.090934	Alameda County
308591	Non-Physician Medical Practitioner	None	1942073507	0	0	PANGILINAN, MICHAEL NP	3/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
308596	Non-Physician Medical Practitioner	None	1124739354	0	0	PISARNWONGS, VOOTTISIN M PA	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 CONGRESS STREET	200	PASADENA	CA	91105	3023	00	06000	34.13396893	-118.1528162	Los Angeles County
308602	Non-Physician Medical Practitioner	None	1730768276	0	0	PANG, MARGARET NP	9/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 BROCKTON AVE	STE 319	RIVERSIDE	CA	92501	4090	00	06000	33.97785263	-117.3836152	Riverside County
308620	Non-Physician Medical Practitioner	None	1992333074	0	0	PEREZ, JENNIFER L PA-C	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 SOUTH GRAND AVE	None	GLENDORA	CA	91741	4218	00	06000	34.132842	-117.872523	Los Angeles County
308623	Non-Physician Medical Practitioner	None	1245252162	0	0	PHILLIPS, CHARLES A	8/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
308624	Non-Physician Medical Practitioner	None	1881298164	0	0	PAT, VERENICE NP	3/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	00	06000	35.351487	-119.1143025	Kern County
308646	Non-Physician Medical Practitioner	None	1720004088	0	0	PONSFORD, LISA R	8/25/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
308663	Non-Physician Medical Practitioner	None	1760435556	0	0	PETERSON, WENDY NP	12/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308670	Non-Physician Medical Practitioner	None	1639345150	0	0	PEDERZOLI-CARRILLO, PAOLA I NP	6/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10933 WELLWORTH AVE	UNIT 17	LOS ANGELES	CA	90024	4865	00	06000	34.05670671	-118.4441557	Los Angeles County
308704	Non-Physician Medical Practitioner	None	1710434410	0	0	PETRUCELLI, MARY R NP	11/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	436 SOUTH 22ND ST	None	SAN JOSE	CA	95116	3155	00	06000	37.33962542	-121.8633004	Santa Clara County
308705	Non-Physician Medical Practitioner	None	1376797795	0	0	POLLACK, DANIELL BENNETT	8/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4065 3RD AVENUE	SUITE 102	SAN DIEGO	CA	92103	2184	00	06000	32.75123948	-117.1627318	San Diego County
308710	Non-Physician Medical Practitioner	None	1285193714	0	0	POPE, LESLIE A NP	9/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2216 BUENAVENTURA BLVD	SUITE B	REDDING	CA	96001	3838	00	06000	40.55453352	-122.3904825	Shasta County
308722	Non-Physician Medical Practitioner	None	1528352341	0	0	PHAN, LANANH NP	2/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3393	00	06000	33.78003775	-118.1866604	Los Angeles County
308737	Non-Physician Medical Practitioner	None	1225389224	0	0	PAREDONES, DOLORES FAVIOLA	3/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	315 N. THIRD AVE.	#207	CAVINA	CA	91723	0000	00	06000	34.08873786	-117.8923869	Los Angeles County
308778	Non-Physician Medical Practitioner	None	1285779058	0	0	PEREZ, LEANNE R NP	3/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	DEPARTMENT OF CV SURGERY	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308788	Non-Physician Medical Practitioner	None	1780742387	0	0	POCETA, LORI ROTH	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12395 EL CAMINO REAL	None	SAN DIEGO	CA	92130	3082	00	06000	32.94324259	-117.2396525	San Diego County
308803	Non-Physician Medical Practitioner	None	1588907893	0	0	PANLILIO, MICHELLE TRICIA	8/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 16TH ST	#206	SANTA MONICA	CA	90404	1235	00	06000	34.02726451	-118.4857138	Los Angeles County
308807	Non-Physician Medical Practitioner	None	1053887265	0	0	PUREWAL, RAMANJOT K PA-C	12/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1908 N BEALE RD	STE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
308811	Non-Physician Medical Practitioner	None	1265972012	0	0	PACHNER, AARON E	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3816 PIEDMONT AVENUE	UNIT 4	OAKLAND	CA	94611	5329	00	06000	37.82412943	-122.2553582	Alameda County
308814	Non-Physician Medical Practitioner	None	1366590283	0	0	PHILLIPS, DENISE C	10/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6550 ABBOTTSWOOD DRIVE	None	RANCHO PALOS VERD	CA	90275	3106	00	06000	33.77185593	-118.3946218	Los Angeles County
308823	Non-Physician Medical Practitioner	None	1295301844	0	0	PFANNENSTIEL, KATRINA R PA-C	7/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2460 BUHNE ST	None	EUREKA	CA	95501	3207	00	06000	40.78588193	-124.1402099	Humboldt County
308844	Non-Physician Medical Practitioner	None	1740066240	0	0	PHAM, VY	2/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	00	06000	37.66742737	-120.9731413	Stanislaus County
308848	Non-Physician Medical Practitioner	None	1952333478	0	0	PARK, DEALIE E	6/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1862 BURLESON AVE	None	THOUSAND OAKS	CA	91360	3202	00	06000	34.20339526	-118.8689037	Ventura County
308873	Non-Physician Medical Practitioner	None	1316201734	0	0	POOLE, MICKOYAN N	8/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27640 EUCALYPTUS AVE	None	MORENO VALLEY	CA	92555	4557	00	06000	33.93749258	-117.1807371	Riverside County
308922	Non-Physician Medical Practitioner	None	1033684774	0	0	PEARL, TARYN A PA-C	3/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	892 AEROVISTA PL	SUITE 130	SAN LUIS OBISPO	CA	93401	8054	00	06000	35.24277125	-120.6405941	San Luis Obispo County
308945	Non-Physician Medical Practitioner	None	1679055586	0	0	PUNG, NATALIE NP	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	00	06000	32.79692047	-117.1567137	San Diego County
308954	Non-Physician Medical Practitioner	None	1063015162	0	0	PANINGBATAN, ANNA SABRINA NP	4/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
308985	Non-Physician Medical Practitioner	None	1801192315	0	0	PONTELL, SARAH	2/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	732 EVELYN AVE	None	ALBANY	CA	94706	1707	00	06000	37.89317777	-122.2953332	Alameda County
308997	Non-Physician Medical Practitioner	None	1417194085	0	0	PATEL, REEMA NAVIN	3/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
309002	Non-Physician Medical Practitioner	None	1366578957	0	0	PAMIROYAN, BONNIE R	8/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
309006	Non-Physician Medical Practitioner	None	1700803418	0	0	PACE, SARAH A NP	9/14/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1019 DORNAJO WAY	218	SACRAMENTO	CA	95825	7392	00	06000	38.584323	-121.406814	Sacramento County
309012	Non-Physician Medical Practitioner	None	1689393761	0	0	PARDOSI, BRANDON K PA-C	1/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
309050	Non-Physician Medical Practitioner	None	1033326442	0	0	PARYANI, NAYNA	4/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5977 E SPRING ST	None	LONG BEACH	CA	90808	3752	00	06000	33.81062147	-118.1154555	Los Angeles County
309073	Non-Physician Medical Practitioner	None	1316581416	0	0	PHAN, ANNIE PA	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
309077	Non-Physician Medical Practitioner	None	1073035093	0	0	PIPKORN, CHRISTINA A	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3856 MAYBELL AVE	None	OAKLAND	CA	94619	2116	00	06000	37.79071125	-122.192562	Alameda County
309091	Non-Physician Medical Practitioner	None	1205811536	0	0	PITCHER, JANET E	11/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST STE 100	CHILD NEUROLOGY	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
309102	Non-Physician Medical Practitioner	None	1184771719	0	0	PERKINS, KATHLEEN E	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	15919 EAST SHORE DRIVE	UNIT B	LYNWOOD	WA	98087	6626	00	06000	47.85347687	-122.2398049	Snohomish County
309171	Non-Physician Medical Practitioner	None	1760156392	0	0	PATEL, MILI	10/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
309181	Non-Physician Medical Practitioner	None	1588279343	0	0	POON, JAMES R PA-C	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
309186	Non-Physician Medical Practitioner	None	1942729363	0	0	PAULEY, CLAIRE E	10/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1667 DOMINICAN WAY	STE 234	SANTA CRUZ	CA	95065	1560	00	06000	36.99032635	-121.9811719	Santa Cruz County
309196	Non-Physician Medical Practitioner	None	1679019863	0	0	PUIG, JOSHUA L PA	11/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
309220	Non-Physician Medical Practitioner	None	1396409884	0	0	PATEL, AMIT PA-C	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3095 OLD CONEJO RD	None	THOUSAND OAKS	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
309232	Non-Physician Medical Practitioner	None	1174261523	0	0	PLASCENCIA, KATHIRIA R NP	12/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
309250	Non-Physician Medical Practitioner	None	1467791194	0	0	POLEVAYA, GALINA E	11/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26630 BARTON RD	APT 1814	REDLANDS	CA	92373	4329	00	06000	34.04822028	-117.2227851	San Bernardino County
309263	Non-Physician Medical Practitioner	None	1053986117	0	0	PARK, MICHELLE PA-C	8/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17051 SIERRA LAKES PKWY	STE 101	FONTANA	CA	92336	1274	00	06000	34.13797332	-117.4324372	San Bernardino County
309305	Non-Physician Medical Practitioner	None	1790525640	0	0	PITTAM, KATHERINE	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30465 AVENIDA DE LAS FLO	STE A	RANCHO SANTA MARG	CA	92688	3937	00	06000	33.64194015	-117.5993205	Orange County
309314	Non-Physician Medical Practitioner	None	1467521922	0	0	PEKEMA, BARBARA CORINNE	5/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
309322	Non-Physician Medical Practitioner	None	1841855590	0	0	PATRIARCA, JANELLE O NP	1/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	621 S BUTTE STREET	None	SAN PEDRO	CA	90732	3510	00	06000	33.73839738	-118.3065444	Los Angeles County
309354	Non-Physician Medical Practitioner	None	1932626728	0	0	PATTERSON, NIKA A NP	9/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 MARCELA DR	None	WILLITS	CA	95490	4225	00	06000	39.3901086	-123.339055	Mendocino County
309385	Non-Physician Medical Practitioner	None	1245493097	0	0	PLANNED PARENTHOOD MAR MONTE, INC	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 N TRACY BLVD	None	TRACY	CA	95376	3445	00	06000	37.744731	-121.4350375	San Joaquin County
309392	Non-Physician Medical Practitioner	None	1053430181	0	0	PREASMYER, SANDRA J NP	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SANTA NELLA	None	RANCHO SANTA MARG	CA	92688	2868	00	06000	33.62905214	-117.6114716	Orange County
309397	Non-Physician Medical Practitioner	None	1285056994	0	0	PINE MOUNTAIN NURSING HEALTH CENTER, INC.	3/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16233 ASKIN DR.	SUITE A	FRAZIER PARK	CA	93222	6536	00	06000	34.85010626	-119.1648907	Kern County
309432	Non-Physician Medical Practitioner	None	1083924906	0	0	PERRY, LORILEE A NP	10/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3279 POE AVE	None	CLOVIS	CA	93619	5017	00	06000	36.80896892	-119.6487946	Fresno County
309466	Non-Physician Medical Practitioner	None	1609282771	0	0	PARK, SARAH S NP	12/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2096 E FRONTERA ST	APT 37	ANAHEIM	CA	92806	7282	00	06000	33.84624766	-117.8603376	Orange County
309467	Non-Physician Medical Practitioner	None	1437813706	0	0	PATEL, AKTA NP	2/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	00	06000	34.13470788	-117.262434	San Bernardino County
309510	Non-Physician Medical Practitioner	None	1669793485	0	0	PETROSIAN, ARINEH	10/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1353 JUSTIN AVENUE	None	GLENDALE	CA	91201	1403	00	06000	34.17579893	-118.2813232	Los Angeles County
309525	Non-Physician Medical Practitioner	None	1578104964	0	0	PARAS, KIMBERLY D NP	3/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309530	Non-Physician Medical Practitioner	None	1215011614	0	0	PATLAN, JUAN M	4/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2898 GRAYBARK AVE	None	CLOVIS	CA	93619	3923	00	06000	36.79940415	-119.6488176	Fresno County
309544	Non-Physician Medical Practitioner	None	1548951890	0	0	PADILLA, CHRISTINE C	2/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27555 YNEZ RD,	SUITE 102	TEMECULA	CA	29591	4741	00	06000	33.50370608	-117.1492569	Riverside County
309550	Non-Physician Medical Practitioner	None	1316571367	0	0	PROWSE, KAYLEIGH M NP	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
309557	Non-Physician Medical Practitioner	None	1407904311	0	0	PARSONS, ROBERT A	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4605 LUCILLE DR	None	SAN DIEGO	CA	92115	1925	00	06000	32.76935933	-117.0938026	San Diego County
309563	Non-Physician Medical Practitioner	None	1134546286	0	0	PECKHAM, SAMANTHA S NP	2/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4245 TEE PEE LANE	None	LAS VEGAS	NV	89129	2628	00	06000	36.2376977	-115.3023389	Clark County
309575	Non-Physician Medical Practitioner	None	1053332783	0	0	PETERS, AARON T	3/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	339 BROADWAY	APT 220	ALAMEDA	CA	94501	6363	00	06000	37.7537865	-122.2462805	Alameda County
309608	Non-Physician Medical Practitioner	None	1477564508	0	0	PELTIER, LYNN M NP	9/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	842 HUASNA RD	None	ARROYO GRANDE	CA	93420	2856	00	06000	35.12754604	-120.5673653	San Luis Obispo County
309627	Non-Physician Medical Practitioner	None	1639574478	0	0	PLANNED PARENTHOOD MAR MONTE, INC.	6/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 BAYWOOD AVE	None	SAN MATEO	CA	94402	1516	00	06000	37.5646848	-122.3290657	San Mateo County
309644	Non-Physician Medical Practitioner	None	1699410753	0	0	PELZER, MICHAEL S NP	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
309659	Non-Physician Medical Practitioner	None	1992147896	0	0	PEPPING, YASMIN F M NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	93 PLAYA CIRCLE	None	ALISO VIEJO	CA	92656	1621	00	06000	33.59543738	-117.7268554	Orange County
309685	Non-Physician Medical Practitioner	None	1447866132	0	0	PARK, LISA Y NP	5/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
309740	Non-Physician Medical Practitioner	None	1770058521	0	0	POCHARDT, TRACI J PA	1/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
309752	Non-Physician Medical Practitioner	None	1548882012	0	0	PEARCE, BENJAMIN NP	1/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
309781	Non-Physician Medical Practitioner	None	1891129516	0	0	PATTON, KENDRA J	7/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	211 QUARRY RD	305	PALO ALTO	CA	94304	1416	00	06000	37.44198478	-122.1694088	Santa Clara County
309804	Non-Physician Medical Practitioner	None	1083035562	0	0	PARKER, SONIA C NP	10/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 E MAIN ST	None	SANTA MARIA	CA	93454	4825	00	06000	34.95282793	-120.4100798	Santa Barbara County
309839	Non-Physician Medical Practitioner	None	1457717647	0	0	POPE, KATHERINE M NP	8/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309900	Non-Physician Medical Practitioner	None	1376033746	0	0	PETTUS, JENNA NP	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	00	06000	38.664027	-121.7933505	Yolo County
309914	Non-Physician Medical Practitioner	None	1477999290	0	0	PEOPLES COMMUNITY CLINIC	3/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 N SAN JACINTO ST	SUITE Q	HEMET	CA	92543	3154	00	06000	33.755229	-116.9586405	Riverside County
309924	Non-Physician Medical Practitioner	None	1710549803	0	0	PARRA, KARINA M PA	9/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	00	06000	34.02390148	-118.184319	Los Angeles County
309926	Non-Physician Medical Practitioner	None	1497088660	0	0	PURDY, PAMONA J	7/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5617 SPRING CREEK WAY	None	ELK GROVE	CA	95758	4729	00	06000	38.422962	-121.438872	Sacramento County
309940	Non-Physician Medical Practitioner	None	1447739867	0	0	POTTER-SMITH, SARAH A PA-C	9/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6719 ALVARADO RD	SUITE 200	SAN DIEGO	CA	92120	5256	00	06000	32.77684978	-117.055137	San Diego County
309947	Non-Physician Medical Practitioner	None	1689775686	0	0	PERLS, KAREN PA-C	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
309961	Non-Physician Medical Practitioner	None	1629142526	0	0	PATEL, NILU G	2/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	4TH FLOOR	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
310014	Non-Physician Medical Practitioner	None	1740566959	0	0	PACK, EMILY SILVA	11/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3001 DOUGLAS BLVD	STE 325	ROSEVILLE	CA	95661	4289	00	06000	38.74415548	-121.2333161	Placer County
310033	Non-Physician Medical Practitioner	None	1184633935	0	0	PATE, KELLY E	4/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 GEMWOOD WAY	None	EL DORADO HILLS	CA	95762	9508	00	06000	38.6246199	-121.0516757	El Dorado County
310042	Non-Physician Medical Practitioner	None	1346661105	0	0	PEDRAJA, CHONA B NP	4/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1908 N MANNING STREET	None	BURBANK	CA	91505	1308	00	06000	34.1816976	-118.3585512	Los Angeles County
310052	Non-Physician Medical Practitioner	None	1093253924	0	0	PHILLIPS, ELIZABETH J	5/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20206 GLENWOOD DRIVE	None	CASTRO VALLEY	CA	94552	5229	00	06000	37.71281748	-122.0293695	Alameda County
310056	Non-Physician Medical Practitioner	None	1770851578	0	0	PHILLIPS, CATHY PA	4/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25495 MEDICAL CENTER DR	STE 200	MURRIETA	CA	92562	4903	00	06000	33.55804188	-117.1834064	Riverside County
310062	Non-Physician Medical Practitioner	None	1851819528	0	0	PALILLA, SARAH G PA-C	10/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2490 HOSPITAL DRIVE	SUITE 111	MOUNTAIN VIEW	CA	94040	4124	00	06000	37.369827	-122.0818185	Santa Clara County
310084	Non-Physician Medical Practitioner	None	1295086262	0	0	PRUETT, ZHIKE CNP	10/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 WASHINGTON STREET	None	SAN DIEGO	CA	92103	2289	00	06000	32.74986289	-117.1599343	San Diego County
310086	Non-Physician Medical Practitioner	None	1164472528	0	0	PANIAGUA, ARTHUR A	12/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	901 MEDICAL PARKWAY	SUITE 102	DAYTON	NV	89403	7460	00	06000	39.26935616	-119.575289	Lyon County
310114	Non-Physician Medical Practitioner	None	1205022175	0	0	PRICE, LA CHUNE F	10/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 W PICO BLVD	None	LOS ANGELES	CA	90006	5011	00	06000	34.04706445	-118.2822723	Los Angeles County
310131	Non-Physician Medical Practitioner	None	1366033573	0	0	PRECIADO, CESAR PA-C	10/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	00	06000	33.89356031	-117.9271656	Orange County
310155	Non-Physician Medical Practitioner	None	1922489384	0	0	PATRIZIO, JESSICA PA-C	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	00	06000	38.91323462	-119.9965999	El Dorado County
310159	Non-Physician Medical Practitioner	None	1629669429	0	0	PERRY, RYAN C PA-C	4/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	00	06000	33.78236048	-117.8664975	Orange County
310168	Non-Physician Medical Practitioner	None	1467000463	0	0	PHAN, OANH H NP	3/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4601 DALE ROAD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
310200	Non-Physician Medical Practitioner	None	1457508103	0	0	PRATER, STEPHANIE A	4/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4600 FOLSOM BLVD	None	SACRAMENTO	CA	95819	4424	00	06000	38.562156	-121.448529	Sacramento County
310211	Non-Physician Medical Practitioner	None	1295257269	0	0	PLAXCO, JAMIE L NP	9/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
310243	Non-Physician Medical Practitioner	None	1972137453	0	0	PEAROSE, SUSAN PA-C	1/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
310254	Non-Physician Medical Practitioner	None	1992031306	0	0	PELAYO, GILBERT NP	11/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1797 HERITAGE LANE	None	PALMDALE	CA	93551	4086	00	06000	34.59730136	-118.1620654	Los Angeles County
310256	Non-Physician Medical Practitioner	None	1760029847	0	0	PANNU, MANPREET K NP	12/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	00	06000	37.78956486	-122.417072	San Francisco County
310258	Non-Physician Medical Practitioner	None	1205409232	0	0	PRIETO, CORINNE PA-C	10/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	00	06000	38.22519621	-122.1327459	Solano County
310267	Non-Physician Medical Practitioner	None	1932619509	0	0	PERKINS, JESSE M	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	76597 CALIFORNIA DR	None	PALM DESERT	CA	92211	7751	00	06000	33.7306686	-116.3282151	Riverside County
310290	Non-Physician Medical Practitioner	None	1174541171	0	0	PRATT, MICHELLE DENISE	10/27/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2840 LONG BEACH BLVD	STE 365	LONG BEACH	CA	90806	1516	00	06000	33.808743	-118.189341	Los Angeles County
310301	Non-Physician Medical Practitioner	None	1891715736	0	0	POSADA, SOFIA E	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1729 SILACCI DR	None	CAMPBELL	CA	95008	5130	00	06000	37.2740724	-121.9804499	Santa Clara County
310312	Non-Physician Medical Practitioner	None	1881883726	0	0	PUI, WING KAY	5/24/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT 342	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
310342	Non-Physician Medical Practitioner	None	1154332492	0	0	PENALOZA, OCTAVIO FRIAS	3/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	783 QUINTANA RD	URGENT CARE OF MORRO BAY	MORRO BAY	CA	93442	1966	00	06000	35.36763559	-120.842467	San Luis Obispo County
310363	Non-Physician Medical Practitioner	None	1275632952	0	0	PLUNKETT, JEANETTE A	11/23/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2751 DEL PASO ROAD	None	SACRAMENTO	CA	95835	0000	00	06000	38.657529	-121.5233235	Sacramento County
310374	Non-Physician Medical Practitioner	None	1730296039	0	0	PIERCE, JACQUELINE M CNM	5/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1226 S 15TH STREET	None	LACROSSE	WI	54601	5609	00	06000	43.798581	-91.23440851	La Crosse County
310379	Non-Physician Medical Practitioner	None	1528176963	0	0	PINTO, FROILAN R	10/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7535 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91605	3148	00	06000	34.207452	-118.3965565	Los Angeles County
310392	Non-Physician Medical Practitioner	None	1821487414	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	4/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	685 MORRO AVE	SUITE C	MORRO BAY	CA	93442	2233	00	06000	35.364564	-120.8511755	San Luis Obispo County
310396	Non-Physician Medical Practitioner	None	1104856574	0	0	PINNER, ANTHONY M	9/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2096 HATHAWAY PLACE	None	RIVERSIDE	CA	92506	5516	00	06000	33.92357897	-117.3748672	Riverside County
310405	Non-Physician Medical Practitioner	None	1144656083	0	0	PATEL, DHARA A PA	8/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39993 FREMONT ST	APT 105	FREMONT	CA	94538	2686	00	06000	37.5410261	-121.973787	Alameda County
310424	Non-Physician Medical Practitioner	None	1043646748	0	0	PATEL, VIPUL NP	1/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7235 N FIRST ST	SUITE 103	FRESNO	CA	93720	2937	00	06000	36.84157633	-119.7748355	Fresno County
310429	Non-Physician Medical Practitioner	None	1003217605	0	0	PAGUNURAN, CHRISTINE G	1/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43549 AQUILA ST	None	INDIO	CA	92203	2702	00	06000	33.73265684	-116.1943854	Riverside County
310460	Non-Physician Medical Practitioner	None	1770359812	0	0	PATTY, ELIZABETH R NP	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
310463	Non-Physician Medical Practitioner	None	1740997873	0	0	PAN, ANGELINE NP	11/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
310483	Non-Physician Medical Practitioner	None	1427174671	0	0	PITMAN, TERESA L	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13227 TOBIASSON RD	None	POWAY	CA	92064	4310	00	06000	32.95533008	-117.0597193	San Diego County
310545	Non-Physician Medical Practitioner	None	1740323344	0	0	PARKER, LAURA E	5/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3618 ELCIA	None	BAKERSFIELD	CA	93309	3329	00	06000	35.3513992	-119.0444584	Kern County
310546	Non-Physician Medical Practitioner	None	1023319746	0	0	PHOU, THAI SI	12/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11677 WAKE CIRCLE	None	CYPRESS	CA	90603	5546	00	06000	33.792867	-118.0338695	Orange County
310547	Non-Physician Medical Practitioner	None	1588079883	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	8/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 S PALISADE DR	SUITE 201	SANTA MARIA	CA	93454	8902	00	06000	34.95143521	-120.412098	Santa Barbara County
310592	Non-Physician Medical Practitioner	None	1255995544	0	0	PENANO, KAREN U NP	9/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
310593	Non-Physician Medical Practitioner	None	1407272636	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	2/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	316 S STRATFORD AVE	SUITE B	SANTA MARIA	CA	93454	5908	00	06000	34.95019447	-120.4147816	Santa Barbara County
310595	Non-Physician Medical Practitioner	None	1932716123	0	0	PULIDO, PHOEBE PA	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 W 6TH ST	250	ONTARIO	CA	91762	1108	00	06000	34.084404	-117.6717015	San Bernardino County
310599	Non-Physician Medical Practitioner	None	1750971271	0	0	PUNIA, RAMANPAL K NP	3/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2150 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4811	00	06000	34.134705	-117.2787865	San Bernardino County
310603	Non-Physician Medical Practitioner	None	1366941973	0	0	POWERS, ALYSIA	12/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	06000	41.659929	-91.548099	Johnson County
310613	Non-Physician Medical Practitioner	None	1811345747	0	0	PRESORES, GLENN J J NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11903 HARVICK AVENUE	None	BAKERSFIELD	CA	93312	6766	00	06000	35.41392075	-119.134929	Kern County
310652	Non-Physician Medical Practitioner	None	1215412655	0	0	PACHECO, CHRISTOPHER S PA	5/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	00	06000	39.13306148	-121.6140103	Sutter County
310657	Non-Physician Medical Practitioner	None	1639528110	0	0	PHUNG, AIVI D PA-C	3/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33494 OAK GLEN RD	None	YUCAIPA	CA	92399	2057	00	06000	34.03255442	-117.0737219	San Bernardino County
310668	Non-Physician Medical Practitioner	None	1235429747	0	0	PATEL, SIMA	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3362 DELANCEY CT	None	CHINO HILLS	CA	91709	4292	00	06000	33.97422167	-117.7305713	San Bernardino County
310673	Non-Physician Medical Practitioner	None	1225745185	0	0	POURMANOUCHEHRI, ANAHITA PA-C	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 E COMMONWEALTH AVE	STE 100	FULLERTON	CA	92832	1905	00	06000	33.87034048	-117.922437	Orange County
310720	Non-Physician Medical Practitioner	None	1083129779	0	0	PEREZ, BIANCA	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310761	Non-Physician Medical Practitioner	None	1316269756	0	0	PEREZ, CARLOS	4/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
310771	Non-Physician Medical Practitioner	None	1871271569	0	0	POWERS, KAITLYN D NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1601 W AVENUE J	SUITE 101, SUITE 102	LANCASTER	CA	93534	2824	00	06000	34.68946047	-118.158849	Los Angeles County
310781	Non-Physician Medical Practitioner	None	1063519734	0	0	PHILLIPS, RACHEL	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	OBGYN DEPT 5 NE	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
310784	Non-Physician Medical Practitioner	None	1043682255	0	0	PUCELY, RANDI L NP	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	206 PARK BLVD	UNIT 203	SAN DIEGO	CA	92101	7445	00	06000	32.70769092	-117.1546408	San Diego County
310794	Non-Physician Medical Practitioner	None	1184960403	0	0	PENE, JEREMY JAMES	10/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
310810	Non-Physician Medical Practitioner	None	1003424425	0	0	PARK, HANNA NP	3/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	00	06000	34.24862229	-118.2886742	Los Angeles County
310833	Non-Physician Medical Practitioner	None	1568280964	0	0	POWERS, BRITTNEY	3/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	00	06000	38.02139448	-121.347738	San Joaquin County
310864	Non-Physician Medical Practitioner	None	1124775010	0	0	PEREZ, ERIKA	11/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
310882	Non-Physician Medical Practitioner	None	1700510096	0	0	PELOBELLO, JONELLE DONICA NP	11/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3 ALTARINDA RD	#200	ORINDA	CA	94563	2601	00	06000	37.88212237	-122.1854034	Contra Costa County
310901	Non-Physician Medical Practitioner	None	1790105971	0	0	PECKHAM, JESSICA J NP	10/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1210 W LAMBERT RD	UNIT 58	LA HABRA	CA	90631	6633	00	06000	33.923745	-117.960933	Orange County
310935	Non-Physician Medical Practitioner	None	1942408166	0	0	PUN, JOSAIAH	10/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
310936	Non-Physician Medical Practitioner	None	1295583532	0	0	PARKER, COURTNEY	8/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 MISSION BLVD	STE 2800	JACKSON	CA	95642	2536	00	06000	38.35163001	-120.7670107	Amador County
310997	Non-Physician Medical Practitioner	None	1609502293	0	0	PATEL, SACHI PA	4/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
311001	Non-Physician Medical Practitioner	None	1154871184	0	0	PANIS, ALEXANDER D NP	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7021 ALONDRA BLVD	APT 13	PARAMOUNT	CA	90723	3950	00	06000	33.88919946	-118.1768625	Los Angeles County
311018	Non-Physician Medical Practitioner	None	1790023281	0	0	PERKINS, SAMANTHA NP	7/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
311041	Non-Physician Medical Practitioner	None	1184915092	0	0	PEACH TREE HEALTHCARE	6/13/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1445 VETERANS MEMORIAL C	STE B	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
311043	Non-Physician Medical Practitioner	None	1417479775	0	0	PARK, CHRISTINE Y P	12/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30160 HOLMBY COURT	None	CASTAIC	CA	91384	4556	00	06000	34.46582173	-118.6196121	Los Angeles County
311048	Non-Physician Medical Practitioner	None	1326322264	0	0	PAZ, JUN NP	4/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5615 WESTCHESTER CIRCLE	None	STOCKTON	CA	95219	7169	00	06000	38.05601608	-121.3848753	San Joaquin County
311081	Non-Physician Medical Practitioner	None	1033881669	0	0	PETERSEN, DANE K NP	12/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2901 N VENTURA RD	STE 120	OXNARD	CA	93036	1126	00	06000	34.24479149	-119.1814409	Ventura County
311084	Non-Physician Medical Practitioner	None	1285948703	0	0	PURDY, SARAH G PA-C	7/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	00	06000	37.4924484	-122.2318516	San Mateo County
311132	Non-Physician Medical Practitioner	None	1306225941	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	7/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1102 E CLARK AVE	SUITE 120A	SANTA MARIA	CA	93455	5174	00	06000	34.86499805	-120.4185338	Santa Barbara County
311159	Non-Physician Medical Practitioner	None	1891319059	0	0	PATEL, PUNIT S	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1704 WEST MANCHESTER AVE	SUITE 106	LOS ANGELES	CA	90047	3056	00	06000	33.9599425	-118.307079	Los Angeles County
311176	Non-Physician Medical Practitioner	None	1023039575	0	0	PRESCOTT, JENNIFER M NP	6/25/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7919 OAK POND CT	None	REDWOOD VALLEY	CA	95470	9525	00	06000	39.25633366	-123.2202541	Mendocino County
311184	Non-Physician Medical Practitioner	None	1487051850	0	0	PHAM, LILLIAN	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8972 POINSETTIA LN	None	GARDEN GROVE	CA	92841	1001	00	06000	33.8018865	-117.9762975	Orange County
311187	Non-Physician Medical Practitioner	None	1962931600	0	0	PEREZ, VICTORIA NP	1/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
311208	Non-Physician Medical Practitioner	None	1336200427	0	0	PRICE, JUDI	2/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	KAISER PERMANENTE DEPT O	2025 MORSE AVE	SACRAMENTO	CA	95825	0000	00	06000	0	0	None
311215	Non-Physician Medical Practitioner	None	1770071094	0	0	PATEL, JAYNA PA	7/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311222	Non-Physician Medical Practitioner	None	1861689911	0	0	POTES, ALICIA A	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6110 JASON COURT	None	APTOS	CA	95003	6012	00	06000	36.98775299	-121.933879	Santa Cruz County
311224	Non-Physician Medical Practitioner	None	1063802536	0	0	PIERCE, ALEXIS R	5/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9705 PORT ORANGE	None	LAS VEGAS	NV	89134	0418	00	06000	36.20243673	-115.3065562	Clark County
311238	Non-Physician Medical Practitioner	None	1467809913	0	0	PARKER, AYAKO M	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6308 SURFBIRD LANE	None	ROCKLIN	CA	95765	4779	00	06000	38.80546666	-121.2818554	Placer County
311319	Non-Physician Medical Practitioner	None	1639950660	0	0	PHILIP, MARISSA	11/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
311357	Non-Physician Medical Practitioner	None	1457526105	0	0	POGORELOV, VLADLEN	9/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4585 N STAR ST	NONE	ROCKLIN	CA	95677	1805	00	06000	38.80034137	-121.2486725	Placer County
311385	Non-Physician Medical Practitioner	None	1649039652	0	0	PIERCE, SHANNON NP	7/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	00	06000	35.356392	-119.092153	Kern County
311393	Non-Physician Medical Practitioner	None	1982084141	0	0	PERETS, RON PA	12/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	00	06000	34.02980528	-118.4786605	Los Angeles County
311432	Non-Physician Medical Practitioner	None	1003113424	0	0	POIRIER, VALERIE L	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2027 KIMBERWICKE CIR	None	OVIEDO	FL	32765	7577	00	06000	28.615104	-81.24003	Seminole County
311461	Non-Physician Medical Practitioner	None	1316321383	0	0	PHAN, VICTORIA N NP	9/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1085 TASMAN DR	SPC 85	SUNNYVALE	CA	94089	5184	00	06000	37.40347474	-121.9995782	Santa Clara County
311479	Non-Physician Medical Practitioner	None	1245869874	0	0	PAL, KAMALDEEP NP	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
311488	Non-Physician Medical Practitioner	None	1144819368	0	0	PHAM, STEPHANIE T PA-C	10/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311491	Non-Physician Medical Practitioner	None	1558066688	0	0	PAYNE, ERIN PA-C	5/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
311497	Non-Physician Medical Practitioner	None	1275599227	0	0	PHILLIPS, CHRISTINA H NP	8/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1781 60TH AVE	None	SACRAMENTO	CA	95822	4223	00	06000	38.496789	-121.497165	Sacramento County
311504	Non-Physician Medical Practitioner	None	1518374255	0	0	PETIT, CASSIE PA	9/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5395 RUFFIN RD	102	SAN DIEGO	CA	92123	1338	00	06000	32.832387	-117.1266225	San Diego County
311544	Non-Physician Medical Practitioner	None	1861749442	0	0	PETERS, MAUREEN NP	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	230 PROSPECT PLACE	SUITE 340B	CORONADO	CA	92118	1991	00	06000	32.69468235	-117.1677128	San Diego County
311572	Non-Physician Medical Practitioner	None	1528533007	0	0	PINEDA, RUSSEL V PA-C	3/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5395 RUFFIN ROAD	STE. 204	SAN DIEGO	CA	92123	1338	00	06000	32.832387	-117.1266225	San Diego County
311590	Non-Physician Medical Practitioner	None	1841663804	0	0	PEARLMAN, ILANA R CNM	5/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1634 HARMON STREET	None	BERKELEY	CA	94703	2622	00	06000	37.84928433	-122.2743693	Alameda County
311603	Non-Physician Medical Practitioner	None	1558505560	0	0	PETREAS, STEPHANIE T NP	11/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 HARDING WAY	None	OAKLAND	CA	94602	1919	00	06000	37.80684737	-122.2112402	Alameda County
311659	Non-Physician Medical Practitioner	None	1629628037	0	0	PROTTER, MAYA F NP	1/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
311671	Non-Physician Medical Practitioner	None	1770101867	0	0	PETERSON, TRENTON L PA	3/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
311678	Non-Physician Medical Practitioner	None	1861564312	0	0	PENN, ANDREW D	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 VETERANS BLVD	4TH FLOOR	REDWOOD CITY	CA	94063	2612	00	06000	37.48892015	-122.218747	San Mateo County
311720	Non-Physician Medical Practitioner	None	1033170600	0	0	PARTAIN, MICHELLE L PA	7/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40461 MURRIETA HOT SPRIN	# J-01	MURRIETA	CA	92563	0001	00	06000	33.55643046	-117.1786329	Riverside County
311725	Non-Physician Medical Practitioner	None	1487815809	0	0	PRUITT, TATESHA M PA	7/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1117 E DEVONSHIRE AVENUE	None	HEMET	CA	92543	3083	00	06000	33.75116909	-116.9601666	Riverside County
311794	Non-Physician Medical Practitioner	None	1760832497	0	0	PEARSON, BRITTANY NP	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
311795	Non-Physician Medical Practitioner	None	1265125504	0	0	PEREZ, SHERRYL-ANNE NP	9/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
311813	Non-Physician Medical Practitioner	None	1336848613	0	0	PEREZ, ERIK R NP	5/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
311859	Non-Physician Medical Practitioner	None	1063477016	0	0	PARK, JI HYE	1/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5629 CANYON VIEW DR	STE. B	PARADISE	CA	95969	5502	00	06000	39.75648234	-121.5692459	Butte County
311861	Non-Physician Medical Practitioner	None	1942552914	0	0	PATEL, SAKSHI M PA-C	3/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20212 LORNE ST	None	WINNETKA	CA	91306	1887	00	06000	34.21713878	-118.5734846	Los Angeles County
311864	Non-Physician Medical Practitioner	None	1245860824	0	0	PARMER, JAMES D NP	9/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
311897	Non-Physician Medical Practitioner	None	1205681350	0	0	PALMER, RENA A	5/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18433 ROSCOE BLVD	SUITE 104	NORTHRIDGE	CA	91325	4108	00	06000	34.22076747	-118.534725	Los Angeles County
311898	Non-Physician Medical Practitioner	None	1619713229	0	0	PRASAD, SHOMAL PA	1/30/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET	None	CHICO	CA	95926	2241	00	06000	39.75090044	-121.8522609	Butte County
311936	Non-Physician Medical Practitioner	None	1720401607	0	0	PIONEERS MEMORIAL HEALTHCARE DISTRICT	3/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 W LEGION RD	SUITE 103	BRAWLEY	CA	92227	7732	00	06000	32.95996012	-115.5538196	Imperial County
311946	Non-Physician Medical Practitioner	None	1942646278	0	0	PRAKASH, BHAVANA	9/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1906 MAGDALENA CIR	APT 54	SANTA CLARA	CA	95051	2517	00	06000	37.35729682	-121.9991001	Santa Clara County
311969	Non-Physician Medical Practitioner	None	1063633493	0	0	PATEL, VANDANABEN P	2/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1134 LONGFELLOW AVE	None	CAMPBELL	CA	95008	7113	00	06000	37.26014869	-121.9516109	Santa Clara County
311976	Non-Physician Medical Practitioner	None	1205937885	0	0	PEARSON-NISHIOKA, DORIEL	5/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSISCIAN B	PALO ALTO	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311983	Non-Physician Medical Practitioner	None	1740534551	0	0	PUGH, MEAGHAN NP	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	00	06000	37.95521179	-122.0898401	Contra Costa County
312009	Non-Physician Medical Practitioner	None	1821322124	0	0	PEARSON, AMY Y	3/18/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	SUITE 200	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
312055	Non-Physician Medical Practitioner	None	1750816823	0	0	PATEL, MEGHNA PA-C	10/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	00	06000	34.07771682	-117.7485431	Los Angeles County
312065	Non-Physician Medical Practitioner	None	1720240708	0	0	PADILLA, FERNANDO M PA-C	4/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 W 17TH ST	1	SANTA ANA	CA	92706	3614	00	06000	33.75995252	-117.873378	Orange County
312099	Non-Physician Medical Practitioner	None	1356317739	0	0	PHILLIPS, SHARON	10/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1530 RAILROAD AVE	None	SAINT HELENA	CA	94574	1106	00	06000	38.50733846	-122.4714652	Napa County
312123	Non-Physician Medical Practitioner	None	1306819552	0	0	PATEL, MUKESH	9/29/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8325 BRIMHALL RD	SUITE 100	BAKERSFIELD	CA	93312	2244	00	06000	35.36875951	-119.0959206	Kern County
312173	Non-Physician Medical Practitioner	None	1972811412	0	0	PAUL, ROBERT PA-C	4/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	00	06000	32.77677653	-117.1592911	San Diego County
312179	Non-Physician Medical Practitioner	None	1184769705	0	0	PARRA, MARGARITA D	9/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1829 E ALASKA ST	None	WEST COVINA	CA	91790	3902	00	06000	34.05891822	-117.9066159	Los Angeles County
312184	Non-Physician Medical Practitioner	None	1033627062	0	0	PATEL, ROMA D NP	11/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
312189	Non-Physician Medical Practitioner	None	1134445745	0	0	PARK, SUNNY S	5/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	825 DELBON AVE	None	TURLOCK	CA	95382	2016	00	06000	37.51052943	-120.8386573	Stanislaus County
312243	Non-Physician Medical Practitioner	None	1073821724	0	0	PAK, LAUREN L NP	4/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
312256	Non-Physician Medical Practitioner	None	1548401250	0	0	POWELL HAL, KARINA PA-C	9/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
312271	Non-Physician Medical Practitioner	None	1477689644	0	0	PETREE, JANIS M	7/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312294	Non-Physician Medical Practitioner	None	1518364512	0	0	PATEL, CHARMI PA-C	1/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	00	06000	36.83745149	-119.6604315	Fresno County
312330	Non-Physician Medical Practitioner	None	1720110661	0	0	PATEL, ALPA M PA	5/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W LA VETA AVE	STE 200	ORANGE	CA	92868	4301	00	06000	33.78028244	-117.8635552	Orange County
312340	Non-Physician Medical Practitioner	None	1194325092	0	0	PIRRUCCELLO, CAITLIN NP	11/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8673 W PICO BLVD	None	LOS ANGELES	CA	90035	2377	00	06000	34.05430223	-118.3810857	Los Angeles County
312353	Non-Physician Medical Practitioner	None	1629698618	0	0	PHAM, DOAN H PA	2/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8078 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1108	00	06000	33.86628	-117.750789	Orange County
312371	Non-Physician Medical Practitioner	None	1871826057	0	0	PLOCHER, LISA M NP	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
312372	Non-Physician Medical Practitioner	None	1407268709	0	0	PEDIATRIC AND FAMILY MEDICAL CENTER	11/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3680 E IMPERIAL HWY	SUITE 200	LYNWOOD	CA	90262	2659	00	06000	33.93211641	-118.2011728	Los Angeles County
312395	Non-Physician Medical Practitioner	None	1154713790	0	0	PROACTIVE CARE NURSING, INC	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8692 WAGERS CIR	None	HUNTINGTON BEACH	CA	92647	5027	00	06000	33.72185249	-117.977166	Orange County
312460	Non-Physician Medical Practitioner	None	1245963479	0	0	PHILLIPS, EMMA A PA-C	12/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
312490	Non-Physician Medical Practitioner	None	1578228219	0	0	PRIETO, CARINA M NP	3/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23080 ALESSANDRO BLVD	#202	MORENO VALLEY	CA	92553	9674	00	06000	33.91731429	-117.2599095	Riverside County
312530	Non-Physician Medical Practitioner	None	1740700350	0	0	PHAN, RICKY N NP	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13591 BOWEN STREET	None	GARDEN GROVE	CA	92843	3223	00	06000	33.765489	-117.9506985	Orange County
312563	Non-Physician Medical Practitioner	None	1275935009	0	0	PARK, RACHEL D NP	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
312588	Non-Physician Medical Practitioner	None	1316229289	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	1/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1941 JOHNSON AVE	SUITE 301	SAN LUIS OBISPO	CA	93401	4140	00	06000	35.27804785	-120.649711	San Luis Obispo County
312602	Non-Physician Medical Practitioner	None	1952727380	0	0	POURMONSHI, KIYANOOSH	4/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5124 M ST	None	SACRAMENTO	CA	95819	4128	00	06000	38.563083	-121.4420715	Sacramento County
312652	Non-Physician Medical Practitioner	None	1730248139	0	0	PEARCE, MELINDA	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312659	Non-Physician Medical Practitioner	None	1013289024	0	0	PHOENIX, JOHN R NP	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1733 BRACKEN AVE	None	LAS VEGAS	NV	89104	3605	00	06000	36.15309446	-115.1258248	Clark County
312701	Non-Physician Medical Practitioner	None	1265669865	0	0	PATEL, PRITI N PA-C	8/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2401 W CHAPMAN AVE	STE 201	ORANGE	CA	92868	2336	00	06000	33.78793069	-117.8784055	Orange County
312704	Non-Physician Medical Practitioner	None	1083176077	0	0	PENA, NICHOLAS J PA	12/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	00	06000	33.89691672	-117.9291749	Orange County
312766	Non-Physician Medical Practitioner	None	1487834016	0	0	PABLO, ANNETTE MAGARRO	12/14/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8500 FLORENCE AVE STE 10	None	DOWNEY	CA	90240	4054	00	06000	33.94970699	-118.1216339	Los Angeles County
312772	Non-Physician Medical Practitioner	None	1902097926	0	0	PETERS, LANSDALE J PA-C	5/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9390 HESPERIA RD	SUITE # 7	HESPERIA	CA	92345	3602	00	06000	34.4212584	-117.3021441	San Bernardino County
312786	Non-Physician Medical Practitioner	None	1326259326	0	0	PETERSON, KAREN ANN	11/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1340 MITCHELL RD	None	MODESTO	CA	95351	0000	00	06000	37.61159722	-120.9387211	Stanislaus County
312800	Non-Physician Medical Practitioner	None	1588806996	0	0	PRESCOTT-JOSEPH CENTER FOR COMMUNITY ENHANCEMENT,	7/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	920 PERALTA ST	None	OAKLAND	CA	94607	1926	00	06000	37.80833921	-122.2963202	Alameda County
312803	Non-Physician Medical Practitioner	None	1619234036	0	0	PRINS, ALISON M	8/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 PACIFIC AVE	409	SAN FRANCISCO	CA	94115	1267	00	06000	37.79334592	-122.435035	San Francisco County
312816	Non-Physician Medical Practitioner	None	1336294651	0	0	PEREZ, JOSE N JR	11/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24 VALLEY STREET	None	SAN FRANCISCO	CA	94110	4922	00	06000	37.74475656	-122.4228217	San Francisco County
312837	Non-Physician Medical Practitioner	None	1457741837	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	11/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1304 ELLA ST	SUITE A	SAN LUIS OBISPO	CA	93401	4100	00	06000	35.27704692	-120.6496857	San Luis Obispo County
312899	Non-Physician Medical Practitioner	None	1790222164	0	0	POON, KENNETH K NP	3/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
312916	Non-Physician Medical Practitioner	None	1285134148	0	0	PIGUILLEM, ANDREA A NP	10/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2235 EAST LOCUST AVENUE	None	ORANGE	CA	92867	6132	00	06000	33.80379107	-117.8294477	Orange County
312931	Non-Physician Medical Practitioner	None	1558761924	0	0	PATEL, HEMANGINI	2/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	161 NORTH CIVIC DRIVE	APT 175	WALNUT CREEK	CA	94596	3904	00	06000	37.90792825	-122.0585941	Contra Costa County
312946	Non-Physician Medical Practitioner	None	1710681218	0	0	PATEL, NIGAH N NP	4/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3280 WASHINGTON ST	None	PLACERVILLE	CA	95667	5838	00	06000	38.72270909	-120.7893981	El Dorado County
312960	Non-Physician Medical Practitioner	None	1609284645	0	0	PERRY, CHRISTOPHER W	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1311 BERRY CREEK ROAD	None	WEST SACRAMENTO	CA	95691	4968	00	06000	38.55199226	-121.5184012	Yolo County
313006	Non-Physician Medical Practitioner	None	1346889623	0	0	PHAM, AN T NP	5/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
313036	Non-Physician Medical Practitioner	None	1730411802	0	0	PARAS, KERRIE M	11/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3921 URANUS AVE	None	LOMPOC	CA	93436	1931	00	06000	34.69644555	-120.4673412	Santa Barbara County
313054	Non-Physician Medical Practitioner	None	1417314485	0	0	PARK, MARINEL A NP	2/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	00	06000	34.058745	-117.2000975	San Bernardino County
313064	Non-Physician Medical Practitioner	None	1750992988	0	0	PEFFER, SARAH J PA-C	10/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9300 VALLEY CHILRENS PL	None	MADERA	CA	93638	8761	00	06000	36.88437894	-119.8003484	Madera County
313070	Non-Physician Medical Practitioner	None	1376274811	0	0	PURCELL, RACHAEL PA	12/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	00	06000	37.89281357	-122.0598728	Contra Costa County
313106	Non-Physician Medical Practitioner	None	1447324355	0	0	PARKER, ANNE E NP	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 HAMPTON AVE	None	SAN ANSELMO	CA	94960	1702	00	06000	37.98461179	-122.5702029	Marin County
313107	Non-Physician Medical Practitioner	None	1700335494	0	0	PASTORES, ALFONSO V NP	7/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3650 S ST	STE 212	LAKEWOOD	CA	90712	1528	00	06000	0	0	None
313158	Non-Physician Medical Practitioner	None	1770695736	0	0	PERRYMAN, JENNIFER D	3/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313182	Non-Physician Medical Practitioner	None	1194343897	0	0	POLAND, ALYSSA	11/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
313197	Non-Physician Medical Practitioner	None	1396952974	0	0	PHAM, NGOCDIEP CLAUDETTE	6/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
313201	Non-Physician Medical Practitioner	None	1982880332	0	0	PEDROZA, JENNIFER VELASCO	3/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
313211	Non-Physician Medical Practitioner	None	1467878819	0	0	PRATT, DARCY L NP	9/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 BERESFORD AVE	None	REDWOOD CITY	CA	94061	3504	00	06000	37.45553547	-122.226087	San Mateo County
313220	Non-Physician Medical Practitioner	None	1235565664	0	0	PADURETS, IOSIF NP	8/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
313221	Non-Physician Medical Practitioner	None	1003250143	0	0	PICKENS, JANN	8/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
313229	Non-Physician Medical Practitioner	None	1598152779	0	0	POLLARD, CRYSTAL PA-C	11/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	00	06000	34.2064445	-118.8824085	Ventura County
313234	Non-Physician Medical Practitioner	None	1275919722	0	0	PARDEE, ERIN K	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3713 MERRIDAN DRIVE	None	CONCORD	CA	94518	1621	00	06000	37.96596677	-122.010398	Contra Costa County
313245	Non-Physician Medical Practitioner	None	1609427137	0	0	PATEL, PRINA NP	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
313253	Non-Physician Medical Practitioner	None	1376107847	0	0	PERRY, TAYLOR PA	11/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
313365	Non-Physician Medical Practitioner	None	1972229854	0	0	PERDOMO, ANA	3/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
313369	Non-Physician Medical Practitioner	None	1427122886	0	0	PRICE, HELEN ELIZABETH	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	00	06000	36.8375685	-119.6781105	Fresno County
313381	Non-Physician Medical Practitioner	None	1447544630	0	0	PRATT, GLENNISE PA	7/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29738 RANCHO CALIFORNIA	SUITE B	TEMECULA	CA	92591	5322	00	06000	33.50612116	-117.1438774	Riverside County
313461	Non-Physician Medical Practitioner	None	1235370156	0	0	PARKER, EDWARD HENRY	2/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4715 VALLEY EAST BLVD	SUITE 3	ARCATA	CA	95521	3584	00	06000	40.90112023	-124.0814061	Humboldt County
313469	Non-Physician Medical Practitioner	None	1326612276	0	0	PLASCENCIA, SAUL PA	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313477	Non-Physician Medical Practitioner	None	1255956546	0	0	PAREDES, MARIA CECILIA U NP	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
313502	Non-Physician Medical Practitioner	None	1598933921	0	0	PETALVER, OLIVER C	7/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11196 SARATOGA DRIVE	None	LOS ALAMITOS	CA	90720	2640	00	06000	33.79988921	-118.0535421	Orange County
313542	Non-Physician Medical Practitioner	None	1104297894	0	0	PETERSON, NANCY E NP	8/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11075 BOREN AVE	None	LOMA LINDA	CA	92354	6518	00	06000	34.05263511	-117.2367185	San Bernardino County
313581	Non-Physician Medical Practitioner	None	1609104470	0	0	PAEZ, RUTH	8/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 N GARFIELD AVE	APT B	MONTEBELLO	CA	90640	1685	00	06000	34.02418144	-118.1324027	Los Angeles County
313583	Non-Physician Medical Practitioner	None	1346627767	0	0	PANGILINAN, LOUISA C NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4321 CABRILLO ST	None	SAN FRANCISCO	CA	94121	3311	00	06000	37.77344697	-122.5049497	San Francisco County
313592	Non-Physician Medical Practitioner	None	1316608904	0	0	PEDERSEN, DANIELLE K PA	6/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313605	Non-Physician Medical Practitioner	None	1659589489	0	0	PHONGDARA, CHRISTINE J NP	10/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8812 CRESTVIEW LANE	None	ANAHEIM HILLS	CA	92808	1663	00	06000	33.85671063	-117.7221783	Orange County
313645	Non-Physician Medical Practitioner	None	1164820114	0	0	PARTOVI, PANTEHA	2/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1912 STONER AVE	None	LOS ANGELES	CA	90025	1815	00	06000	34.03762326	-118.4522233	Los Angeles County
313697	Non-Physician Medical Practitioner	None	1114611381	0	0	PETRONIJEVIC, NICHOLAS	8/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	00	06000	36.66192801	-121.6413283	Monterey County
313715	Non-Physician Medical Practitioner	None	1982075107	0	0	PEDIATRIC AND FAMILY MEDICAL	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15477 VENTURA BLVD	SUITE 300	SHERMAN OAKS	CA	91403	3006	00	06000	34.15468022	-118.4712272	Los Angeles County
313716	Non-Physician Medical Practitioner	None	1285665778	0	0	PARK, ELVIN M NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1662 ALDERWOOD PL	None	THOUSAND OAKS	CA	91362	1222	00	06000	34.22039579	-118.8484654	Ventura County
313724	Non-Physician Medical Practitioner	None	1710952643	0	0	PERRY, BEVERLY	4/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9107 STATEN ISLAND DR	None	BAKERSFIELD	CA	93311	9672	00	06000	35.29965353	-119.1037545	Kern County
313728	Non-Physician Medical Practitioner	None	1982075115	0	0	PEDIATRIC AND FAMILY MEDICAL	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6618 VAN NUYS BLVD	None	VAN NUYS	CA	91405	4617	00	06000	34.19123738	-118.4487091	Los Angeles County
313757	Non-Physician Medical Practitioner	None	1215286778	0	0	PAZ, LISETTE A	7/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	274 DIAMOND ST	None	SAN FRANCISCO	CA	94114	2421	00	06000	37.7580174	-122.43696	San Francisco County
313778	Non-Physician Medical Practitioner	None	1174811475	0	0	PAIK, CHRISTINA	10/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDRENS WAY	STE 410	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
313783	Non-Physician Medical Practitioner	None	1154193761	0	0	PERRY, ZACHARY	1/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	00	06000	33.49961197	-117.7420867	Orange County
313799	Non-Physician Medical Practitioner	None	1922711209	0	0	PATEL, KRINA NP	1/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
313801	Non-Physician Medical Practitioner	None	1548713258	0	0	PEREZ, JIM L NP	9/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
313822	Non-Physician Medical Practitioner	None	1285839449	0	0	POLI, RON PA	4/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 HARTNELL AVE	None	REDDING	CA	96002	1843	00	06000	40.56739956	-122.3690135	Shasta County
313843	Non-Physician Medical Practitioner	None	1528558087	0	0	PRUSSE, ANNALIESE	6/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 TRANSPARENT COURT	None	BAKERSFIELD	CA	93313	5364	00	06000	35.28363331	-119.0642867	Kern County
313856	Non-Physician Medical Practitioner	None	1659671600	0	0	PLANNED PARENTHOOD: SHASTA-DIABLO, INC.	4/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 SONOMA AVE	None	SANTA ROSA	CA	95405	4817	00	06000	38.440458	-122.699502	Sonoma County
313857	Non-Physician Medical Practitioner	None	1093457194	0	0	PARK, SUNG J PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26024 ACERO	None	MISSION VIEJO	CA	92691	2768	00	06000	33.61784172	-117.6769661	Orange County
313874	Non-Physician Medical Practitioner	None	1710211180	0	0	PACE, LEA M PA-C	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2323 ADAMS AVE	SUITE 205	SAN DIEGO	CA	92116	1254	00	06000	32.76281455	-117.13941	San Diego County
313878	Non-Physician Medical Practitioner	None	1588157879	0	0	PARK, SIJIN PA	6/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313935	Non-Physician Medical Practitioner	None	1053956896	0	0	PRESTON, TIMOTHY M PA-C	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 SAN PABLO AVE	STE 400, 410, 420	BERKELEY	CA	94702	2498	00	06000	37.85066636	-122.286288	Alameda County
313947	Non-Physician Medical Practitioner	None	1538486741	0	0	POMONA COMMUNITY HEALTH CENTER	3/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	750 S PARK AVE # 101	None	POMONA	CA	91766	3129	00	06000	34.05272034	-117.7543163	Los Angeles County
313965	Non-Physician Medical Practitioner	None	1457742249	0	0	PAINTER, RACHEL E	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5041 MONTEVERDE LANE	None	LINCOLN	CA	95648	7912	00	06000	38.86309992	-121.237914	Placer County
313990	Non-Physician Medical Practitioner	None	1770997033	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	2/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 S PALISADE DR	SUITE 204	SANTA MARIA	CA	93454	8902	00	06000	34.95143521	-120.412098	Santa Barbara County
314020	Non-Physician Medical Practitioner	None	1164990677	0	0	PASTERNAK, ANNA NP	1/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
314056	Non-Physician Medical Practitioner	None	1972140804	0	0	PETERSON, MAELEY R NP	3/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
314060	Non-Physician Medical Practitioner	None	1760780654	0	0	PARK, KATHY NP	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
314077	Non-Physician Medical Practitioner	None	1154762003	0	0	PAMELAR, CHRISTINA T NP	9/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
314096	Non-Physician Medical Practitioner	None	1285930685	0	0	POWELL, CYNTHIA M	10/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1858 E BELMONT CT	None	PLACENTIA	CA	92870	5499	00	06000	33.86779412	-117.8246272	Orange County
314109	Non-Physician Medical Practitioner	None	1053403782	0	0	PORTO MADURSKI, KRISTINE PA	11/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
314116	Non-Physician Medical Practitioner	None	1154141257	0	0	PRICE, CODY M PA	10/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
314120	Non-Physician Medical Practitioner	None	1386839306	0	0	PHAM, SALLY T NP	5/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9115 OAK LEAF WAY	None	GRANITE BAY	CA	95746	9630	00	06000	38.71869482	-121.1835894	Placer County
314214	Non-Physician Medical Practitioner	None	1972807345	0	0	PENA, DAVID	2/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2275 E TICONDEROGA DR	None	FRESNO	CA	93720	4645	00	06000	36.87926858	-119.7426776	Fresno County
314218	Non-Physician Medical Practitioner	None	1336139708	0	0	PALEY, CHRISTINE	9/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2143 EVERGLADE	None	CLOVIS	CA	93619	2818	00	06000	36.86508659	-119.6767628	Fresno County
314224	Non-Physician Medical Practitioner	None	1487112371	0	0	PAK, REBECCA A NP	10/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26700 TOWNE CENTRE DR	SUITE 150	FOOTHILL RANCH	CA	92610	2845	00	06000	33.67455886	-117.6639195	Orange County
314262	Non-Physician Medical Practitioner	None	1558021097	0	0	PATA, LUKE	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	00	06000	34.08060971	-117.9958001	Los Angeles County
314280	Non-Physician Medical Practitioner	None	1841838588	0	0	PARK, LAUREN PA-C	1/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
314309	Non-Physician Medical Practitioner	None	1568686020	0	0	PARKIN, SEAN E	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 CAPRICORN AVENUE	None	OAKLAND	CA	94611	1955	00	06000	37.8386724	-122.2183291	Alameda County
314311	Non-Physician Medical Practitioner	None	1598064149	0	0	PROBERT, JESSICA L PA	1/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
314316	Non-Physician Medical Practitioner	None	1649904210	0	0	PHAN, JACKLYNNE PA-C	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4282 GENESEE AVE	STE 202	SAN DIEGO	CA	92117	4989	00	06000	32.82092667	-117.1828683	San Diego County
314330	Non-Physician Medical Practitioner	None	1225431703	0	0	PEUGH, JASON B	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5330 ALVOCA WAY	None	SACRAMENTO	CA	95835	1725	00	06000	38.671659	-121.4997705	Sacramento County
314335	Non-Physician Medical Practitioner	None	1154788560	0	0	POMONA COMMUNITY HEALTH CENT	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4241	00	06000	34.045119	-117.6464565	San Bernardino County
314336	Non-Physician Medical Practitioner	None	1720747629	0	0	PEARD, ANDREW W PA	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
314367	Non-Physician Medical Practitioner	None	1902215726	0	0	PIZANO, JESSICA L PA-C	10/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15280 LAVERNE DR	None	SAN LEANDRO	CA	94579	1943	00	06000	37.6853908	-122.1568762	Alameda County
314368	Non-Physician Medical Practitioner	None	1740463611	0	0	PAULSON, AIMEE ERIN	12/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4333 PIEDMONT AVE	None	OAKLAND	CA	94611	4715	00	06000	37.82948302	-122.2484385	Alameda County
314370	Non-Physician Medical Practitioner	None	1760568018	0	0	PERNAK, GERALD A	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	88 SKIPPER ST	None	BELGRADE	MT	59714	9231	00	06000	45.776628	-111.233646	Gallatin County
314381	Non-Physician Medical Practitioner	None	1518145002	0	0	PARKS, DION FRANCIS	11/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	SUITE 302	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
314392	Non-Physician Medical Practitioner	None	1841840501	0	0	PARAGNA, KATHRINA CNP	6/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	650 HOWE AVE	SUITE 600	SACRAMENTO	CA	95825	4731	00	06000	38.577294	-121.4146395	Sacramento County
314404	Non-Physician Medical Practitioner	None	1215123112	0	0	PARRA, SUZANNE E	12/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4700 INGLEWOOD BLVD	#102	LOS ANGELES	CA	90230	5896	00	06000	33.99315523	-118.4151866	Los Angeles County
314408	Non-Physician Medical Practitioner	None	1134335672	0	0	PIERCE, MELISSA L	4/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2234 FARGO ST	None	LOS ANGELES	CA	90039	3108	00	06000	34.09237229	-118.2596651	Los Angeles County
314427	Non-Physician Medical Practitioner	None	1124593207	0	0	PFEIFFER, JENNIFER K NP	11/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
314428	Non-Physician Medical Practitioner	None	1225768054	0	0	PUJANAUSKI, AMBER L PA	9/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1235 W VINE ST	None	LODI	CA	95240	5144	00	06000	38.12279179	-121.2879362	San Joaquin County
314434	Non-Physician Medical Practitioner	None	1225410129	0	0	PRIETO, ERIN E	1/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2357 BROOKHAVEN DR	None	CHINO HILLS	CA	91709	1735	00	06000	33.99246441	-117.7539585	San Bernardino County
314441	Non-Physician Medical Practitioner	None	1346695384	0	0	PETERSON, CHERYLE N APRN	4/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9982 SHADOW LANDING AVE	None	LAS VEGAS	NV	89166	5144	00	06000	36.31104012	-115.3134621	Clark County
314444	Non-Physician Medical Practitioner	None	1063512093	0	0	PROUSE, DEBORAH M	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	486 SOBRE COLINAS PL	None	CAMARILLO	CA	93012	5262	00	06000	34.22083657	-119.0053045	Ventura County
314474	Non-Physician Medical Practitioner	None	1174078646	0	0	PRICE, WENDY S NP	11/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3134 N HORNET AVE	None	FRESNO	CA	93737	9235	00	06000	36.78187019	-119.6588364	Fresno County
314484	Non-Physician Medical Practitioner	None	1881867919	0	0	POLLOCK, WILLIAM PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
314509	Non-Physician Medical Practitioner	None	1053945220	0	0	POTES, MARIA VICTORIA V NP	2/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12550 HESPERIA RD	SUITE 100	VICTORVILLE	CA	92395	5873	00	06000	34.47928534	-117.2909553	San Bernardino County
314524	Non-Physician Medical Practitioner	None	1710082235	0	0	PHILLIPS, ROBERT PA	4/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
314551	Non-Physician Medical Practitioner	None	1396358370	0	0	PADILLA VILLAR, CARLOS	4/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5901 W OLYMPIC BLVD STE	None	LOS ANGELES	CA	90036	4669	00	06000	34.05764121	-118.3603115	Los Angeles County
314625	Non-Physician Medical Practitioner	None	1144692237	0	0	PETTUS, AMANDA H PA-C	10/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	00	06000	34.44856821	-118.5794922	Los Angeles County
314667	Non-Physician Medical Practitioner	None	1144648825	0	0	PERTSCHUK, SARAH A PA-C	6/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	00	06000	34.01379685	-118.4159354	Los Angeles County
314735	Non-Physician Medical Practitioner	None	1528605961	0	0	PINEDA-FLORES, ELSA L NP	9/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 S CENTRAL AVE	SUITE 240	GLENDALE	CA	91204	2570	00	06000	34.12709764	-118.2577911	Los Angeles County
314751	Non-Physician Medical Practitioner	None	1154819548	0	0	PLACENSIO-GUZMAN, MARIBEL NP	11/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12459 CRICKET LN	None	VICTORVILLE	CA	92392	4842	00	06000	34.45431344	-117.391513	San Bernardino County
314752	Non-Physician Medical Practitioner	None	1306456835	0	0	PACE, ERIN M NP	10/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
314771	Non-Physician Medical Practitioner	None	1952413098	0	0	PISANO, RUSSELL C	1/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 S SUNRISE WAY	None	PALM SPRINGS	CA	92262	0118	00	06000	33.821694	-116.5282555	Riverside County
314822	Non-Physician Medical Practitioner	None	1730286824	0	0	PATEL, MEETAL V PA	5/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70453535	-121.8586496	Alameda County
314836	Non-Physician Medical Practitioner	None	1336739333	0	0	PADILLA RENDON, ALICIA E NP	2/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7023 OWENSMOUTH AVE	None	CANOGA PARK	CA	91303	2006	00	06000	34.19809485	-118.6015764	Los Angeles County
314855	Non-Physician Medical Practitioner	None	1104371806	0	0	PASILABAN, KLAR F	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1822 SPRINGGATE LN	UNIT G	SIMI VALLEY	CA	93065	2982	00	06000	34.26927637	-118.7981373	Ventura County
314867	Non-Physician Medical Practitioner	None	1184083099	0	0	PAUL, LISA G	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6581 SAN DIEGO DR	None	BUENA PARK	CA	90620	2861	00	06000	33.84388289	-118.0189325	Orange County
314902	Non-Physician Medical Practitioner	None	1003044785	0	0	PLOTKOWSKI, MICHAEL J	9/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2721 6TH STREET	APT 209	SANTA MONICA	CA	90405	4443	00	06000	34.00370453	-118.4778826	Los Angeles County
314937	Non-Physician Medical Practitioner	None	1356444848	0	0	PEREIRA-AMBROSE, IVANA NP	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
314951	Non-Physician Medical Practitioner	None	1881655074	0	0	PRICE, PAULA L	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2802 GRANT STREET	None	BERKELEY	CA	94703	2104	00	06000	37.85763152	-122.2731782	Alameda County
314953	Non-Physician Medical Practitioner	None	1457577587	0	0	PALLAN, DANIEL R	5/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8163 LAKE KNOLL DR	None	ROSEMEAD	CA	91770	3941	00	06000	34.05058495	-118.0913936	Los Angeles County
314981	Non-Physician Medical Practitioner	None	1184018137	0	0	PENG, LIFANG	5/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6401 TRUXTUN AVE	STE B	BAKERSFIELD	CA	93309	0674	00	06000	35.36227673	-119.07391	Kern County
314985	Non-Physician Medical Practitioner	None	1376891432	0	0	PRESTON, KATHLEEN M NP	11/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 CORONA CT	None	NOVATO	CA	94945	1622	00	06000	38.1189812	-122.5952809	Marin County
315000	Non-Physician Medical Practitioner	None	1851014922	0	0	PISANI, AUDRA L NP	10/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
315002	Non-Physician Medical Practitioner	None	1104645852	0	0	PURCELL, ERIK NP	11/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4049 BROCKTON AVE	None	RIVERSIDE	CA	92501	3440	00	06000	33.98177617	-117.3807605	Riverside County
315063	Non-Physician Medical Practitioner	None	1891259537	0	0	PENNING, PAULETTE	4/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
315067	Non-Physician Medical Practitioner	None	1326491440	0	0	PHILLIPS, JOSHUA D PA-C	3/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	00	06000	33.784695	-117.867327	Orange County
315100	Non-Physician Medical Practitioner	None	1184160301	0	0	PALENYY, ALEKSANDR Y	2/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6318 RING DRIVE	None	SACRAMENTO	CA	95824	4328	00	06000	38.51181	-121.4227215	Sacramento County
315102	Non-Physician Medical Practitioner	None	1538833041	0	0	PIWEK, NATALIE E PA-C	7/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	00	06000	33.78003775	-118.1866604	Los Angeles County
315143	Non-Physician Medical Practitioner	None	1437781283	0	0	PAYNE, VENESSA E NP	5/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	00	06000	33.98867148	-118.3837334	Los Angeles County
315158	Non-Physician Medical Practitioner	None	1336111327	0	0	PHILLIPS, ALICE	2/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3581 PALMER DR	SUITE 602	CAMERON PARK	CA	95682	8239	00	06000	38.66109103	-120.9649544	El Dorado County
315159	Non-Physician Medical Practitioner	None	1952538779	0	0	PINKERTON, TONYA M	6/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	223 E 43RD ST	None	SAN BERNARDINO	CA	92404	1222	00	06000	34.16763382	-117.2819629	San Bernardino County
315166	Non-Physician Medical Practitioner	None	1700120631	0	0	PRADO, FRANCES W T NP	11/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1404 MYRTLEWOOD COURT	None	MARTINEZ	CA	94553	4814	00	06000	37.9896175	-122.0965342	Contra Costa County
315205	Non-Physician Medical Practitioner	None	1477959161	0	0	PEREZ-MEDINA, JEREEN B NP	8/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7214 ANDREA ST	None	FONTANA	CA	92336	4413	00	06000	34.12287732	-117.4737622	San Bernardino County
315225	Non-Physician Medical Practitioner	None	1699389692	0	0	PETERSON, KAYLIE D NP	6/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
315226	Non-Physician Medical Practitioner	None	1457578924	0	0	PIERRE, DONALD R PA	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6766 PASSONS BLVD.	A&B	PICO RIVERA	CA	90660	3632	00	06000	33.97972571	-118.0896078	Los Angeles County
315243	Non-Physician Medical Practitioner	None	1821004581	0	0	PEPPE-NANI, SHELLY A	4/1/1998	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31460 COTTONTAIL LANE	None	BONSALL	CA	92003	4609	00	06000	33.28538975	-117.1912994	San Diego County
315258	Non-Physician Medical Practitioner	None	1154504520	0	0	PENDILLA, RACHEL MITZI	1/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1617 E 1ST ST STE A	None	SANTA ANA	CA	92701	6385	00	06000	33.74616534	-117.8462414	Orange County
315267	Non-Physician Medical Practitioner	None	1104455773	0	0	PETERSON, ASHLEY S PA-C	12/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SHRADER ST	SUITE 650	SAN FRANCISCO	CA	94117	1036	00	06000	37.77467326	-122.4529451	San Francisco County
315269	Non-Physician Medical Practitioner	None	1023441359	0	0	PATTON, MARY V NP	6/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1430 FRANCISCO ST	APT 5	SAN FRANCISCO	CA	94123	2245	00	06000	37.80275028	-122.4288064	San Francisco County
315278	Non-Physician Medical Practitioner	None	1225319486	0	0	PEREZ, SHARON R PA	6/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
315304	Non-Physician Medical Practitioner	None	1720007347	0	0	PAMELA, TIMOTHY	12/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	#1617	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
315308	Non-Physician Medical Practitioner	None	1639460322	0	0	PO-GARCIA, LILLIANA NP	11/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21840 S NORMANDIE AVE	STE 100A	TORRANCE	CA	90502	2047	00	06000	33.82982744	-118.2991395	Los Angeles County
315316	Non-Physician Medical Practitioner	None	1720558018	0	0	PHAM, JENNIE L PA-C	6/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18226 VENTURA BLVD	102	TARZANA	CA	91356	4246	00	06000	34.16628399	-118.5299288	Los Angeles County
315348	Non-Physician Medical Practitioner	None	1639709553	0	0	PIRVU, DENISA NP	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	00	06000	33.591699	-117.2368285	Riverside County
315358	Non-Physician Medical Practitioner	None	1659504447	0	0	PIMENTEL, JERRY WILLIAM	1/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8397 LANDER AVE	None	HILMAR	CA	95324	8324	00	06000	37.4101079	-120.8500956	Merced County
315381	Non-Physician Medical Practitioner	None	1306231576	0	0	PINEDO, VICTOR J NP	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12020 GROVEDALE DR	None	WHITTIER	CA	90604	3753	00	06000	33.922044	-117.988322	Los Angeles County
315419	Non-Physician Medical Practitioner	None	1295808004	0	0	PETERSEN, THERESE MARIE	10/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	MAIL CODE 5221	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315455	Non-Physician Medical Practitioner	None	1972556751	0	0	PATRICK, BRENDA FAYE	3/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13851 E 14TH ST	SUITE 206	SAN LEANDRO	CA	94578	2631	00	06000	37.71458918	-122.1418781	Alameda County
315472	Non-Physician Medical Practitioner	None	1720136948	0	0	PATEL, PINTU	12/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7467 CRAWFORD PI	None	RANCHO CUCAMONGA	CA	91739	8860	00	06000	34.11788521	-117.5205226	San Bernardino County
315535	Non-Physician Medical Practitioner	None	1730244989	0	0	PEASE, VICKI L NP	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11608 N VIA VENITZIA AVE	None	FRESNO	CA	93730	7035	00	06000	36.90497193	-119.7490255	Fresno County
315537	Non-Physician Medical Practitioner	None	1821692336	0	0	POLIZZI, BRITTANY NP	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
315543	Non-Physician Medical Practitioner	None	1063996916	0	0	PHAN, MINDY T PA-C	9/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
315555	Non-Physician Medical Practitioner	None	1245705086	0	0	PHAM, RYAN D PA	9/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
315580	Non-Physician Medical Practitioner	None	1568163962	0	0	PERMANN, ROXANNE NP	7/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	00	06000	38.570805	-121.4696385	Sacramento County
315592	Non-Physician Medical Practitioner	None	1437122769	0	0	PIONEERS MEMORIAL HEALTHCARE DISTRICT	3/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 E BIRCH ST	None	CALEXICO	CA	92231	2375	00	06000	32.67912485	-115.4913398	Imperial County
315609	Non-Physician Medical Practitioner	None	1164075289	0	0	PASTORELLI, JENNA NP	10/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 WILSHIRE BLVD	STE 100	SANTA MONICA	CA	90401	2072	00	06000	34.02509887	-118.4909994	Los Angeles County
315617	Non-Physician Medical Practitioner	None	1790934453	0	0	PEREZ, SCOTT C	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 SUNFLOWER CT	None	CHICO	CA	95926	2619	00	06000	39.75950737	-121.8265849	Butte County
315627	Non-Physician Medical Practitioner	None	1184014565	0	0	PACIFIC CENTRAL COAST HEALTH CENTERS	7/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 PEACH ST	SUITE A	SAN LUIS OBISPO	CA	93401	2837	00	06000	35.28647825	-120.6599674	San Luis Obispo County
315635	Non-Physician Medical Practitioner	None	1942503701	0	0	PLAKAS, MARIANNE NP	8/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7914 ETIWANDA AVE	None	RESEDA	CA	91335	2006	00	06000	34.21434726	-118.5316871	Los Angeles County
315642	Non-Physician Medical Practitioner	None	1891254884	0	0	PAN, MIN PA-C	5/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
315649	Non-Physician Medical Practitioner	None	1225376809	0	0	PLANNED PARENTHOOD OF ORANGE AND SAN BERNARDINO CO	8/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15403 PARK AVE E	None	VICTORVILLE	CA	92392	2482	00	06000	34.50640129	-117.3250645	San Bernardino County
315682	Non-Physician Medical Practitioner	None	1598860355	0	0	PRATT, JANA L	7/30/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2420 SONOMA ST STE B	None	REDDING	CA	96001	3027	00	06000	40.57316457	-122.4023033	Shasta County
315690	Non-Physician Medical Practitioner	None	1629473293	0	0	PHILLIPS, BRANDIN L	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	108 E OAK STREET	None	OJAI	CA	93023	2611	00	06000	34.45064686	-119.2467303	Ventura County
315695	Non-Physician Medical Practitioner	None	1639907108	0	0	PATEL, AVANI	8/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
315720	Non-Physician Medical Practitioner	None	1043037849	0	0	PROVERBS, MARISSA	2/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MISSION BLVD	None	JACKSON	CA	95642	2564	00	06000	38.35007723	-120.7659932	Amador County
315762	Non-Physician Medical Practitioner	None	1871964676	0	0	PALMER, KASIE PA	3/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1074 MURRIETA BLVD	None	LIVERMORE	CA	94550	4111	00	06000	37.67593509	-121.7822303	Alameda County
315764	Non-Physician Medical Practitioner	None	1407496433	0	0	PATONONA, RONAN B NP	1/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16660 PARAMOUNT BLVD	306	PARAMOUNT	CA	90723	5459	00	06000	33.882723	-118.1599535	Los Angeles County
315815	Non-Physician Medical Practitioner	None	1093262354	0	0	PAYNE, CHRISTI	11/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 SKYLINE DRIVE	None	MONTEREY	CA	93940	4110	00	06000	36.59323606	-121.9166669	Monterey County
315850	Non-Physician Medical Practitioner	None	1154456408	0	0	PALM-LEIS, JAYE	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
315879	Non-Physician Medical Practitioner	None	1760765085	0	0	PHAM, HUNG T	2/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12514 CRYSTAL COVE AVE	None	BAKERSFIELD	CA	93311	5117	00	06000	35.34207093	-119.1419065	Kern County
315885	Non-Physician Medical Practitioner	None	1487422077	0	0	PUCCETTI, MADISON PA	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
315894	Non-Physician Medical Practitioner	None	1548852809	0	0	PETRIK, OKSANA NP	9/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	00	06000	37.712385	-122.143428	Alameda County
315902	Non-Physician Medical Practitioner	None	1215187794	0	0	PLATA, RICARDO	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 MAIN ST STE 3	None	WATSONVILLE	CA	95076	3760	00	06000	36.9163164	-121.7698107	Santa Cruz County
315922	Non-Physician Medical Practitioner	None	1255859724	0	0	PEREZ, ANGELICA NP	9/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
315933	Non-Physician Medical Practitioner	None	1265869457	0	0	PETRICH, AUSTIN M	10/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
315938	Non-Physician Medical Practitioner	None	1669898722	0	0	PORTAL, KIMBERLY C PA-C	9/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
315950	Non-Physician Medical Practitioner	None	1184204067	0	0	PHAM, QUEENIE T PA-C	8/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
316011	Non-Physician Medical Practitioner	None	1669060562	0	0	PETER, IRIS PA	2/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4646 BROCKTON AVE	STE 101	RIVERSIDE	CA	92506	0103	00	06000	33.9760171	-117.3860626	Riverside County
316025	Non-Physician Medical Practitioner	None	1083705909	0	0	PAYNE, THERESA M NP	1/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3660 PARK SIERRA DR	SUITE 208	RIVERSIDE	CA	92505	3059	00	06000	33.90330693	-117.4707039	Riverside County
316041	Non-Physician Medical Practitioner	None	1164296398	0	0	PACKARD, AUDRA PA-C	1/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	00	06000	36.98863619	-121.9830754	Santa Cruz County
316052	Non-Physician Medical Practitioner	None	1275755142	0	0	PINCH, COLLEEN M NP	3/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2395 LOMBARD ST	None	SAN FRANCISCO	CA	94123	2601	00	06000	37.79922688	-122.4406853	San Francisco County
316072	Ordering, Referring, Prescribing	N/A	1003051004	0	0	PASCUAL, PRISCILLA E LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37145	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
316073	Ordering, Referring, Prescribing	N/A	1003057597	0	0	PIROUZ, SHOLEH	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125208	N/A	N/A	N/A	N/A	N/A	200 E KATELLA AVE	None	ORANGE	CA	92867	4804	00	06000	33.80906952	-117.851751	Orange County
316080	Ordering, Referring, Prescribing	N/A	1003076845	0	0	PEDNEAULT, GARY MD	1/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48685	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE	SUITE A	LOS ANGELES	CA	90014	1200	00	06000	34.04323075	-118.2485358	Los Angeles County
316103	Ordering, Referring, Prescribing	N/A	1003114414	0	0	PRITCHETT, DAVID M PA	4/19/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA56742	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
316150	Ordering, Referring, Prescribing	N/A	1003182445	0	0	PIROG, STEVEN C MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128295	N/A	N/A	N/A	N/A	N/A	2525 GEARY BLVD	M160	SAN FRANCISCO	CA	94117	3358	00	06000	37.78246242	-122.4448129	San Francisco County
316202	Ordering, Referring, Prescribing	N/A	1003256066	0	0	PEARSTON, CHRISTINE A PSYD	7/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28606	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
316218	Ordering, Referring, Prescribing	N/A	1003269051	0	0	PHAN, CORRINE T LCSW	3/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100441	N/A	N/A	N/A	N/A	N/A	995 GATEWAY CENTER WAY	STE 300	SAN DIEGO	CA	92102	4500	00	06000	32.71405516	-117.1158459	San Diego County
316238	Ordering, Referring, Prescribing	N/A	1003296104	0	0	PATEL, PRINTUBEN PHARMD	12/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58439	N/A	N/A	N/A	N/A	N/A	8851 CENTER DR #110	None	LA MESA	CA	91942	3031	00	06000	32.78189749	-117.0075062	San Diego County
316258	Ordering, Referring, Prescribing	N/A	1003330044	0	0	PACCASSI, SUMMER LMFT	10/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52601	N/A	N/A	N/A	N/A	N/A	1105 S MADERA AVE	None	MADERA	CA	93637	5576	00	06000	36.9427796	-120.05597	Madera County
316309	Ordering, Referring, Prescribing	N/A	1003398611	0	0	POURTABIB, MICHELLE S MD	4/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177647	N/A	N/A	N/A	N/A	N/A	925 N LAKE BLVD	STE 102	TAHOE CITY	CA	96145	2307	00	06000	39.17441644	-120.1374812	Placer County
316311	Ordering, Referring, Prescribing	N/A	1003405952	0	0	PATEL, KIRTY PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83626	N/A	N/A	N/A	N/A	N/A	6100 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	2503	00	06000	34.181325	-118.463634	Los Angeles County
316318	Ordering, Referring, Prescribing	N/A	1003415951	0	0	PHAM, TAMMY L	1/5/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105622	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
316338	Ordering, Referring, Prescribing	N/A	1003439365	0	0	POON, DENNIS D NP	7/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008131	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
316354	Ordering, Referring, Prescribing	N/A	1003462722	0	0	PARK, CAITLYN J NP	3/4/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	F03210263	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	9 A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
316365	Ordering, Referring, Prescribing	N/A	1003482613	0	0	PARNELL, JUSTIN MA OTR	7/15/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	24461	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
316373	Ordering, Referring, Prescribing	N/A	1003493024	0	0	PRATT, ALEXIA L CNP	4/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017197	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
316386	Ordering, Referring, Prescribing	N/A	1003523838	0	0	PUYAU, MEGAN NP	6/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021139	N/A	N/A	N/A	N/A	N/A	390 N PACIFIC COAST HWY	STE 2060	EL SEGUNDO	CA	90245	4401	00	06000	33.92077214	-118.3960953	Los Angeles County
316395	Ordering, Referring, Prescribing	N/A	1003561416	0	0	PATEL, PANKTI	9/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85127	N/A	N/A	N/A	N/A	N/A	2600 MOWRY AVE	None	FREMONT	CA	94538	1619	00	06000	37.55561189	-121.9825927	Alameda County
316400	Ordering, Referring, Prescribing	N/A	1003565367	0	0	PAUL, JULIANNA V	3/5/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189224	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
316422	Ordering, Referring, Prescribing	N/A	1003836974	0	0	PENA, RAYMOND MD	10/25/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61340	N/A	N/A	N/A	N/A	N/A	1530 MANNING AVE	None	REEDLEY	CA	93309	7081	00	06000	36.60413846	-119.4316515	Fresno County
316430	Ordering, Referring, Prescribing	N/A	1003900705	0	0	PHAM, KEVIN T	2/1/2002	Taxonomy not applicable	NA	n/a	099	DENTIST	D48979	N/A	N/A	N/A	N/A	N/A	7746 LORRAINE AVE	STE 204	STOCKTON	CA	95210	4234	00	06000	38.02041	-121.283254	San Joaquin County
316433	Ordering, Referring, Prescribing	N/A	1003902792	0	0	POON, ALAINA PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH45452	N/A	N/A	N/A	N/A	N/A	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
316453	Ordering, Referring, Prescribing	N/A	1003941360	0	0	PLUCINIK, STANLEY J LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40582	N/A	N/A	N/A	N/A	N/A	8939 S SEPULVEDA BLVD	460	LOS ANGELES	CA	90045	3631	00	06000	33.95485856	-118.3962461	Los Angeles County
316474	Ordering, Referring, Prescribing	N/A	1003980608	0	0	PERRY, RENEE DO	1/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8802	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
316508	Ordering, Referring, Prescribing	N/A	1013043777	0	0	PARK, DAVID Y DDS	5/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	105049	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
316559	Ordering, Referring, Prescribing	N/A	1013150176	0	0	PANG, EVA K PSYD	6/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23428	N/A	N/A	N/A	N/A	N/A	501 1ST AVENUE	None	SAN MATEO	CA	94401	3475	00	06000	37.56829343	-122.32232	San Mateo County
316562	Ordering, Referring, Prescribing	N/A	1013156967	0	0	PUGH, SHAWNNELL J LCSW	9/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	63759	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
316594	Ordering, Referring, Prescribing	N/A	1013209782	0	0	POST, MARINA MD	5/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122986	N/A	N/A	N/A	N/A	N/A	185 MARTINVALE LN	None	SAN JOSE	CA	95119	1319	00	06000	37.22953469	-121.7790244	Santa Clara County
316603	Ordering, Referring, Prescribing	N/A	1013217165	0	0	PASSARELLI, MARIELA V PHARMD	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	57523	N/A	N/A	N/A	N/A	N/A	2938 TAPO CANYON RD	None	SIMI VALLEY	CA	93063	2171	00	06000	34.287723	-118.715364	Ventura County
316612	Ordering, Referring, Prescribing	N/A	1013229111	0	0	PREECHAKUL, ROSALIN PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64188	N/A	N/A	N/A	N/A	N/A	12751 NOTTINGHAM ST	None	CERRITOS	CA	90703	7275	00	06000	33.85802444	-118.0595682	Los Angeles County
316662	Ordering, Referring, Prescribing	N/A	1013319821	0	0	PISHEH, LEILA C NP	2/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000768	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
316691	Ordering, Referring, Prescribing	N/A	1013352640	0	0	PEREZ, MONICA D	7/17/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88854	N/A	N/A	N/A	N/A	N/A	3800 FLORIN ROAD	None	SACRAMENTO	CA	95823	1802	00	06000	38.495052	-121.463874	Sacramento County
316696	Ordering, Referring, Prescribing	N/A	1013365881	0	0	PACK, JESSICA YOON K	7/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100104	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
316713	Ordering, Referring, Prescribing	N/A	1013392083	0	0	PHIPPS, DON K	11/28/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D64721	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
316774	Ordering, Referring, Prescribing	N/A	1013489715	0	0	PAULSON, AVERY J NP	1/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024036	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
316820	Ordering, Referring, Prescribing	N/A	1013591379	0	0	PLUMTREE, JULIE M PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84120	N/A	N/A	N/A	N/A	N/A	800 E LUGONIA AVE	None	REDLANDS	CA	92374	2550	00	06000	34.07000118	-117.1731789	San Bernardino County
316828	Ordering, Referring, Prescribing	N/A	1013620087	0	0	PAPPAS, SYDNEY P LCSW	4/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW14488	N/A	N/A	N/A	N/A	N/A	2490 W SHAW AVE	None	FRESNO	CA	93711	3305	00	06000	36.80841598	-119.8371594	Fresno County
316833	Ordering, Referring, Prescribing	N/A	1013640358	0	0	PATEL, MITASHA S PA-C	6/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62808	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	200	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
316892	Ordering, Referring, Prescribing	N/A	1023108024	0	0	PHUONG, LINDA PHARMD	9/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57448	N/A	N/A	N/A	N/A	N/A	1569 LEXANN AVE	SUITE 130	SAN JOSE	CA	95121	1794	00	06000	37.30790568	-121.8141983	Santa Clara County
316893	Ordering, Referring, Prescribing	N/A	1023106804	0	0	PITTMAN, THERESA NP	3/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5519	N/A	N/A	N/A	N/A	N/A	3095 YERBA BUENA RD	None	SAN JOSE	CA	95135	1513	00	06000	37.300122	-121.7627775	Santa Clara County
316908	Ordering, Referring, Prescribing	N/A	1023140688	0	0	PORTILLA, HAROLD I	6/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D51989	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
316915	Ordering, Referring, Prescribing	N/A	1023149713	0	0	PEREZ, ANGELA LMFT	12/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40963	N/A	N/A	N/A	N/A	N/A	3787 S. VERMONT AVENUE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
316935	Ordering, Referring, Prescribing	N/A	1023197555	0	0	POWELL, BRYAN PSYD	5/26/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17709	N/A	N/A	N/A	N/A	N/A	1701 OCEAN AVE	None	SAN FRANCISCO	CA	94112	1727	00	06000	37.72476918	-122.4604495	San Francisco County
316999	Ordering, Referring, Prescribing	N/A	1023337698	0	0	PERRY, MICHAEL D DO	4/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	0057253	N/A	N/A	N/A	N/A	N/A	1400 E BOULDER ST	700	COLORADO SPRINGS	CO	80909	5533	00	06000	38.8388119	-104.7995065	El Paso County
317014	Ordering, Referring, Prescribing	N/A	1023370798	0	0	PROVONSHA, CHRISTINA E LMFT	11/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94656	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
317023	Ordering, Referring, Prescribing	N/A	1023366457	0	0	PEREZ, ERIC V LCSW	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71148	N/A	N/A	N/A	N/A	N/A	8019 S. COMPTON AVE.	None	LOS ANGELES	CA	90001	9998	00	06000	33.9664185	-118.2477481	Los Angeles County
317055	Ordering, Referring, Prescribing	N/A	1023434677	0	0	PLUMMER, TEDDI M LPCC	8/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7466	N/A	N/A	N/A	N/A	N/A	5079 HWY 140	None	MARIPOSA	CA	95338	0062	00	06000	37.48746975	-119.9681179	Mariposa County
317061	Ordering, Referring, Prescribing	N/A	1023441011	0	0	PAGE, HEIDIE K MSW LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87883	N/A	N/A	N/A	N/A	N/A	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
317066	Ordering, Referring, Prescribing	N/A	1023445319	0	0	PARIKH, PARTH P PHARMD	1/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	69700	N/A	N/A	N/A	N/A	N/A	6650-6652 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	3533	00	06000	33.98444005	-118.0959576	Los Angeles County
317109	Ordering, Referring, Prescribing	N/A	1023513009	0	0	PLACONE, NICHOLAS MD	6/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164390	N/A	N/A	N/A	N/A	N/A	1551 BISHOP ST	STE 230	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.27475609	-120.6454494	San Luis Obispo County
317150	Ordering, Referring, Prescribing	N/A	1023579513	0	0	PARK, VALENTINA MD	3/31/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177690	N/A	N/A	N/A	N/A	N/A	1360 E 6TH ST	205	SAN PEDRO	CA	90732	3567	00	06000	33.73886546	-118.3075065	Los Angeles County
317153	Ordering, Referring, Prescribing	N/A	1023588563	0	0	PATEL, CAROLYN R PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54759	N/A	N/A	N/A	N/A	N/A	4175 E LA PALMA AVE	240	ANAHEIM	CA	92807	1842	00	06000	33.85947346	-117.8265479	Orange County
317220	Ordering, Referring, Prescribing	N/A	1023764891	0	0	PAPE, KATHLEEN A NP	3/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95020164	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
317269	Ordering, Referring, Prescribing	N/A	1033207881	0	0	PRATHER, RICHARD D MD	5/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G57996	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	DOOR # 4	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
317284	Ordering, Referring, Prescribing	N/A	1033238621	0	0	PINTO, GUILLERMINA A	3/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28458	N/A	N/A	N/A	N/A	N/A	310 HARBOR BLVD	E	BELMONT	CA	94002	4018	00	06000	37.52045283	-122.2680405	San Mateo County
317290	Ordering, Referring, Prescribing	N/A	1033245857	0	0	PANYANOUVONG, KEVIN LCSW	3/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25999	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
317309	Ordering, Referring, Prescribing	N/A	1033277033	0	0	PEARCE, BEATA A NP	10/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000416	N/A	N/A	N/A	N/A	N/A	8920 WILSHIRE BLVD.	425	BEVERLY HILLS	CA	90211	2004	00	06000	34.06703599	-118.3863456	Los Angeles County
317325	Ordering, Referring, Prescribing	N/A	1033303805	0	0	PALMA-WILLIAMS, ANGELINA LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60933	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
317356	Ordering, Referring, Prescribing	N/A	1033369509	0	0	PEUGH, CHARLES B LMFT	11/19/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53131	N/A	N/A	N/A	N/A	N/A	40298 JUNCTION DR	SUITE B	OAKHURST	CA	93644	9051	00	06000	37.33437817	-119.6576878	Madera County
317413	Ordering, Referring, Prescribing	N/A	1033460274	0	0	PEREZ, LAUREN PSYD	6/3/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32695	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	B5, STE. 5M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
317417	Ordering, Referring, Prescribing	N/A	1033461884	0	0	PORTER, JONATHON D DO	11/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12424	N/A	N/A	N/A	N/A	N/A	1420 ROCKY RIDGE DR	230	ROSEVILLE	CA	95661	2835	00	06000	38.75342679	-121.246502	Placer County
317426	Ordering, Referring, Prescribing	N/A	1033475231	0	0	PERAZA, PRISCILLA M LCSW	10/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97957	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
317434	Ordering, Referring, Prescribing	N/A	1033477633	0	0	PHAM, KRISTIE T PHARMD	2/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56622	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	VSC, # 340	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
317438	Ordering, Referring, Prescribing	N/A	1033480009	0	0	PHAN, PAUL PHARMD	7/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52018	N/A	N/A	N/A	N/A	N/A	946 S BROOKHURST ST	None	ANAHEIM	CA	92804	4305	00	06000	33.818652	-117.958912	Orange County
317444	Ordering, Referring, Prescribing	N/A	1033493747	0	0	PATEL, KELLY M CNP	1/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004735	N/A	N/A	N/A	N/A	N/A	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	7104	00	06000	32.78273202	-117.2524549	San Diego County
317456	Ordering, Referring, Prescribing	N/A	1033482476	0	0	PADILLA, ELOISA LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93513	N/A	N/A	N/A	N/A	N/A	2928 E CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
317464	Ordering, Referring, Prescribing	N/A	1033505813	0	0	PARMAR, MONISH MD	4/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144627	N/A	N/A	N/A	N/A	N/A	9990 COUNTY FARM ROAD	None	RIVERSIDE	CA	92503	3542	00	06000	33.9201112	-117.4577963	Riverside County
317483	Ordering, Referring, Prescribing	N/A	1033546361	0	0	PARIKH, UCHITA P PHARMD	5/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69699	N/A	N/A	N/A	N/A	N/A	6650 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	3333	00	06000	33.98445039	-118.0959494	Los Angeles County
317494	Ordering, Referring, Prescribing	N/A	1033562053	0	0	PERETZ, RYAN H MD	8/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157483	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
317505	Ordering, Referring, Prescribing	N/A	1033581905	0	0	PARK, JESSICA PHARMD	6/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	73545	N/A	N/A	N/A	N/A	N/A	2720 S BRISTOL ST	None	SANTA ANA	CA	92704	6207	00	06000	33.710463	-117.8854565	Orange County
317512	Ordering, Referring, Prescribing	N/A	1033587431	0	0	PEREZ, DONNA C LCSW	8/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87941	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVENUE	155	TORRANCE	CA	90502	1314	00	06000	33.84828383	-118.2860386	Los Angeles County
317530	Ordering, Referring, Prescribing	N/A	1033620166	0	0	PAGE, LISA LMFT	11/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118581	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
317551	Ordering, Referring, Prescribing	N/A	1033653605	0	0	PAPAGEORGE, NICHOLAS A	9/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141734	N/A	N/A	N/A	N/A	N/A	106 JUANA MARIA AVE	None	SANTA BARBARA	CA	93103	2714	00	06000	34.4233005	-119.6798803	Santa Barbara County
317563	Ordering, Referring, Prescribing	N/A	1033669288	0	0	PHILLIPS, LINDSAY LCSW	11/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92907	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST	375	PASADENA	CA	91103	3697	00	06000	34.14963648	-118.1522925	Los Angeles County
317569	Ordering, Referring, Prescribing	N/A	1033674098	0	0	PRIETO, HILDA DDS	1/10/2024	Taxonomy not applicable	NA	n/a	000	Unknown	103525	N/A	N/A	N/A	N/A	N/A	2414 S FAIRVIEW ST	107A	SANTA ANA	CA	92704	5318	00	06000	33.71437705	-117.9079237	Orange County
317577	Ordering, Referring, Prescribing	N/A	1033690938	0	0	PIMENTEL, TERESA LMFT	8/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127406	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
317592	Ordering, Referring, Prescribing	N/A	1033699558	0	0	PORTILLO, ALICIA PA	11/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57496	N/A	N/A	N/A	N/A	N/A	533 E PALMDALE BLVD	SUITE 533-A1	PALMDALE	CA	93550	2374	00	06000	34.5796702	-118.1198284	Los Angeles County
317611	Ordering, Referring, Prescribing	N/A	1033752860	0	0	PENNON, JENNIFER NP	12/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013052	N/A	N/A	N/A	N/A	N/A	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	0001	00	06000	35.11274104	-120.588873	San Luis Obispo County
317679	Ordering, Referring, Prescribing	N/A	1043282429	0	0	PALFY, SHELLEY MD	12/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104009	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
317696	Ordering, Referring, Prescribing	N/A	1043338577	0	0	PRIOR, JODI M LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38373	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	2301	00	06000	34.70150394	-118.1452081	Los Angeles County
317698	Ordering, Referring, Prescribing	N/A	1043341092	0	0	PACHECO, SABRINA LCSW	11/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83568	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	SUITE 150	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
317723	Ordering, Referring, Prescribing	N/A	1043380827	0	0	PERKINS, JOHN D	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39833	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
317759	Ordering, Referring, Prescribing	N/A	1043441033	0	0	POMA, HELENA B LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85118	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
317768	Ordering, Referring, Prescribing	N/A	1043473051	0	0	PEARCE, ELIZABETH A PSYD	5/21/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26090	N/A	N/A	N/A	N/A	N/A	39420 LIBERTY STREET	STE. 252	FREMONT	CA	94538	2200	00	06000	37.54914567	-121.9786657	Alameda County
317773	Ordering, Referring, Prescribing	N/A	1043475569	0	0	PERCH, YULIYA MD	2/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126038	N/A	N/A	N/A	N/A	N/A	6060 PARAMOUNT BLVD	None	LONG BEACH	CA	90805	3711	00	06000	33.865083	-118.157517	Los Angeles County
317791	Ordering, Referring, Prescribing	N/A	1043520273	0	0	PILGRIM, SARAH LMFT	4/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52560	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
317804	Ordering, Referring, Prescribing	N/A	1043555154	0	0	POOL, ROBYN O CNM	6/22/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	350	N/A	N/A	N/A	N/A	N/A	415 ROLLING OAKS DR	SUITE 190	THOUSAND OAKS	CA	91361	1029	00	06000	34.17439717	-118.8691161	Ventura County
317820	Ordering, Referring, Prescribing	N/A	1043576077	0	0	PAPAZIAN, TALAR S	3/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0673785	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
317821	Ordering, Referring, Prescribing	N/A	1043587207	0	0	PHONG, DAO N	9/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64304	N/A	N/A	N/A	N/A	N/A	2050 IRVING ST	None	SAN FRANCISCO	CA	94122	1716	00	06000	37.76346003	-122.4800787	San Francisco County
317828	Ordering, Referring, Prescribing	N/A	1043599020	0	0	PEREZ, MARIA LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102299	N/A	N/A	N/A	N/A	N/A	11565 LAUREL CANYON BLVD	116	SAN FERNANDO	CA	91340	4168	00	06000	34.28018218	-118.4549135	Los Angeles County
317857	Ordering, Referring, Prescribing	N/A	1043638166	0	0	PAGI, REUT R MD	7/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145862	N/A	N/A	N/A	N/A	N/A	2888 LONG BEACH BLVD	340	LONG BEACH	CA	90806	1530	00	06000	33.809706	-118.189343	Los Angeles County
317892	Ordering, Referring, Prescribing	N/A	1043688633	0	0	PATEL RASOOL, MISBAH MD	9/24/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151374	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
317914	Ordering, Referring, Prescribing	N/A	1043716939	0	0	PAI, DARSHANA S MD	8/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174381	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
317915	Ordering, Referring, Prescribing	N/A	1043719966	0	0	PATEL, SHEKHA D PHARMD	10/1/2020	Taxonomy not applicable	NA	n/a	000	Unknown	60337	N/A	N/A	N/A	N/A	N/A	12665 GARDEN GROVE BLVD	STE 108	GARDEN GROVE	CA	92843	1901	00	06000	33.77450141	-117.9123364	Orange County
317935	Ordering, Referring, Prescribing	N/A	1043744279	0	0	PARK, JUN MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169512	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
317942	Ordering, Referring, Prescribing	N/A	1043753353	0	0	POTTS, CANDITA T NP	12/12/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	694624	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVE	STE 370	LONG BEACH	CA	90806	2661	00	06000	33.805854	-118.1936805	Los Angeles County
317962	Ordering, Referring, Prescribing	N/A	1043785710	0	0	PHILLIPS, STEVEN K PA-C	2/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57858	N/A	N/A	N/A	N/A	N/A	665 NORTH D STREET	None	SAN BERNARDINO	CA	92401	1109	00	06000	34.111737	-117.2918735	San Bernardino County
318057	Ordering, Referring, Prescribing	N/A	1053045963	0	0	PESSEREAU, MORGAN M PA-C	9/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61651	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LANE	100	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
318085	Ordering, Referring, Prescribing	N/A	1053084079	0	0	PEDROZA, ALYSSA OD	7/24/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34864	N/A	N/A	N/A	N/A	N/A	955 S CARILLO AVE	STE 105	LOS ANGELES	CA	90048	5400	00	06000	33.73540787	-118.2946295	Los Angeles County
318096	Ordering, Referring, Prescribing	N/A	1053363820	0	0	PATEL, DILIPKUMAR R MD	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52291	N/A	N/A	N/A	N/A	N/A	40 OFFSHORE	None	NEWPORT COAST	CA	92657	2163	00	06000	33.57314085	-117.8241924	Orange County
318099	Ordering, Referring, Prescribing	N/A	1053404848	0	0	PHAM, KATHY H PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50553	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
318116	Ordering, Referring, Prescribing	N/A	1053435370	0	0	PARADISE, BARBARA LMFT	12/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42138	N/A	N/A	N/A	N/A	N/A	42455 10TH ST W	SUITE 103	LANCASTER	CA	93534	7060	00	06000	34.65438079	-118.1478341	Los Angeles County
318117	Ordering, Referring, Prescribing	N/A	1053440743	0	0	PINTO, ANNETTE F OT	6/8/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT1486	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
318122	Ordering, Referring, Prescribing	N/A	1053441287	0	0	PEREZ, LILIAM MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87095	N/A	N/A	N/A	N/A	N/A	299 12TH ST	A	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
318136	Ordering, Referring, Prescribing	N/A	1053458265	0	0	PINANONG, PATTY P MD	5/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A77049	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
318137	Ordering, Referring, Prescribing	N/A	1053461541	0	0	PLUE, LAURA W DDS	10/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS42449	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
318157	Ordering, Referring, Prescribing	N/A	1053489567	0	0	PALMER, DAVID J LCSW	1/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20198	N/A	N/A	N/A	N/A	N/A	1907 BOYS REPUBLIC DR	None	CHINO HILLS	CA	91709	5447	00	06000	33.993846	-117.725661	San Bernardino County
318159	Ordering, Referring, Prescribing	N/A	1053493734	0	0	PRAKASAM, LILIANA P NP	5/18/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	569971	N/A	N/A	N/A	N/A	N/A	308 N LA CADENA DR	None	COLTON	CA	92324	9246	00	06000	34.06815282	-117.3240225	San Bernardino County
318181	Ordering, Referring, Prescribing	N/A	1053532374	0	0	PEREZ, ROSA O LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29341	N/A	N/A	N/A	N/A	N/A	40 E MINARETS AVE	None	PINEDALE	CA	93650	1239	00	06000	36.84269447	-119.7897525	Fresno County
318233	Ordering, Referring, Prescribing	N/A	1053626952	0	0	PITBLADDO, VERONICA LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100512	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE.	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
318239	Ordering, Referring, Prescribing	N/A	1053642835	0	0	PASAYLO, ANA DARYL	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63191	N/A	N/A	N/A	N/A	N/A	2293 RIVER OAKS BLVD	None	PLUMAS LAKE	CA	95961	9194	00	06000	39.01987812	-121.5507996	Yuba County
318290	Ordering, Referring, Prescribing	N/A	1053713156	0	0	PARK, JOSEPH DDS	9/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64009	N/A	N/A	N/A	N/A	N/A	925 W FOOTHILL BLVD STE	None	MONROVIA	CA	91016	6603	00	06000	34.15116148	-118.0194705	Los Angeles County
318326	Ordering, Referring, Prescribing	N/A	1053752485	0	0	PRESTON, GWENDOLYN NP	12/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21719	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
318337	Ordering, Referring, Prescribing	N/A	1053770867	0	0	PETERSON, TARA LMFT	1/22/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87204	N/A	N/A	N/A	N/A	N/A	700 PACIFIC ST	None	MONTEREY	CA	93940	2815	00	06000	36.59516521	-121.897712	Monterey County
318357	Ordering, Referring, Prescribing	N/A	1053790824	0	0	PORTUGAL, THERESA DO	3/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15371	N/A	N/A	N/A	N/A	N/A	1215 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	1793	00	06000	34.06877078	-117.9349578	Los Angeles County
318360	Ordering, Referring, Prescribing	N/A	1053791152	0	0	PARK, ELIZABETH LMFT	2/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110792	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
318372	Ordering, Referring, Prescribing	N/A	1053804393	0	0	PHAN, ALLEN MD	1/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192741	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS ROAD	SUITE 200	CONCORD	CA	94520	2553	00	06000	37.96956948	-122.0507563	Contra Costa County
318395	Ordering, Referring, Prescribing	N/A	1053855007	0	0	PAREDES, CHERRY BELLE G NP	6/2/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005674	N/A	N/A	N/A	N/A	N/A	12507 ALONDRA BLVD.	None	NORWALK	CA	90650	7351	00	06000	33.88780847	-118.0660905	Los Angeles County
318409	Ordering, Referring, Prescribing	N/A	1053871947	0	0	PATEL, KANISHKA G MD	3/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176976	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
318453	Ordering, Referring, Prescribing	N/A	1053974899	0	0	PINEDA, ABIGAIL LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT95104	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
318458	Ordering, Referring, Prescribing	N/A	1053998013	0	0	PAYTON, ETHAN MD	3/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194641	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
318459	Ordering, Referring, Prescribing	N/A	1063000578	0	0	POSEY, DINA J LMFT	7/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123733	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	None	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
318482	Ordering, Referring, Prescribing	N/A	1063052512	0	0	PATEL, KARAN S PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81872	N/A	N/A	N/A	N/A	N/A	498 CASTRO ST	None	SAN FRANCISCO	CA	94114	2020	00	06000	37.76111969	-122.4350504	San Francisco County
318484	Ordering, Referring, Prescribing	N/A	1063061661	0	0	PINEDA, ALEX PSYD	7/16/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34247	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
318487	Ordering, Referring, Prescribing	N/A	1063064822	0	0	PADILLA, SHERE LPCC	8/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17253	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
318491	Ordering, Referring, Prescribing	N/A	1063080943	0	0	PINO, BRENT C DO	2/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	2A022506	N/A	N/A	N/A	N/A	N/A	5823 YORK BLVD	SUITE 1	LOS ANGELES	CA	90042	0000	00	06000	34.11850913	-118.1915335	Los Angeles County
318494	Ordering, Referring, Prescribing	N/A	1063091320	0	0	PHAM, TAMMY B MD	7/16/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197764	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
318506	Ordering, Referring, Prescribing	N/A	1063137438	0	0	PUNSALAN, PILAR NP	6/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95030371	N/A	N/A	N/A	N/A	N/A	1611 1ST ST	None	BAKERSFIELD	CA	93304	2901	00	06000	35.35506651	-119.020518	Kern County
318521	Ordering, Referring, Prescribing	N/A	1063178739	0	0	PIPER, STEVEN M PA-C	1/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA60563	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
318579	Ordering, Referring, Prescribing	N/A	1063540391	0	0	PETROS, STELLA L LCSW	10/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25802	N/A	N/A	N/A	N/A	N/A	223 NORTH JACKSON STREET	None	GLENDALE	CA	91206	4334	00	06000	34.14893716	-118.2502138	Los Angeles County
318606	Ordering, Referring, Prescribing	N/A	1063574804	0	0	PRENDERGAST, JEFF A LMSW	9/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62888	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
318608	Ordering, Referring, Prescribing	N/A	1063580587	0	0	PROFFITT, PAULA MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G40787	N/A	N/A	N/A	N/A	N/A	550 W VISTA WAY	STE 109	VISTA	CA	92083	5732	00	06000	33.19564771	-117.2534095	San Diego County
318657	Ordering, Referring, Prescribing	N/A	1063684546	0	0	PELAEZ, EVANGELINE B	10/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0560404	N/A	N/A	N/A	N/A	N/A	3225 E COLORADO BLVD	None	PASADENA	CA	91107	3815	00	06000	34.14624852	-118.0838475	Los Angeles County
318660	Ordering, Referring, Prescribing	N/A	1063686376	0	0	PERRY, RACHEL A MD	10/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131371	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
318691	Ordering, Referring, Prescribing	N/A	1063735017	0	0	PRESTON, CYNTHIA	4/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	ND403	N/A	N/A	N/A	N/A	N/A	16601 PACIFIC COAST HIGH	None	SUNSET BEACH	CA	90742	1452	00	06000	33.72108919	-118.0742289	Orange County
318694	Ordering, Referring, Prescribing	N/A	1063739498	0	0	PERPETUO, THERESA A	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0684108	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
318695	Ordering, Referring, Prescribing	N/A	1063749067	0	0	PICHARDO, VICKY M LCSW	3/14/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74308	N/A	N/A	N/A	N/A	N/A	308 N LA CADENA DR	None	COLTON	CA	92324	2946	00	06000	34.06815282	-117.3240225	San Bernardino County
318701	Ordering, Referring, Prescribing	N/A	1063759355	0	0	PHAM, CHRISTAL PHARMD	3/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	67138	N/A	N/A	N/A	N/A	N/A	795 E 2ND STREET	1	POMONA	CA	91766	2007	00	06000	34.05845654	-117.7423951	Los Angeles County
318718	Ordering, Referring, Prescribing	N/A	1063776128	0	0	PEDRO, JUDY H RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	589688	N/A	N/A	N/A	N/A	N/A	1530 E 19TH ST	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
318767	Ordering, Referring, Prescribing	N/A	1063819928	0	0	POMEROY, WILLIAM I	3/13/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D39196	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
318786	Ordering, Referring, Prescribing	N/A	1063854669	0	0	PETERSEN, ANDREA R PA	11/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65363	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
318813	Ordering, Referring, Prescribing	N/A	1063894905	0	0	PERNI, NIHARIKA MD	3/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154687	N/A	N/A	N/A	N/A	N/A	4900 CALIFORNIA AVE	STE 400B	BAKERSFIELD	CA	93309	7081	00	06000	35.36440586	-119.0562732	Kern County
318817	Ordering, Referring, Prescribing	N/A	1063884633	0	0	PEARSON, WING-SZE T	12/28/2015	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	71751	N/A	N/A	N/A	N/A	N/A	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
318819	Ordering, Referring, Prescribing	N/A	1063896611	0	0	PAI, LINDA PHARMD	6/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	43357	N/A	N/A	N/A	N/A	N/A	26521 AGOURA RD	None	CALABASAS	CA	91302	1958	00	06000	34.14393164	-118.6996508	Los Angeles County
318835	Ordering, Referring, Prescribing	N/A	1063927242	0	0	PHILLIPS, KATHERINE DC	4/29/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33915	N/A	N/A	N/A	N/A	N/A	1620 ALPINE BLVD	110	ALPINE	CA	91901	1102	00	06000	32.83781579	-116.7799366	San Diego County
318859	Ordering, Referring, Prescribing	N/A	1063971240	0	0	POTTER, MATTHEW DO	3/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20003	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
318869	Ordering, Referring, Prescribing	N/A	1063988517	0	0	PEREYRA, VIVIANA LCSW	10/1/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126476	N/A	N/A	N/A	N/A	N/A	901 W VICTORIA ST	STE F&G	COMPTON	CA	90220	5819	00	06000	33.86784006	-118.2368928	Los Angeles County
318902	Ordering, Referring, Prescribing	N/A	1073035093	0	0	PIPKORN, CHRISTINA A	11/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	54710	N/A	N/A	N/A	N/A	N/A	6095 N 1ST ST	None	FRESNO	CA	93710	0000	00	06000	36.82524765	-119.7723922	Fresno County
318908	Ordering, Referring, Prescribing	N/A	1073053955	0	0	PENG, SOPHIA C DMD	1/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS101160	N/A	N/A	N/A	N/A	N/A	11328 BARTLETT AVE	UNIT 3	ADELANTO	CA	92301	1709	00	06000	34.57921051	-117.417186	San Bernardino County
318909	Ordering, Referring, Prescribing	N/A	1073043626	0	0	PEREZ, CAROLINA LCSW	8/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110234	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
318946	Ordering, Referring, Prescribing	N/A	1073101416	0	0	PHAN, LYNDA PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82750	N/A	N/A	N/A	N/A	N/A	6316 IRVINE BLVD	None	IRVINE	CA	92620	2102	00	06000	33.69920001	-117.7393832	Orange County
318952	Ordering, Referring, Prescribing	N/A	1073107520	0	0	POLLACK, CARLY LCSW	2/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113909	N/A	N/A	N/A	N/A	N/A	208 PROVIDENCE MINE RD	STE 122	NEVADA CITY	CA	95959	2955	00	06000	39.25021269	-121.0300958	Nevada County
318961	Ordering, Referring, Prescribing	N/A	1073141586	0	0	PRESTGARD-DUKE, MICHAEL J MD	11/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182973	N/A	N/A	N/A	N/A	N/A	3544 30TH STREET	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
318965	Ordering, Referring, Prescribing	N/A	1073157426	0	0	POE, JENNIFER NP	12/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012566	N/A	N/A	N/A	N/A	N/A	235 S PALISADE DR	None	SANTA MARIA	CA	93454	0001	00	06000	34.9516506	-120.4121902	Santa Barbara County
318975	Ordering, Referring, Prescribing	N/A	1073173332	0	0	PIERCE, HUNTER N CNP	8/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026131	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
318992	Ordering, Referring, Prescribing	N/A	1073262135	0	0	PALOMARES, OSVALDO MD	9/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191167	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
319052	Ordering, Referring, Prescribing	N/A	1073645032	0	0	PADILLA, JESSICA LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91304	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
319060	Ordering, Referring, Prescribing	N/A	1073663886	0	0	PIERRE, PETERSON MD	11/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66363	N/A	N/A	N/A	N/A	N/A	5333 HOLLISTER AVE	STE 105	SANTA BARBARA	CA	93111	3309	00	06000	34.43491982	-119.8105484	Santa Barbara County
319074	Ordering, Referring, Prescribing	N/A	1073700472	0	0	PURI, NEERJA MD	11/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42147	N/A	N/A	N/A	N/A	N/A	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	00	06000	33.922863	-118.2431655	Los Angeles County
319078	Ordering, Referring, Prescribing	N/A	1073711198	0	0	PAZMINO, RAQUEL LCSW	2/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28297	N/A	N/A	N/A	N/A	N/A	10953 RAMONA BLVD	None	EL MONTE	CA	91731	2629	00	06000	34.07205148	-118.0372365	Los Angeles County
319081	Ordering, Referring, Prescribing	N/A	1073709473	0	0	PHILIPSON, SOGOL LCSW	2/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66853	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE ST	None	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
319153	Ordering, Referring, Prescribing	N/A	1073891016	0	0	PONS, ADRIANA E NP	2/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	682697	N/A	N/A	N/A	N/A	N/A	840 DELBON AVE	None	TURLOCK	CA	95382	2005	00	06000	37.51046091	-120.8383932	Stanislaus County
319159	Ordering, Referring, Prescribing	N/A	1073896601	0	0	PHAN, LINDA K PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54952	N/A	N/A	N/A	N/A	N/A	7155 24TH ST	None	SACRAMENTO	CA	95822	4494	00	06000	38.496231	-121.482207	Sacramento County
319174	Ordering, Referring, Prescribing	N/A	1073924130	0	0	PENN, NATALIE C MD	1/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	176042	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
319198	Ordering, Referring, Prescribing	N/A	1073965992	0	0	POWELL, JEFFREY L CNP	8/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018259	N/A	N/A	N/A	N/A	N/A	506 W JACKMAN ST	None	LANCASTER	CA	93534	2531	00	06000	34.70193469	-118.1377582	Los Angeles County
319203	Ordering, Referring, Prescribing	N/A	1073973038	0	0	PADGETT, WENDY L LCSW	1/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106534	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	SUITE A	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
319206	Ordering, Referring, Prescribing	N/A	1073976353	0	0	PETERSON, CATHERINE MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168446	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2252	00	06000	38.555181	-121.4566785	Sacramento County
319215	Ordering, Referring, Prescribing	N/A	1073981585	0	0	PATEL, CHETAK PHARMD	8/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH73036	N/A	N/A	N/A	N/A	N/A	3100 FOWLER AVE	None	CLOVIS	CA	93611	2100	00	06000	36.794754	-119.6840025	Fresno County
319225	Ordering, Referring, Prescribing	N/A	1083000293	0	0	PAT, CARMEN S LMFT	7/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122009	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	SUITE 108	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
319236	Ordering, Referring, Prescribing	N/A	1083012579	0	0	PHILLIPPI, JULIE A LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116436	N/A	N/A	N/A	N/A	N/A	1418 J STREET	None	MODESTO	CA	95354	1418	00	06000	37.64385262	-120.9958717	Stanislaus County
319251	Ordering, Referring, Prescribing	N/A	1083011407	0	0	PATEL, ROSHNI R	9/9/2015	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	71805	N/A	N/A	N/A	N/A	N/A	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
319252	Ordering, Referring, Prescribing	N/A	1083028930	0	0	PETERSON, MELISSA A NP	6/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000725	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS 66	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
319344	Ordering, Referring, Prescribing	N/A	1083165542	0	0	PEREZ, JOSEPHINE M LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114049	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE.	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
319347	Ordering, Referring, Prescribing	N/A	1083169064	0	0	PALMER, ANNIE R NP	9/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21227	N/A	N/A	N/A	N/A	N/A	1005 ATLANTIC AVE	None	ALAMEDA	CA	94501	1148	00	06000	37.78080326	-122.2676078	Alameda County
319348	Ordering, Referring, Prescribing	N/A	1083167589	0	0	PELAYO, MARITZA LCSW	8/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102116	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVENUE	STE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
319359	Ordering, Referring, Prescribing	N/A	1083172720	0	0	PUN, KHUSBU DO	11/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22312	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
319366	Ordering, Referring, Prescribing	N/A	1083195358	0	0	PLANT, DARLA BSN PHN	10/15/2020	Taxonomy not applicable	NA	n/a	000	Unknown	845103	N/A	N/A	N/A	N/A	N/A	12935 MARENGO RD	None	GALT	CA	95632	8422	00	06000	38.28694218	-121.2826312	Sacramento County
319377	Ordering, Referring, Prescribing	N/A	1083224620	0	0	PATEL, MEERA PHARMD	9/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82235	N/A	N/A	N/A	N/A	N/A	6255 SUNSET BLVD	21ST FLOOR	LOS ANGELES	CA	90028	9093	00	06000	34.09802749	-118.3255515	Los Angeles County
319403	Ordering, Referring, Prescribing	N/A	1083273171	0	0	PENATE, RACHEL K LCSW	11/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW119390	N/A	N/A	N/A	N/A	N/A	316 E. 111TH STREET	None	LOS ANGELES	CA	90061	3004	00	06000	33.93477147	-118.2689419	Los Angeles County
319417	Ordering, Referring, Prescribing	N/A	1083302905	0	0	PHAM, CALEB H DMD	11/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	111034	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
319418	Ordering, Referring, Prescribing	N/A	1083314421	0	0	PINTO-OCHOA, MIA NP	2/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024359	N/A	N/A	N/A	N/A	N/A	7600 HOSPITAL DR	J	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
319421	Ordering, Referring, Prescribing	N/A	1083313787	0	0	PASHANIAN, ELIZABETH LCSW	2/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113825	N/A	N/A	N/A	N/A	N/A	4137 VERDUGO RD	None	LOS ANGELES	CA	90065	3820	00	06000	34.1261475	-118.2319835	Los Angeles County
319462	Ordering, Referring, Prescribing	N/A	1083637318	0	0	PARKER ANDERSON, KAREN D PHD	3/10/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY13264	N/A	N/A	N/A	N/A	N/A	200 SOUTH WELLS ROAD	250	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
319471	Ordering, Referring, Prescribing	N/A	1083698120	0	0	PORTER, DAWN	10/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS20398	N/A	N/A	N/A	N/A	N/A	1490 N CLAREMONT BLVD	None	CLAREMONT	CA	91711	3519	00	06000	34.11108358	-117.7019894	Los Angeles County
319480	Ordering, Referring, Prescribing	N/A	1083725006	0	0	PRATHER, ALLYSON M LMFT	7/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45441	N/A	N/A	N/A	N/A	N/A	425 N DATE ST	None	ESCONDIDO	CA	92025	3413	00	06000	33.1292461	-117.0716509	San Diego County
319615	Ordering, Referring, Prescribing	N/A	1083991368	0	0	PHUNG, TIEN T PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66270	N/A	N/A	N/A	N/A	N/A	1833 N MILPITAS BLVD	None	MILPITAS	CA	95035	2734	00	06000	37.45652323	-121.9113373	Santa Clara County
319631	Ordering, Referring, Prescribing	N/A	1083999437	0	0	PARK, BRIAN J PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55551	N/A	N/A	N/A	N/A	N/A	331 N PACIFIC COAST HWY	None	EL SEGUNDO	CA	90245	4444	00	06000	33.92058735	-118.39638	Los Angeles County
319677	Ordering, Referring, Prescribing	N/A	1093088932	0	0	PARK, MADISON LCSW	3/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88785	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
319686	Ordering, Referring, Prescribing	N/A	1093108292	0	0	PETERSON, TATYANA LMFT	7/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104560	N/A	N/A	N/A	N/A	N/A	500 JEFFERSON BLVD	150	WEST SACRAMENTO	CA	95605	2350	00	06000	38.58758543	-121.5270475	Yolo County
319723	Ordering, Referring, Prescribing	N/A	1093167546	0	0	PISTONE, SABRINA M LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106453	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
319733	Ordering, Referring, Prescribing	N/A	1093179517	0	0	PARK, JINA MD	11/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152646	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
319743	Ordering, Referring, Prescribing	N/A	1093189235	0	0	PERKINS, SAMANTHA LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93653	N/A	N/A	N/A	N/A	N/A	406 SUNRISE AVE.	300	ROSEVILLE	CA	95661	0606	00	06000	38.73944898	-121.2720559	Placer County
319766	Ordering, Referring, Prescribing	N/A	1093218869	0	0	PHILLIPS, ASHAKIE NP	2/23/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008658	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
319790	Ordering, Referring, Prescribing	N/A	1093258923	0	0	PEPA, PATRICIA ANN Y	4/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72854	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	BLDG B	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
319814	Ordering, Referring, Prescribing	N/A	1093288813	0	0	PHAN, DIEM THUY H RN	3/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	632967	N/A	N/A	N/A	N/A	N/A	16703 S. CLARK AVE	None	BELLFLOWER	CA	90706	5245	00	06000	33.88289607	-118.1340285	Los Angeles County
319842	Ordering, Referring, Prescribing	N/A	1093371056	0	0	PARK, HOJUN N	10/9/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105381	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
319844	Ordering, Referring, Prescribing	N/A	1093370900	0	0	PELINA, KYLE LMFT	6/4/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90113	N/A	N/A	N/A	N/A	N/A	84 E J ST	None	CHULA VISTA	CA	91910	6115	00	06000	32.6320024	-117.0582826	San Diego County
319853	Ordering, Referring, Prescribing	N/A	1093372591	0	0	POELMAN, THOMAS DDS PC	6/5/2020	Taxonomy not applicable	NA	n/a	000	Unknown	102703	N/A	N/A	N/A	N/A	N/A	2100 W 3RD ST	301	LOS ANGELES	CA	90057	1944	00	06000	34.06308947	-118.2733326	Los Angeles County
319855	Ordering, Referring, Prescribing	N/A	1093393951	0	0	POLO, ANDREA M NP	2/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016674	N/A	N/A	N/A	N/A	N/A	3230 BEARD RD	None	NAPA	CA	94558	3673	00	06000	38.3216968	-122.2953847	Napa County
319862	Ordering, Referring, Prescribing	N/A	1093418493	0	0	POPPLEWELL, AMY NP	2/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029040	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
319912	Ordering, Referring, Prescribing	N/A	1093806556	0	0	PINTO, GINA M LMFT	4/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	31239	N/A	N/A	N/A	N/A	N/A	1350 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2422	00	06000	35.12076617	-120.6044977	San Luis Obispo County
319945	Ordering, Referring, Prescribing	N/A	1093871840	0	0	PENSAK, MELANIE CCC-SLP	4/25/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	23352	N/A	N/A	N/A	N/A	N/A	1197 E CHESTNUT ST	None	FORT BRAGG	CA	95437	4503	00	06000	39.43638847	-123.7892085	Mendocino County
320032	Ordering, Referring, Prescribing	N/A	1104036565	0	0	PEMBERTON, TERESA M LMFT	7/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47439	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
320044	Ordering, Referring, Prescribing	N/A	1104052307	0	0	PEACHER, JORGE J	9/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	R8256	N/A	N/A	N/A	N/A	N/A	555 CREEKSIDE XING	None	NEW BRAUNFELS	TX	78130	2594	00	06000	29.721942	-98.0702055	Comal County
320061	Ordering, Referring, Prescribing	N/A	1104103209	0	0	PRICE, JANET L LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110112	N/A	N/A	N/A	N/A	N/A	121 DOWNEY AVE	None	MODESTO	CA	95354	1208	00	06000	37.64552748	-120.992607	Stanislaus County
320067	Ordering, Referring, Prescribing	N/A	1104109966	0	0	PHAM, TUNG M	8/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60187	N/A	N/A	N/A	N/A	N/A	15740 WOODRUFF AVE	None	BELLFLOWER	CA	90706	4018	00	06000	33.890067	-118.1173645	Los Angeles County
320075	Ordering, Referring, Prescribing	N/A	1104113158	0	0	PROFIT, DENISHA L LCSW	5/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80561	N/A	N/A	N/A	N/A	N/A	1701 STINE RD	None	BAKERSFIELD	CA	93309	4827	00	06000	35.33828383	-119.0513543	Kern County
320084	Ordering, Referring, Prescribing	N/A	1104150747	0	0	PHAN, BRIAN X PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61165	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
320094	Ordering, Referring, Prescribing	N/A	1104162544	0	0	PATEL, DARSHANA PHARMD	9/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59857	N/A	N/A	N/A	N/A	N/A	10990 WARNER AVENUE	SUITE A	FOUNTAIN VALLEY	CA	92708	3849	00	06000	33.7162557	-117.9373439	Orange County
320123	Ordering, Referring, Prescribing	N/A	1104207059	0	0	PHAM, BOI-TU K PHARMD	3/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	69987	N/A	N/A	N/A	N/A	N/A	2500 E IMPERIAL HWY	158	BREA	CA	92821	6122	00	06000	33.91089485	-117.8664611	Orange County
320127	Ordering, Referring, Prescribing	N/A	1104213479	0	0	PATRICK, BETHANY L NP	3/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024465	N/A	N/A	N/A	N/A	N/A	9699 SIERRA AVE.	None	FONTANA	CA	92335	5716	00	06000	34.077834	-117.4356515	San Bernardino County
320129	Ordering, Referring, Prescribing	N/A	1104213271	0	0	PHELPS, JAZMA DO	2/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	20A16990	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
320153	Ordering, Referring, Prescribing	N/A	1104252188	0	0	PATEL, SHUSHMA PHARMD	1/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH45967	N/A	N/A	N/A	N/A	N/A	1215 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4642	00	06000	34.01110985	-118.113546	Los Angeles County
320180	Ordering, Referring, Prescribing	N/A	1104303486	0	0	PITTS, AMANDA L RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	621682	N/A	N/A	N/A	N/A	N/A	1300 BAKER STREET	None	BAKERSFIELD	CA	93305	4326	00	06000	35.38256022	-118.990868	Kern County
320192	Ordering, Referring, Prescribing	N/A	1104324235	0	0	PHAM, TRUNG V RDH	8/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	28807	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	235	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
320193	Ordering, Referring, Prescribing	N/A	1104324755	0	0	PHAM, VICTORIA A PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77866	N/A	N/A	N/A	N/A	N/A	4014 PLAZA GOLDORADO CIR	None	CAMERON PARK	CA	95682	8257	00	06000	38.66238736	-120.970458	El Dorado County
320195	Ordering, Referring, Prescribing	N/A	1104325208	0	0	PONDER, TRIVA A LMFT	6/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102289	N/A	N/A	N/A	N/A	N/A	415 N CAMDEN DR.	214	BEVERLY HILLS	CA	90210	4439	00	06000	34.06887783	-118.4043847	Los Angeles County
320220	Ordering, Referring, Prescribing	N/A	1104355270	0	0	POMERANTZ, LIZA P	12/17/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	103142	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
320243	Ordering, Referring, Prescribing	N/A	1104382472	0	0	PINEDAGARCIA, KARINA LMFT	6/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140092	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
320249	Ordering, Referring, Prescribing	N/A	1104390806	0	0	POOSTI, KAMRON LMFT	3/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124629	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
320280	Ordering, Referring, Prescribing	N/A	1104474634	0	0	PETERSON, TARA PA-C	7/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61012	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
320300	Ordering, Referring, Prescribing	N/A	1104566884	0	0	PENAFIEL WONSANG, LIANA DDS	4/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110010	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DR	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
320310	Ordering, Referring, Prescribing	N/A	1104594126	0	0	PEREZ, DAVID L	10/19/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106872	N/A	N/A	N/A	N/A	N/A	126 FIFTH STREET	None	GONZALEZ	CA	93926	0000	00	06000	36.50856521	-121.4441675	Monterey County
320323	Ordering, Referring, Prescribing	N/A	1104817147	0	0	PATEL, RENUKA N MD	9/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C181973	N/A	N/A	N/A	N/A	N/A	295910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	2769	00	06000	33.61769745	-117.6771529	Orange County
320330	Ordering, Referring, Prescribing	N/A	1104853597	0	0	PENDLETON, LINDA PA-C	1/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	10631	N/A	N/A	N/A	N/A	N/A	1515 SPRINGFIELD DR	STE 175	CHICO	CA	95928	5995	00	06000	39.73096434	-121.8089646	Butte County
320334	Ordering, Referring, Prescribing	N/A	1104856574	0	0	PINNER, ANTHONY M PA-C	12/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA16717	N/A	N/A	N/A	N/A	N/A	2071 COMPTON AVE STE	None	CORONA	CA	92881	7972	00	06000	33.848487	-117.5361705	Riverside County
320350	Ordering, Referring, Prescribing	N/A	1104940204	0	0	PHILLIPS, AIMEE S LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26972	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
320382	Ordering, Referring, Prescribing	N/A	1104988062	0	0	PIGMAN, EMILY S	8/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44022	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
320418	Ordering, Referring, Prescribing	N/A	1114056504	0	0	PRUETT, MARIA G LMFT	2/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94908	N/A	N/A	N/A	N/A	N/A	650 HOWE AVE	BLDG 300	SACRAMENTO	CA	95825	4732	00	06000	38.577294	-121.4146395	Sacramento County
320423	Ordering, Referring, Prescribing	N/A	1114052867	0	0	PONCEDELEON, ANTONIETA LMFT	5/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109100	N/A	N/A	N/A	N/A	N/A	4500 E PACIFIC COAST HWY	100	LONG BEACH	CA	90807	4417	00	06000	33.78808863	-118.1399827	Los Angeles County
320461	Ordering, Referring, Prescribing	N/A	1114125085	0	0	POPAT, UMANGI	10/6/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT13335	N/A	N/A	N/A	N/A	N/A	4816 E 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
320492	Ordering, Referring, Prescribing	N/A	1114207131	0	0	PAULSON, ROBIN D LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46994	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
320508	Ordering, Referring, Prescribing	N/A	1114228194	0	0	PUERTOLLANO, XERINA G	10/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	59082	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
320509	Ordering, Referring, Prescribing	N/A	1114234275	0	0	PIZANO-GONZALEZ, JESSICA M LMFT	10/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99468	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
320511	Ordering, Referring, Prescribing	N/A	1114228806	0	0	PHAM, CHRISTINE D PHARMD	10/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH40345	N/A	N/A	N/A	N/A	N/A	250 E. PARKCENTER BLVD.	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
320535	Ordering, Referring, Prescribing	N/A	1114287463	0	0	PANTALEON, AMANDA T LMFT	9/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93604	N/A	N/A	N/A	N/A	N/A	631 SOUTH STATE STREET	None	UKIAH	CA	95482	0631	00	06000	39.14437767	-123.2065712	Mendocino County
320568	Ordering, Referring, Prescribing	N/A	1114335627	0	0	PANCHAL, JAYEN S PHARMD	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70023	N/A	N/A	N/A	N/A	N/A	1339 N DAVIS RD	None	SALINAS	CA	93907	1988	00	06000	36.70358481	-121.6669768	Monterey County
320571	Ordering, Referring, Prescribing	N/A	1114345568	0	0	PARK, FRANCINE MD	2/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138635	N/A	N/A	N/A	N/A	N/A	8780 19TH STREET	196	ALTA LOMA	CA	91701	0000	00	06000	34.13384937	-117.6135871	San Bernardino County
320592	Ordering, Referring, Prescribing	N/A	1114377173	0	0	PESSOA, CARLOS E	8/25/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34675	N/A	N/A	N/A	N/A	N/A	65 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	00	06000	36.0663928	-119.01714	Tulare County
320600	Ordering, Referring, Prescribing	N/A	1114388014	0	0	PHILLIP, NIMEKA N MD	7/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163662	N/A	N/A	N/A	N/A	N/A	36977 PARK AVE	None	BURNEY	CA	96013	4067	00	06000	40.87640189	-121.6730441	Shasta County
320601	Ordering, Referring, Prescribing	N/A	1114392420	0	0	PADILLA, DANIELLE LCSW	10/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84165	N/A	N/A	N/A	N/A	N/A	162 E. CARSON STREET	None	COLUSA	CA	95932	2880	00	06000	39.20587882	-122.0061518	Colusa County
320607	Ordering, Referring, Prescribing	N/A	1114399680	0	0	PANCZEL, LORAND R PHARMD	7/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48245	N/A	N/A	N/A	N/A	N/A	1801 N ROSE AVE	None	OXNARD	CA	93030	2600	00	06000	34.21761901	-119.1584531	Ventura County
320631	Ordering, Referring, Prescribing	N/A	1114436060	0	0	PALMER, LACEY L LMFT	1/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111662	N/A	N/A	N/A	N/A	N/A	8304 WINDMILL FARMS DRIV	None	COTATI	CA	94931	4569	00	06000	38.33038455	-122.6903136	Sonoma County
320661	Ordering, Referring, Prescribing	N/A	1114479789	0	0	PORTKA, ANA STEPHANIE LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119872	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
320671	Ordering, Referring, Prescribing	N/A	1114516036	0	0	PALAFOX, MARIBEL LMFT	8/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120839	N/A	N/A	N/A	N/A	N/A	110 N MACLAY AVE	SUITE 114	SAN FERNANDO	CA	91340	2989	00	06000	34.28449525	-118.4396137	Los Angeles County
320687	Ordering, Referring, Prescribing	N/A	1114553815	0	0	PHU, KEVIN PHARMD	1/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82216	N/A	N/A	N/A	N/A	N/A	15 MARINA BLVD	None	SAN FRANCISCO	CA	94123	1201	00	06000	37.80508602	-122.4330005	San Francisco County
320692	Ordering, Referring, Prescribing	N/A	1114558897	0	0	PARK, DAVID S PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82036	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
320718	Ordering, Referring, Prescribing	N/A	1114591526	0	0	PHAN, AMY OD	8/9/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35152	N/A	N/A	N/A	N/A	N/A	1015 S NOGALES ST	STE 109	ROWLAND HEIGHTS	CA	91748	1309	00	06000	33.99637543	-117.8884823	Los Angeles County
320839	Ordering, Referring, Prescribing	N/A	1124162649	0	0	PAULSEN, TERI S PSYD	12/21/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23308	N/A	N/A	N/A	N/A	N/A	2600 E. REDONDO AVE.	6TH FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
320842	Ordering, Referring, Prescribing	N/A	1124177076	0	0	POWERS, LESLIE L LCSW	7/9/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26401	N/A	N/A	N/A	N/A	N/A	2042 MARKET ST	None	REDDING	CA	96001	1926	00	06000	40.57913792	-122.3886718	Shasta County
320908	Ordering, Referring, Prescribing	N/A	1124320122	0	0	POYTRESS, MARGARET LMFT	11/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135623	N/A	N/A	N/A	N/A	N/A	930 EXECUTIVE WAY	125	REDDING	CA	96002	0632	00	06000	40.57621989	-122.3550841	Shasta County
320931	Ordering, Referring, Prescribing	N/A	1124362884	0	0	PAKAZ, MARY ANNE LCSW	8/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96087	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	None	BALDWIN PARK	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
320972	Ordering, Referring, Prescribing	N/A	1124421425	0	0	PEREYRA-PITTS, MARIANA LCSW	8/16/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109926	N/A	N/A	N/A	N/A	N/A	2280 KENWOOD AVE	None	SAN JOSE	CA	95128	1332	00	06000	37.33265072	-121.9427961	Santa Clara County
320990	Ordering, Referring, Prescribing	N/A	1124451448	0	0	PERATA, ELYSE LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102659	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	100	CONCORD	CA	94520	7928	00	06000	37.97055112	-122.0492933	Contra Costa County
321026	Ordering, Referring, Prescribing	N/A	1124495668	0	0	PEREZ-DENIZ, DALIA LCSW	9/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94298	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
321097	Ordering, Referring, Prescribing	N/A	1124611843	0	0	PATEL, MINAL G PA-C	5/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61123	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
321147	Ordering, Referring, Prescribing	N/A	1124755400	0	0	PHAM, JAMES J DMD	6/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107559	N/A	N/A	N/A	N/A	N/A	965 S BEACH BLVD	None	ANAHEIM	CA	92804	3983	00	06000	33.81777	-117.9934155	Orange County
321159	Ordering, Referring, Prescribing	N/A	1124775010	0	0	PEREZ, ERIKA PA	7/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64835	N/A	N/A	N/A	N/A	N/A	2651 S C STREET	100	OXNARD	CA	93033	3560	00	06000	34.17497898	-119.1811966	Ventura County
321165	Ordering, Referring, Prescribing	N/A	1124893011	0	0	PULIDO, MYRNA NP	11/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028079	N/A	N/A	N/A	N/A	N/A	850 W OLIVE AVE	None	MERCED	CA	95348	2427	00	06000	37.31843749	-120.4834376	Merced County
321177	Ordering, Referring, Prescribing	N/A	1134177744	0	0	PHARRIS, CARLA J MD	3/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G154757	N/A	N/A	N/A	N/A	N/A	3111 PROFESSIONAL DRIVE	None	AUBURN	CA	95603	2456	00	06000	38.940327	-121.1007585	Placer County
321192	Ordering, Referring, Prescribing	N/A	1134209588	0	0	PITCHER, KATHERINE PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54172	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
321231	Ordering, Referring, Prescribing	N/A	1134274012	0	0	PATEL, SUNIL H DO	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11335	N/A	N/A	N/A	N/A	N/A	16003 TUSCOLA RD.	SUITE G	APPLE VALLEY	CA	92307	0825	00	06000	34.54197921	-117.2692581	San Bernardino County
321259	Ordering, Referring, Prescribing	N/A	1134344435	0	0	PHILLIPS, ERIC LMFT	2/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53816	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	None	CONCORD	CA	94520	4832	00	06000	37.98393807	-122.0466953	Contra Costa County
321273	Ordering, Referring, Prescribing	N/A	1134373525	0	0	PARROTT, SONYA LMFT	5/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53257	N/A	N/A	N/A	N/A	N/A	9601 KIEFER BLVD	None	SACRAMENTO	CA	95827	3818	00	06000	38.54628	-121.3397415	Sacramento County
321315	Ordering, Referring, Prescribing	N/A	1134465032	0	0	PATEL, BRIJESH G DC	1/24/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC30251	N/A	N/A	N/A	N/A	N/A	308 W. SIXTH ST. STE 109	None	CORONA	CA	92882	3349	00	06000	33.874497	-117.569682	Riverside County
321320	Ordering, Referring, Prescribing	N/A	1134477557	0	0	PORTER, MICHELLE L LMFT	6/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87950	N/A	N/A	N/A	N/A	N/A	2633 E 27TH ST	None	OAKLAND	CA	94601	1912	00	06000	37.79111794	-122.2219009	Alameda County
321322	Ordering, Referring, Prescribing	N/A	1134482367	0	0	PARHAMI, IMAN MD MPH	11/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131928	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST.	None	CHATSWORTH	CA	91311	0000	00	06000	34.23182352	-118.572948	Los Angeles County
321358	Ordering, Referring, Prescribing	N/A	1134533318	0	0	PINEDA, MYLA NP	11/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000819	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
321362	Ordering, Referring, Prescribing	N/A	1134535289	0	0	POUND, LOREN D LMFT	1/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120737	N/A	N/A	N/A	N/A	N/A	4190 DOUGLAS BLVD.	SUITE 300	ROSEVILLE	CA	95746	5918	00	06000	38.740617	-121.2229935	Placer County
321369	Ordering, Referring, Prescribing	N/A	1134550379	0	0	PESCE, CHRISTINA M LMFT	6/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119579	N/A	N/A	N/A	N/A	N/A	2447 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7815	00	06000	38.441403	-122.6637585	Sonoma County
321416	Ordering, Referring, Prescribing	N/A	1134617939	0	0	PERKINS, NKECHI O NP	7/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009314	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
321429	Ordering, Referring, Prescribing	N/A	1134644040	0	0	PHENIX, DIANE LCSW	7/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95779	N/A	N/A	N/A	N/A	N/A	995 HELLING WAY	None	NEVADA CITY	CA	95959	8619	00	06000	39.27021381	-121.0243425	Nevada County
321439	Ordering, Referring, Prescribing	N/A	1134654007	0	0	PYO, THOMAS MD	4/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157695	N/A	N/A	N/A	N/A	N/A	6330 RUGBY AVE	SUITE 200	HUNTINGTON PARK	CA	90225	6938	00	06000	33.98277323	-118.2265373	Los Angeles County
321456	Ordering, Referring, Prescribing	N/A	1134680010	0	0	PRICE, COLLIN M MD	5/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178778	N/A	N/A	N/A	N/A	N/A	1749 14TH ST	None	SANTA MONICA	CA	90404	4342	00	06000	34.01877575	-118.4794554	Los Angeles County
321459	Ordering, Referring, Prescribing	N/A	1134692247	0	0	PARK, HYUNGWOOK LAC	1/20/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18255	N/A	N/A	N/A	N/A	N/A	2050 W CHAPMAN AVE	SUITE 102	ORANGE	CA	92868	2647	00	06000	33.78787054	-117.87498	Orange County
321467	Ordering, Referring, Prescribing	N/A	1134700107	0	0	PAK, ANDREW MD	2/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194251	N/A	N/A	N/A	N/A	N/A	2277 N. GAREY AVE.	None	POMONA	CA	91767	0000	00	06000	34.089543	-117.7508295	Los Angeles County
321541	Ordering, Referring, Prescribing	N/A	1144095886	0	0	PIETRANGELO, MARIAH NP	10/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027581	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
321542	Ordering, Referring, Prescribing	N/A	1144095977	0	0	PEREIRA, JACLYN L	11/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028125	N/A	N/A	N/A	N/A	N/A	3307 WHISPERING GLEN CT	None	SIMI VALLEY	CA	93065	0596	00	06000	34.29550037	-118.7544867	Ventura County
321549	Ordering, Referring, Prescribing	N/A	1144231341	0	0	PRICE, NANCY J LMFT	6/13/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	18534	N/A	N/A	N/A	N/A	N/A	32133 VIA VIENTE	None	SAN JUAN CAPISTRA	CA	92675	3613	00	06000	33.4956683	-117.6672473	Orange County
321556	Ordering, Referring, Prescribing	N/A	1144265570	0	0	PIA, LALLY MD	1/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90516	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
321563	Ordering, Referring, Prescribing	N/A	1144300534	0	0	PUTRUS, RAMIZ MD	3/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68184	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
321567	Ordering, Referring, Prescribing	N/A	1144316167	0	0	PEREIRA, JUDY L PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51369	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
321597	Ordering, Referring, Prescribing	N/A	1144366113	0	0	PHONGBOUPHA ALMONDIA, SOMCHITH LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80938	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	2ND FLOOR	SAN PABLO	CA	94806	3804	00	06000	37.95651393	-122.3371491	Contra Costa County
321602	Ordering, Referring, Prescribing	N/A	1144382912	0	0	PARRA, MICHAEL J PHD	3/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY11832	N/A	N/A	N/A	N/A	N/A	800 N ECKHOFF ST	None	ORANGE	CA	92868	1008	00	06000	33.79960624	-117.8741126	Orange County
321619	Ordering, Referring, Prescribing	N/A	1144416793	0	0	PHAN, DANA Y OD	9/20/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12488	N/A	N/A	N/A	N/A	N/A	8951 KNOTT AVE	SUITE K	BUENA PARK	CA	90620	4108	00	06000	33.832791	-118.0110995	Orange County
321654	Ordering, Referring, Prescribing	N/A	1144504317	0	0	PHAM, LILIE M NP	1/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008298	N/A	N/A	N/A	N/A	N/A	21507 EAST CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
321666	Ordering, Referring, Prescribing	N/A	1144518960	0	0	PHILLIPS, KATLIN LCSW	8/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80075	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93455	2178	00	06000	34.44240122	-119.7765542	Santa Barbara County
321670	Ordering, Referring, Prescribing	N/A	1144530429	0	0	PARTOVI, RYAN D	11/7/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	ND503	N/A	N/A	N/A	N/A	N/A	1349 CAMINO DEL MAR	SUITE B	DEL MAR	CA	92014	2553	00	06000	32.9584249	-117.2648329	San Diego County
321692	Ordering, Referring, Prescribing	N/A	1144581018	0	0	PEREZ, JESSICA	7/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90469	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
321724	Ordering, Referring, Prescribing	N/A	1144621533	0	0	PHILLIPS, ASHLEY PHD	8/14/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	34460	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
321746	Ordering, Referring, Prescribing	N/A	1144662115	0	0	PHAM, TRAVIS PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68590	N/A	N/A	N/A	N/A	N/A	1421 MANHATTAN AVE	None	FULLERTON	CA	92831	5221	00	06000	33.85701	-117.902438	Orange County
321757	Ordering, Referring, Prescribing	N/A	1144671389	0	0	PELLICCIOTTI, AARON A PHARMD	1/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	71137	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	STE 801	LOS ANGELES	CA	90015	0000	00	06000	34.03692236	-118.2655238	Los Angeles County
321764	Ordering, Referring, Prescribing	N/A	1144681073	0	0	PALAPAZ, RYAN J MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151731	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
321771	Ordering, Referring, Prescribing	N/A	1144686577	0	0	PARK, JUNG W NP	9/12/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	835101	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
321781	Ordering, Referring, Prescribing	N/A	1144696840	0	0	PARSONS, WILHELMINA M LMFT	1/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49001	N/A	N/A	N/A	N/A	N/A	500 W HOSPTIAL RD	SUITE B	FRENCHA CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
321817	Ordering, Referring, Prescribing	N/A	1144739277	0	0	PEREZ, LUIS A LCSW	2/17/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128714	N/A	N/A	N/A	N/A	N/A	405 W 5TH ST	None	SANTA ANA	CA	92701	4599	00	06000	33.74893088	-117.8713859	Orange County
321823	Ordering, Referring, Prescribing	N/A	1144759465	0	0	PHORTH, MICHAEL L PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76512	N/A	N/A	N/A	N/A	N/A	122 ROBLES WAY	None	VALLEJO	CA	94591	8039	00	06000	38.08348053	-122.2102102	Solano County
321829	Ordering, Referring, Prescribing	N/A	1144770967	0	0	PICOS, CLAUDIA	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74723	N/A	N/A	N/A	N/A	N/A	4520 BALFOUR RD	None	BRENTWOOD	CA	94513	1529	00	06000	37.92552452	-121.6954215	Contra Costa County
321845	Ordering, Referring, Prescribing	N/A	1144780966	0	0	PRESTWOOD, TYLER R	5/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179044	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
321851	Ordering, Referring, Prescribing	N/A	1144794264	0	0	PARK, JANICE PHARMD	2/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	79792	N/A	N/A	N/A	N/A	N/A	1421 MANHATTAN AVE	None	FULLERTON	CA	92831	5221	00	06000	33.85701	-117.902438	Orange County
321877	Ordering, Referring, Prescribing	N/A	1144834029	0	0	PORTILLO-SEGOVIA, EMELY A LCSW	8/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125063	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 404	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
321890	Ordering, Referring, Prescribing	N/A	1144849522	0	0	PEREZ, EDEN MD	7/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184731	N/A	N/A	N/A	N/A	N/A	2720 S BRISTOL ST	110	SANTA ANA	CA	92704	6207	00	06000	33.710463	-117.8854565	Orange County
321956	Ordering, Referring, Prescribing	N/A	1154065498	0	0	PETERSEN, THERESA A RN BS	8/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	417246	N/A	N/A	N/A	N/A	N/A	5050 BARRANCA PKWY	None	IRVINE	CA	92604	4652	00	06000	33.67614248	-117.7922942	Orange County
322011	Ordering, Referring, Prescribing	N/A	1154406106	0	0	PADILLA, CHRISTINA LCSW	10/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28826	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	6TH FLOOR	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
322025	Ordering, Referring, Prescribing	N/A	1154445351	0	0	PRUITT, LINDSEY R LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73888	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
322036	Ordering, Referring, Prescribing	N/A	1154463891	0	0	PAZ, MARCO LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64405	N/A	N/A	N/A	N/A	N/A	1339 20TH STREET	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
322045	Ordering, Referring, Prescribing	N/A	1154493138	0	0	PURSE, SIMON J LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111095	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
322064	Ordering, Referring, Prescribing	N/A	1154520708	0	0	PHENCO, JULIE ANN H MD	12/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124059	N/A	N/A	N/A	N/A	N/A	18217 HALE AVENUE	None	MORGAN HILL	CA	95037	3547	00	06000	37.13761496	-121.6664813	Santa Clara County
322081	Ordering, Referring, Prescribing	N/A	1154560415	0	0	PE, IRENE MD	6/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49301	N/A	N/A	N/A	N/A	N/A	12665 GARDEN GROVE BLVD.	STE.606	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
322107	Ordering, Referring, Prescribing	N/A	1154602688	0	0	PARADA, EDNA F LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106742	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
322148	Ordering, Referring, Prescribing	N/A	1154684579	0	0	PHAM, KHANH L PHARMD	12/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	58557	N/A	N/A	N/A	N/A	N/A	725 E SANTA CLARA ST	202	SAN JOSE	CA	95112	1900	00	06000	37.34328626	-121.8756374	Santa Clara County
322186	Ordering, Referring, Prescribing	N/A	1154741254	0	0	PATEL, BHAKTI H MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142439	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
322197	Ordering, Referring, Prescribing	N/A	1154755981	0	0	PARREIRA, KRYSTALINA B	3/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97022	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
322201	Ordering, Referring, Prescribing	N/A	1154770808	0	0	PHAM, NGOC-MINH DO	9/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16381	N/A	N/A	N/A	N/A	N/A	303 E VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
322211	Ordering, Referring, Prescribing	N/A	1154783736	0	0	PHAN, THEODORE M LCSW	7/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95767	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
322241	Ordering, Referring, Prescribing	N/A	1154838597	0	0	PULLIAM, CHRISTINE L LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41990	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	SUITE 800	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
322264	Ordering, Referring, Prescribing	N/A	1154865053	0	0	PATEL, NEERALI PHARMD	3/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73651	N/A	N/A	N/A	N/A	N/A	2777 OLIVE AVE	None	FREMONT	CA	94539	5057	00	06000	37.53392172	-121.9480376	Alameda County
322273	Ordering, Referring, Prescribing	N/A	1154871184	0	0	PANIS, ALEXANDER D NP	11/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005025	N/A	N/A	N/A	N/A	N/A	808 W. 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
322303	Ordering, Referring, Prescribing	N/A	1154943769	0	0	PERARA, MEGAN NP	8/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016344	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
322315	Ordering, Referring, Prescribing	N/A	1154960045	0	0	PEEBLES, HEATHER N LCSW	1/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113236	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS ROAD	200	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
322370	Ordering, Referring, Prescribing	N/A	1164073706	0	0	PERUSSE, MICHELLE LCSW	3/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121709	N/A	N/A	N/A	N/A	N/A	3540 HOWARD WAY	SUITE 150	COSTA MESA	CA	92626	1467	00	06000	33.69823787	-117.9273979	Orange County
322417	Ordering, Referring, Prescribing	N/A	1164240297	0	0	PARKER, SERENA PHARMD	9/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	90147	N/A	N/A	N/A	N/A	N/A	8408 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3402	00	06000	34.07601949	-118.373409	Los Angeles County
322421	Ordering, Referring, Prescribing	N/A	1164246906	0	0	PALEEYANG, ALEX DC	7/29/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC37042	N/A	N/A	N/A	N/A	N/A	449 S MADERA AVE	None	KERMAN	CA	93630	1537	00	06000	36.72866432	-120.0603346	Fresno County
322445	Ordering, Referring, Prescribing	N/A	1164472528	0	0	PANIAGUA, ARTHUR	6/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	16163	N/A	N/A	N/A	N/A	N/A	554-580 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
322453	Ordering, Referring, Prescribing	N/A	1164534780	0	0	PAKNEJAD, JANICE S OD	4/30/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12947TPL	N/A	N/A	N/A	N/A	N/A	11151 TAMPA AVE	None	NORTHRIDGE	CA	91326	1520	00	06000	34.27373836	-118.5564202	Los Angeles County
322457	Ordering, Referring, Prescribing	N/A	1164541249	0	0	PADREZ, STEPHANIE A LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51955	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
322494	Ordering, Referring, Prescribing	N/A	1164591533	0	0	PHUNG, ANH-THU T MD	9/8/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87716	N/A	N/A	N/A	N/A	N/A	10402 WESTMINSTER AVE	STE 100C	GARDEN GROVE	CA	92834	4861	00	06000	33.75951204	-117.9478527	Orange County
322564	Ordering, Referring, Prescribing	N/A	1164737680	0	0	PERALES, RONALD W LMFT	6/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96997	N/A	N/A	N/A	N/A	N/A	22750 HAWTHORNE BLVD.	SUITE 213	TORRANCE	CA	90505	3667	00	06000	33.820596	-118.350971	Los Angeles County
322568	Ordering, Referring, Prescribing	N/A	1164731964	0	0	PROSSER, DIANE B LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT21767	N/A	N/A	N/A	N/A	N/A	4411 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.73594649	-119.7521955	Fresno County
322581	Ordering, Referring, Prescribing	N/A	1164758751	0	0	PRESTON, ANA M	10/19/2017	Taxonomy not applicable	NA	n/a	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	95007073	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
322596	Ordering, Referring, Prescribing	N/A	1164797080	0	0	PADUA-EMPLEO, CHARMAINE L PA-C	11/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA22019	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
322603	Ordering, Referring, Prescribing	N/A	1164806519	0	0	PU, SERENA W	2/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72529	N/A	N/A	N/A	N/A	N/A	7251 CAMINO ARROYO	None	GILROY	CA	95020	7340	00	06000	37.00917535	-121.5548666	Santa Clara County
322626	Ordering, Referring, Prescribing	N/A	1164833505	0	0	PADILLA JENKINS, RACHEL A LMFT	10/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135388	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
322636	Ordering, Referring, Prescribing	N/A	1164857611	0	0	PASHKAM, SALPI K	10/2/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	69588	N/A	N/A	N/A	N/A	N/A	14049 VENTURA BLVD	None	SHERMAN OAKS	CA	91423	5234	00	06000	34.1493915	-118.4393354	Los Angeles County
322637	Ordering, Referring, Prescribing	N/A	1164845335	0	0	POWER, BRITTNEY A LMFT	10/14/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107462	N/A	N/A	N/A	N/A	N/A	10601 CHURCH ST.	112	RIVERSIDE	CA	91730	6840	00	06000	34.11301097	-117.5717343	San Bernardino County
322641	Ordering, Referring, Prescribing	N/A	1164859476	0	0	PHILLIPS, MEGHAN A LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99788	N/A	N/A	N/A	N/A	N/A	42475 JEFFERSON AVE	None	MURRIETA	CA	92562	7285	00	06000	33.55518095	-117.2039532	Riverside County
322650	Ordering, Referring, Prescribing	N/A	1164886842	0	0	PORTER, MATEUS LMFT	5/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100817	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVE	SUITE 100	SOUTH SAN FRANCIS	CA	94080	5971	00	06000	37.64441633	-122.4219331	San Mateo County
322689	Ordering, Referring, Prescribing	N/A	1164942298	0	0	PERCY, SARAH E LCSW	4/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121940	N/A	N/A	N/A	N/A	N/A	9860 SUNNYSIDE ST	None	OAKLAND	CA	94603	2750	00	06000	37.74652707	-122.1618127	Alameda County
322706	Ordering, Referring, Prescribing	N/A	1164973293	0	0	PIKE, CHRISTOPHER L LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116005	N/A	N/A	N/A	N/A	N/A	2615 S MILLER ST	106	SANTA MARIA	CA	93455	1775	00	06000	34.91141828	-120.4320168	Santa Barbara County
322719	Ordering, Referring, Prescribing	N/A	1164993648	0	0	POLADIAN, LAURA A LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109066	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
322752	Ordering, Referring, Prescribing	N/A	1174056345	0	0	PATEL, DIMPLE M MD	5/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158745	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE. 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
322774	Ordering, Referring, Prescribing	N/A	1174090179	0	0	PARK, ELLEN S PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78909	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	7628	00	06000	34.17030266	-118.5881699	Los Angeles County
322775	Ordering, Referring, Prescribing	N/A	1174100911	0	0	PEREZ, CHRISTIAN A MD	6/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182756	N/A	N/A	N/A	N/A	N/A	5420 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4118	00	06000	34.10779213	-118.196385	Los Angeles County
322796	Ordering, Referring, Prescribing	N/A	1174110282	0	0	PORTILLO, DIANA LCSW	9/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118188	N/A	N/A	N/A	N/A	N/A	3031 S VERMONT AVE	None	LOS ANGELES	CA	90007	3033	00	06000	34.02666679	-118.2915608	Los Angeles County
322810	Ordering, Referring, Prescribing	N/A	1174151542	0	0	PATEL, MONICA H PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76298	N/A	N/A	N/A	N/A	N/A	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	00	06000	37.9991883	-122.2867117	Contra Costa County
322818	Ordering, Referring, Prescribing	N/A	1174154744	0	0	POTTERVELD, DIANA PA	5/26/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA57772	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
322825	Ordering, Referring, Prescribing	N/A	1174168603	0	0	POLANCO, PAULINA MSW LCSW	12/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119610	N/A	N/A	N/A	N/A	N/A	6800 OWENSMOUTH AVE	160	CANOGA PARK	CA	91303	3159	00	06000	34.194276	-118.6014945	Los Angeles County
322831	Ordering, Referring, Prescribing	N/A	1174184238	0	0	PURCELL, VALERIE J LCSW	7/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95366	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
322863	Ordering, Referring, Prescribing	N/A	1174302350	0	0	PADILLA, KRISTOPHER S NP	9/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027407	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
322875	Ordering, Referring, Prescribing	N/A	1174511067	0	0	PIERCE, RANDALL MD	9/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G59581	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
322879	Ordering, Referring, Prescribing	N/A	1174588297	0	0	POPE, JOHN M MD	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	46616	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
322887	Ordering, Referring, Prescribing	N/A	1174613913	0	0	PHAM, HUNG Q LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23055	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
322907	Ordering, Referring, Prescribing	N/A	1174651368	0	0	PALAD, VERONICA PHD	11/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28725	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	350	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
322916	Ordering, Referring, Prescribing	N/A	1174657571	0	0	PRESZLER, MATT N LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37730	N/A	N/A	N/A	N/A	N/A	565 BRUNSWICK RD	SUITE 10	GRASS VALLEY	CA	95945	0001	00	06000	39.23341432	-121.0294421	Nevada County
322922	Ordering, Referring, Prescribing	N/A	1174666200	0	0	PARTON, RONALD R LCSW	2/4/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	9187	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
322933	Ordering, Referring, Prescribing	N/A	1174698716	0	0	PADILLA, LILIA G LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24011	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	10TH FLOOR	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
322966	Ordering, Referring, Prescribing	N/A	1174777635	0	0	PANTOJA, LILIANA F	11/5/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D32753	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
322968	Ordering, Referring, Prescribing	N/A	1174779599	0	0	PITTENGER, TERRI PSYD	3/10/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26732	N/A	N/A	N/A	N/A	N/A	3802 MAIN ST	None	OCCIDENTAL	CA	95465	0100	00	06000	38.40900707	-122.9476089	Sonoma County
322994	Ordering, Referring, Prescribing	N/A	1174822365	0	0	PEREZ, CECILIA LMFT	10/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80322	N/A	N/A	N/A	N/A	N/A	1 BODEGA AVE	None	PETALUMA	CA	94952	2666	00	06000	38.23424409	-122.6475108	Sonoma County
323015	Ordering, Referring, Prescribing	N/A	1174861017	0	0	PADIYAR, PRIYA	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65541	N/A	N/A	N/A	N/A	N/A	700 TWELVE BRIDGES DR	None	LINCOLN	CA	95648	8824	00	06000	38.85127671	-121.2882649	Placer County
323053	Ordering, Referring, Prescribing	N/A	1174904338	0	0	PICOU, KASSY PHARMD	9/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	68668	N/A	N/A	N/A	N/A	N/A	411 MAIN ST	None	QUINCY	CA	95971	9120	00	06000	39.93675653	-120.9465135	Plumas County
323059	Ordering, Referring, Prescribing	N/A	1174913784	0	0	PARKS, ANDREW J LCSW	9/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108593	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
323088	Ordering, Referring, Prescribing	N/A	1174927594	0	0	PARAND, LEILA MD	1/31/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153877	N/A	N/A	N/A	N/A	N/A	300 MEDICAL PLZ	STE B200	LOS ANGELES	CA	90095	8346	00	06000	34.06473399	-118.445865	Los Angeles County
323091	Ordering, Referring, Prescribing	N/A	1174945950	0	0	PEREZ, ROSA L LMFT	11/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108097	N/A	N/A	N/A	N/A	N/A	1529 EAST PALMDALE BLVD	210	PALMDALE	CA	93550	2029	00	06000	34.57966052	-118.102275	Los Angeles County
323169	Ordering, Referring, Prescribing	N/A	1184049363	0	0	POOL, MARIA J LCSW	8/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108321	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
323177	Ordering, Referring, Prescribing	N/A	1184058463	0	0	PEREZ, JOHANNA N LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87157	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA BLVD.	None	HARBOR CITY	CA	90710	0000	00	06000	33.79785936	-118.3016552	Los Angeles County
323247	Ordering, Referring, Prescribing	N/A	1184157281	0	0	PASTERNAK, NOAH S LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113657	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
323248	Ordering, Referring, Prescribing	N/A	1184160186	0	0	PADILLA, DEANNA A NP	2/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	822296	N/A	N/A	N/A	N/A	N/A	1014 CALLOWAY DRIVE	None	BAKERSFIELD	CA	93312	6337	00	06000	35.36769028	-119.1111246	Kern County
323283	Ordering, Referring, Prescribing	N/A	1184223026	0	0	PACHECO, JESSICA LMFT	8/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT148698	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	6000	LOS ANGELES	CA	90015	0000	00	06000	34.03692236	-118.2655238	Los Angeles County
323292	Ordering, Referring, Prescribing	N/A	1184249724	0	0	PARTIDA, ALMA M CCC-SLP	11/6/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	27738	N/A	N/A	N/A	N/A	N/A	1205 FREEDOM BLVD	3B	WATSONVILLE	CA	95076	2777	00	06000	36.92401492	-121.7624518	Santa Cruz County
323315	Ordering, Referring, Prescribing	N/A	1184284408	0	0	POINDEXTER, PAMELA J LCSW	9/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109158	N/A	N/A	N/A	N/A	N/A	830 ATLANTIC AVENUE	None	LONG BEACH	CA	90813	4513	00	06000	33.77718	-118.185023	Los Angeles County
323318	Ordering, Referring, Prescribing	N/A	1184285124	0	0	PINEDA, KARINA N LMFT	10/31/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151026	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
323330	Ordering, Referring, Prescribing	N/A	1184342560	0	0	PAPELIAN, TENI PHARMD	8/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86564	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
323388	Ordering, Referring, Prescribing	N/A	1184696007	0	0	PRAKASH, OM MD	1/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39024	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
323397	Ordering, Referring, Prescribing	N/A	1184731598	0	0	PHAM, NHUNG DMD	3/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63346	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
323417	Ordering, Referring, Prescribing	N/A	1184756702	0	0	PATTON, MICHAEL LCSW	5/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18244	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
323436	Ordering, Referring, Prescribing	N/A	1184807943	0	0	PEREZ, ALEJANDRA PSYD	5/30/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25139	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
323481	Ordering, Referring, Prescribing	N/A	1184889404	0	0	PATEL, MAULIBEN N	11/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	55164	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVE	#A	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
323485	Ordering, Referring, Prescribing	N/A	1184895195	0	0	PASSERINO, THOMAS P OT	1/13/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	2192	N/A	N/A	N/A	N/A	N/A	3738 WALNUT AVE	None	CARMICHAEL	CA	95608	3054	00	06000	38.63331	-121.3453485	Sacramento County
323496	Ordering, Referring, Prescribing	N/A	1184906307	0	0	PHAM, TAN P PHARMD	12/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64459	N/A	N/A	N/A	N/A	N/A	431 N TUSTIN AVE	STE C	SANTA ANA	CA	92705	3821	00	06000	33.74883544	-117.8340691	Orange County
323499	Ordering, Referring, Prescribing	N/A	1184910960	0	0	PARK, HYO KYUNG MD	6/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160736	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
323503	Ordering, Referring, Prescribing	N/A	1184915407	0	0	POULIN, SHAYNE MD	3/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146174	N/A	N/A	N/A	N/A	N/A	15403 PARK AVE EAST	None	VICTORVILLE	CA	92392	2482	00	06000	34.50640129	-117.3250645	San Bernardino County
323509	Ordering, Referring, Prescribing	N/A	1184930919	0	0	PINES, PHILIP S PSYD	2/19/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28698	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	SUITE 201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
323523	Ordering, Referring, Prescribing	N/A	1184949042	0	0	POLSKY, GAYLE C MD	11/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110133	N/A	N/A	N/A	N/A	N/A	201 CENTRE PLAZA DR	6TH FLOOR	MONTEREY PARK	CA	91754	2142	00	06000	34.05878156	-118.1663435	Los Angeles County
323530	Ordering, Referring, Prescribing	N/A	1184971590	0	0	PALMER, GRAYSON D	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D61604	N/A	N/A	N/A	N/A	N/A	959 MYRTLE AVE	None	EUREKA	CA	95501	1219	00	06000	40.80062789	-124.1497475	Humboldt County
323536	Ordering, Referring, Prescribing	N/A	1184974073	0	0	PORTO, JONATHAN G LMFT	9/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150139	N/A	N/A	N/A	N/A	N/A	1400 E JANSS RD	None	THOUSAND OAKS	CA	91362	2133	00	06000	34.19964827	-118.8541386	Ventura County
323542	Ordering, Referring, Prescribing	N/A	1184979387	0	0	PATEL, SHARVANI V PHARMD	9/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	66075	N/A	N/A	N/A	N/A	N/A	12832 VALLEY VIEW ST	A	GARDEN GROVE	CA	92845	0000	00	06000	33.77717962	-118.0346285	Orange County
323547	Ordering, Referring, Prescribing	N/A	1184992000	0	0	PIGEON, ROBERT J PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42629	N/A	N/A	N/A	N/A	N/A	11900 BEACH BLVD.	None	STANTON	CA	90680	3611	00	06000	33.78918964	-117.9928074	Orange County
323558	Ordering, Referring, Prescribing	N/A	1194003053	0	0	PETERSON, CHRISTOPHER M LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102726	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
323560	Ordering, Referring, Prescribing	N/A	1194021469	0	0	PATEL, KOMAL G MD	5/18/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132872	N/A	N/A	N/A	N/A	N/A	1531 ESPLANADE	None	CHICO	CA	95926	3310	00	06000	39.74248474	-121.8493369	Butte County
323606	Ordering, Referring, Prescribing	N/A	1194109298	0	0	PIROZZI, ASHLEY MD	10/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147668	N/A	N/A	N/A	N/A	N/A	5350 MACHADO RD	None	CULVER CITY	CA	90230	0000	00	06000	33.99781622	-118.3966503	Los Angeles County
323619	Ordering, Referring, Prescribing	N/A	1194125757	0	0	PARK, JANE	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	71331	N/A	N/A	N/A	N/A	N/A	900 S HARBOR BLVD	None	FULLERTON	CA	92832	3025	00	06000	33.862491	-117.921951	Orange County
323690	Ordering, Referring, Prescribing	N/A	1194247445	0	0	PALESTRINI-JONES, JAMI LMFT	2/18/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142509	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
323693	Ordering, Referring, Prescribing	N/A	1194247072	0	0	PATEL, DEEP	4/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006804	N/A	N/A	N/A	N/A	N/A	6711 ARLINGTON AVE	B	RIVERSIDE	CA	92504	1955	00	06000	33.9459035	-117.442989	Riverside County
323712	Ordering, Referring, Prescribing	N/A	1194272286	0	0	POZZESI, KADETH D LMFT	6/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126444	N/A	N/A	N/A	N/A	N/A	2118 WILLOW PASS ROAD	500	CONCORD	CA	94519	2588	00	06000	37.97666461	-122.033785	Contra Costa County
323716	Ordering, Referring, Prescribing	N/A	1194279083	0	0	PATEL, RAVI P	9/6/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100668	N/A	N/A	N/A	N/A	N/A	6810 N MILBURN AVE	None	FRESNO	CA	93722	2155	00	06000	36.83655963	-119.8788638	Fresno County
323738	Ordering, Referring, Prescribing	N/A	1194346858	0	0	PETERSON, ERIC D LCSW	11/3/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91959	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
323751	Ordering, Referring, Prescribing	N/A	1194374165	0	0	PETERSON, JEANICE	9/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	3666	N/A	N/A	N/A	N/A	N/A	41914 50TH ST W	None	LANCASTER	CA	93536	2963	00	06000	34.644744	-118.2184015	Los Angeles County
323755	Ordering, Referring, Prescribing	N/A	1194399030	0	0	PASCHEN, MELODY G LCSW	11/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112201	N/A	N/A	N/A	N/A	N/A	5 MAREBLU	100	ALISO VIEJO	CA	92656	3014	00	06000	33.57250566	-117.7027366	Orange County
323784	Ordering, Referring, Prescribing	N/A	1194498444	0	0	PASTORES, REGINALD DWIGHT	11/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	106666	N/A	N/A	N/A	N/A	N/A	330 N STATE COLLEGE BLVD	105	ANAHEIM	CA	92806	2940	00	06000	33.843825	-117.8891135	Orange County
323808	Ordering, Referring, Prescribing	N/A	1194778894	0	0	PETTY, LEONORA K MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C38026	N/A	N/A	N/A	N/A	N/A	3490 THE ALAMEDA	None	SANTA CLARA	CA	95050	4333	00	06000	37.35380924	-121.9418703	Santa Clara County
323826	Ordering, Referring, Prescribing	N/A	1194844399	0	0	PLEITEZ, ANA I PSYD	11/20/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27754	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
323827	Ordering, Referring, Prescribing	N/A	1194849612	0	0	PALUMBO, TODD L LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49981	N/A	N/A	N/A	N/A	N/A	811 GRAND AVE.	D	SACRAMENTO	CA	95838	3466	00	06000	38.637621	-121.4470125	Sacramento County
323933	Ordering, Referring, Prescribing	N/A	1205055431	0	0	PORTELA, LUCILIA G PT	2/1/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT39512	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
323937	Ordering, Referring, Prescribing	N/A	1205069911	0	0	PADRON, NELIDA P LCSW	7/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74432	N/A	N/A	N/A	N/A	N/A	11627 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4911	00	06000	33.93480209	-118.1323324	Los Angeles County
323988	Ordering, Referring, Prescribing	N/A	1205148749	0	0	PHILLIPS-COPELAND, ROBERTA L LMFT	6/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47674	N/A	N/A	N/A	N/A	N/A	1025 E OCEAN AVE	A	LOMPOC	CA	93436	7088	00	06000	34.6389048	-120.4454929	Santa Barbara County
323994	Ordering, Referring, Prescribing	N/A	1205152717	0	0	PETERSEN, DAENA L MD MPH	7/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167968	N/A	N/A	N/A	N/A	N/A	299 12TH STREET	SUITE A	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
324003	Ordering, Referring, Prescribing	N/A	1205160439	0	0	PHILLIPS, MELISHIA R LMFT	3/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138638	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	3839	00	06000	34.54007429	-117.2744761	San Bernardino County
324022	Ordering, Referring, Prescribing	N/A	1205227386	0	0	PARK, JULIA J	6/3/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D64038	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
324029	Ordering, Referring, Prescribing	N/A	1205237161	0	0	PELAYO, AIDA A LCSW	4/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114755	N/A	N/A	N/A	N/A	N/A	1515 S. BON VIEW AVE	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
324041	Ordering, Referring, Prescribing	N/A	1205254703	0	0	PHAM, HUNG-VIET N MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141127	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
324090	Ordering, Referring, Prescribing	N/A	1205324969	0	0	PARK, JONATHAN B MD	2/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165509	N/A	N/A	N/A	N/A	N/A	8876 MISSION BOULEVARD	None	JURUPA VALLEY	CA	92509	2661	00	06000	34.01176954	-117.476118	Riverside County
324095	Ordering, Referring, Prescribing	N/A	1205335122	0	0	PATEL, KINJAL G PHARMD	9/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	61294	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE	110	NEWPORT BEACH	CA	92660	8105	00	06000	33.66641504	-117.857408	Orange County
324127	Ordering, Referring, Prescribing	N/A	1205377637	0	0	PIAO, CINDY MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157485	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
324154	Ordering, Referring, Prescribing	N/A	1205430444	0	0	POTTER, ANDREW L PHD	8/17/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30839	N/A	N/A	N/A	N/A	N/A	350 E K ST	None	BENICIA	CA	94510	3437	00	06000	38.05073543	-122.1514108	Solano County
324184	Ordering, Referring, Prescribing	N/A	1205480936	0	0	PHAM, CALVIN H PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57091	N/A	N/A	N/A	N/A	N/A	5890 LAKEWOOD BLVD	None	LAKEWOOD	CA	90711	0000	00	06000	33.8614515	-118.1423595	Los Angeles County
324188	Ordering, Referring, Prescribing	N/A	1205507217	0	0	PARK, YOON K PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85285	N/A	N/A	N/A	N/A	N/A	600 S BROADWAY	None	WALNUT CREEK	CA	94596	5208	00	06000	37.89749614	-122.057329	Contra Costa County
324215	Ordering, Referring, Prescribing	N/A	1205678547	0	0	POUDEL DHAKAL, SWASTIKA	5/17/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030156	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
324259	Ordering, Referring, Prescribing	N/A	1205962842	0	0	PHILLIPS, CHRISTINA E PA-C	10/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	18747	N/A	N/A	N/A	N/A	N/A	1236 N. MAGNOLIA AVE.	None	ANAHEIM	CA	92801	2607	00	06000	33.8508897	-117.9761562	Orange County
324268	Ordering, Referring, Prescribing	N/A	1205968138	0	0	PARKER TRAUTMANN, AMANDA B LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70047	N/A	N/A	N/A	N/A	N/A	29341 KIMBERLINA RD	None	WASCO	CA	93280	7617	00	06000	35.55797409	-119.3237232	Kern County
324273	Ordering, Referring, Prescribing	N/A	1205971520	0	0	PATEL, JYOTSNABEN LMFT	10/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44184	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
324278	Ordering, Referring, Prescribing	N/A	1205989431	0	0	PAGE, MICHAEL W DC	12/21/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	27504	N/A	N/A	N/A	N/A	N/A	7512 MORRO RD	None	ATASCADERO	CA	93422	4404	00	06000	35.47716258	-120.6674786	San Luis Obispo County
324311	Ordering, Referring, Prescribing	N/A	1215061809	0	0	PIERSON, JESSICA L LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25474	N/A	N/A	N/A	N/A	N/A	2677 ZOE AVE	114	HUNTINGTON PARK	CA	90255	4195	00	06000	33.9793143	-118.2230319	Los Angeles County
324340	Ordering, Referring, Prescribing	N/A	1215107024	0	0	POURVASEI, JENNIFER M	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49598	N/A	N/A	N/A	N/A	N/A	1221 E DYER RD	STE 220	SANTA ANA	CA	92705	5600	00	06000	33.70872153	-117.857052	Orange County
324382	Ordering, Referring, Prescribing	N/A	1215204060	0	0	PHAM, ANDY M PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58788	N/A	N/A	N/A	N/A	N/A	16108 E FOOTHILL BLVD	None	FONTANA	CA	92335	3356	00	06000	34.10659147	-117.4529823	San Bernardino County
324390	Ordering, Referring, Prescribing	N/A	1215217609	0	0	PARMAR, RASHMI P MD	11/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126880	N/A	N/A	N/A	N/A	N/A	302 CHERRY LN	208	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
324400	Ordering, Referring, Prescribing	N/A	1215225933	0	0	PENA GAMEZ, ERIKA LPCC	12/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	12818	N/A	N/A	N/A	N/A	N/A	2865 LOGAN AVE	None	SAN DIEGO	CA	92113	2411	00	06000	32.69694991	-117.1324497	San Diego County
324434	Ordering, Referring, Prescribing	N/A	1215286950	0	0	PEREZ GONZALEZ, MAYRA LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95088	N/A	N/A	N/A	N/A	N/A	12440 E. FIRESTONE BLVD	316	NORWALK	CA	90605	0000	00	06000	33.90523023	-118.0681168	Los Angeles County
324435	Ordering, Referring, Prescribing	N/A	1215289749	0	0	PROPHET, REBECCA C LMFT	1/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50286	N/A	N/A	N/A	N/A	N/A	2180 MILVIA ST	None	BERKELEY	CA	94704	1122	00	06000	37.86948606	-122.2705246	Alameda County
324456	Ordering, Referring, Prescribing	N/A	1215321070	0	0	PARK, KYUNG H PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71726	N/A	N/A	N/A	N/A	N/A	25821 S VERMONT AVE	None	LOS ANGELES	CA	90710	3518	00	06000	33.78934581	-118.2936765	Los Angeles County
324458	Ordering, Referring, Prescribing	N/A	1215322789	0	0	PENDLEY, NICOLE M LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113182	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	2	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
324471	Ordering, Referring, Prescribing	N/A	1215337324	0	0	PANG, ANDY PHARMD	7/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70971	N/A	N/A	N/A	N/A	N/A	1524 POLK ST	None	SAN FRANCISCO	CA	94109	3607	00	06000	37.79099372	-122.4207382	San Francisco County
324492	Ordering, Referring, Prescribing	N/A	1215371364	0	0	PON, NATALIE C MD	7/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143578	N/A	N/A	N/A	N/A	N/A	3490 THE ALAMEDA	None	SANTA CLARA	CA	95050	4333	00	06000	37.35380924	-121.9418703	Santa Clara County
324495	Ordering, Referring, Prescribing	N/A	1215357793	0	0	PRUITT, CRYSTAL MD	2/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143165	N/A	N/A	N/A	N/A	N/A	264 N HIGHLAND SPRINGS A	STE 3D	BANNING	CA	92220	3085	00	06000	33.93063	-116.946864	Riverside County
324498	Ordering, Referring, Prescribing	N/A	1215379409	0	0	PONTHIER, JAZMIN J LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68816	N/A	N/A	N/A	N/A	N/A	5275 CLAREMONT AVE	None	OAKLAND	CA	94618	1032	00	06000	37.8391822	-122.260841	Alameda County
324527	Ordering, Referring, Prescribing	N/A	1215428610	0	0	PETERMAN, CAITLIN MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165168	N/A	N/A	N/A	N/A	N/A	3301	SUITE 1400	SACRAMENTO	CA	95816	3300	00	06000	0	0	None
324549	Ordering, Referring, Prescribing	N/A	1215472774	0	0	PARK, JAMIE PHARMD	6/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56130	N/A	N/A	N/A	N/A	N/A	3900 W. 3RD ST	ZION DRUG	LOS ANGELES	CA	90020	2675	00	06000	34.06898849	-118.2995505	Los Angeles County
324592	Ordering, Referring, Prescribing	N/A	1215543426	0	0	PERRY, KATHERINE A NP	7/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014964	N/A	N/A	N/A	N/A	N/A	2630 FIRST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
324614	Ordering, Referring, Prescribing	N/A	1215597042	0	0	PHAN, BAO PHARMD	7/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74314	N/A	N/A	N/A	N/A	N/A	1538 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	00	06000	33.78779155	-117.8367795	Orange County
324648	Ordering, Referring, Prescribing	N/A	1215682372	0	0	PARK, SANGJI E LMFT	7/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147929	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
324664	Ordering, Referring, Prescribing	N/A	1215971817	0	0	POWER, RACHAEL MD	2/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C193895	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	100	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
324782	Ordering, Referring, Prescribing	N/A	1225282437	0	0	PHELPS, STEPHANIE NP	2/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18297	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
324789	Ordering, Referring, Prescribing	N/A	1225292642	0	0	PATEL, VISHAL MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130093	N/A	N/A	N/A	N/A	N/A	9280 W STOCKTON BLVD	230	ELK GROVE	CA	95758	8078	00	06000	38.420235	-121.394961	Sacramento County
324792	Ordering, Referring, Prescribing	N/A	1225311640	0	0	PHAM, BINH G PHARMD	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52652	N/A	N/A	N/A	N/A	N/A	26610 YNEZ RD	None	TEMECULA	CA	92591	4697	00	06000	33.52155695	-117.1568629	Riverside County
324812	Ordering, Referring, Prescribing	N/A	1225343668	0	0	PRECIADO, LUZ E LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101171	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
324846	Ordering, Referring, Prescribing	N/A	1225404643	0	0	PONCE, MONA-MARIE LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116550	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD	300	PITTSBURG	CA	94565	2068	00	06000	38.0354387	-121.8837345	Contra Costa County
324853	Ordering, Referring, Prescribing	N/A	1225413636	0	0	PERRY, LAUREN RN CPNP	3/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002733	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
324884	Ordering, Referring, Prescribing	N/A	1225462153	0	0	POWELL, ALEXANDRA LCSW	11/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88738	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
324898	Ordering, Referring, Prescribing	N/A	1225487846	0	0	PARKER, REBECCA MD	1/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162326	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS#54	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
324901	Ordering, Referring, Prescribing	N/A	1225489552	0	0	PHAM, JESSICA PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72813	N/A	N/A	N/A	N/A	N/A	2235 MERCURY WAY	SUITE 240	SANTA ROSA	CA	95407	5473	00	06000	38.422404	-122.751261	Sonoma County
324915	Ordering, Referring, Prescribing	N/A	1225506397	0	0	PETERSON, LARISSA K	8/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014921	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
324919	Ordering, Referring, Prescribing	N/A	1225511785	0	0	PEREZ, MAYRA LCSW	9/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107559	N/A	N/A	N/A	N/A	N/A	3569 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	00	06000	34.0744277	-118.039296	Los Angeles County
324939	Ordering, Referring, Prescribing	N/A	1225532757	0	0	PHAM, DIANA LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106900	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
324944	Ordering, Referring, Prescribing	N/A	1225539109	0	0	PARK, JULIE LMFT	8/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148802	N/A	N/A	N/A	N/A	N/A	222 S HARBOR BLVD	SUITE 650	ANAHEIM	CA	92805	3700	00	06000	33.83250163	-117.9188893	Orange County
324955	Ordering, Referring, Prescribing	N/A	1225556988	0	0	POWELL, DONNISE LCSW	10/23/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126885	N/A	N/A	N/A	N/A	N/A	750 INTERNATIONAL BLVD.	None	OAKLAND	CA	94606	2902	00	06000	37.79376751	-122.2515138	Alameda County
324968	Ordering, Referring, Prescribing	N/A	1225566102	0	0	PRASAD, SHREESH K MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158631	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
324973	Ordering, Referring, Prescribing	N/A	1225576903	0	0	PELEHBERG, SKARLET LCSW	12/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106224	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	220	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
324976	Ordering, Referring, Prescribing	N/A	1225579576	0	0	PRITCHARD, DAVID MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157539	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1460	00	06000	38.555181	-121.4566785	Sacramento County
324991	Ordering, Referring, Prescribing	N/A	1225608722	0	0	POLLEY, SHANNON PA-C	3/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60864	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
325008	Ordering, Referring, Prescribing	N/A	1225657513	0	0	POLLACK, JOHN H MD	4/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4205	N/A	N/A	N/A	N/A	N/A	455 O' CONNOR DR	SUITE 200	SAN JOSE	CA	95128	1632	00	06000	37.326654	-121.939897	Santa Clara County
325010	Ordering, Referring, Prescribing	N/A	1225666928	0	0	PAN, WENTAO A MD	8/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184037	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	110	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
325068	Ordering, Referring, Prescribing	N/A	1235184219	0	0	PADUA, NARCISO MD	11/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45172	N/A	N/A	N/A	N/A	N/A	2039 FOREST AVE	STE 105	SAN JOSE	CA	95128	4817	00	06000	37.32711929	-121.934266	Santa Clara County
325117	Ordering, Referring, Prescribing	N/A	1235303298	0	0	PAIRSH, REBEKAH NP	11/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033137	N/A	N/A	N/A	N/A	N/A	1563 MISSION STREET	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
325125	Ordering, Referring, Prescribing	N/A	1235329913	0	0	PENA, MICHAEL A LMFT	2/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43488	N/A	N/A	N/A	N/A	N/A	18217 HALE AVE	None	MORGAN HILL	CA	95037	3547	00	06000	37.13761496	-121.6664813	Santa Clara County
325126	Ordering, Referring, Prescribing	N/A	1235316761	0	0	PARK, JYUNG KYUNG	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28665	N/A	N/A	N/A	N/A	N/A	21840 S NORMANDIE AVE	500	TORRANCE	CA	90502	2047	00	06000	33.82982744	-118.2991395	Los Angeles County
325146	Ordering, Referring, Prescribing	N/A	1235366626	0	0	PIGGOTT, KURT D MD	6/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C187084	N/A	N/A	N/A	N/A	N/A	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
325173	Ordering, Referring, Prescribing	N/A	1235411687	0	0	PHAN, SANDY D PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49318	N/A	N/A	N/A	N/A	N/A	8052 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	3303	00	06000	33.75925468	-117.988843	Orange County
325195	Ordering, Referring, Prescribing	N/A	1235448036	0	0	PARIKH, SHREYASI T	10/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D64417	N/A	N/A	N/A	N/A	N/A	7843 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2523	00	06000	34.213581	-118.3878055	Los Angeles County
325226	Ordering, Referring, Prescribing	N/A	1235504994	0	0	PRICE, LESLIE M NP	8/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95079099	N/A	N/A	N/A	N/A	N/A	71777 SAN JACINTO DRIVE	SUITE 202	RANCHO MIRAGE	CA	92270	4457	00	06000	33.74394755	-116.4124572	Riverside County
325243	Ordering, Referring, Prescribing	N/A	1235520941	0	0	PANG, HELENTINA L PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71385	N/A	N/A	N/A	N/A	N/A	7000 INDIANA AVE	SUITE 112	RIVERSIDE	CA	92506	4154	00	06000	33.94079162	-117.3949924	Riverside County
325259	Ordering, Referring, Prescribing	N/A	1235546342	0	0	PERI, NATALIE LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86365	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
325263	Ordering, Referring, Prescribing	N/A	1235546920	0	0	POONI, NAVNEET K PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68924	N/A	N/A	N/A	N/A	N/A	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5300	00	06000	37.89189148	-122.057999	Contra Costa County
325284	Ordering, Referring, Prescribing	N/A	1235580705	0	0	PERRY, CHRISTINA LMFT	9/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121865	N/A	N/A	N/A	N/A	N/A	545 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4611	00	06000	37.72679439	-122.1491972	Alameda County
325298	Ordering, Referring, Prescribing	N/A	1235590134	0	0	PEREZ, CHRISTINE NICOLE A PHARMD	4/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	74510	N/A	N/A	N/A	N/A	N/A	1235 STRATFORD AVE	None	DIXON	CA	95620	2024	00	06000	38.45801447	-121.838922	Solano County
325306	Ordering, Referring, Prescribing	N/A	1235620147	0	0	PANDYA, HEENA U DDS	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS48844	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
325352	Ordering, Referring, Prescribing	N/A	1235687245	0	0	PALOMINO, YALINA LCSW	4/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94099	N/A	N/A	N/A	N/A	N/A	7365 CARNELIAN ST	222E	RANCHO CUCAMONGA	CA	91730	1158	00	06000	34.12038413	-117.6160525	San Bernardino County
325373	Ordering, Referring, Prescribing	N/A	1235750498	0	0	PHAN, THU M LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88715	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
325423	Ordering, Referring, Prescribing	N/A	1235994112	0	0	PEEK, WHITNEY NP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029058	N/A	N/A	N/A	N/A	N/A	1104 BUCHANAN ROAD	C10	ANTIOCH	CA	94509	4226	00	06000	37.99867244	-121.823243	Contra Costa County
325430	Ordering, Referring, Prescribing	N/A	1245078088	0	0	PUREWAL, TARWINDER PHARMD	7/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	89603	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
325445	Ordering, Referring, Prescribing	N/A	1245241991	0	0	PETRA, ALEXIS MD	6/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A87698	N/A	N/A	N/A	N/A	N/A	21835 N 51ST ST	None	PHOENIX	AZ	85054	7140	00	06000	33.685569	-111.9690405	Maricopa County
325455	Ordering, Referring, Prescribing	N/A	1245297084	0	0	PRATHIKANTI, SUDHA MD	5/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G74510	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	7M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
325458	Ordering, Referring, Prescribing	N/A	1245304773	0	0	PAPOYAN, ROSEANNE R PHARD	9/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54097	N/A	N/A	N/A	N/A	N/A	1253 VINE ST	#11	LOS ANGELES	CA	90038	1662	00	06000	34.09398102	-118.3266517	Los Angeles County
325482	Ordering, Referring, Prescribing	N/A	1245356757	0	0	PUSATERI, TONI L	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99220	N/A	N/A	N/A	N/A	N/A	275 S MADERA AVE	None	KERMAN	CA	93630	1403	00	06000	36.73165922	-120.0602617	Fresno County
325493	Ordering, Referring, Prescribing	N/A	1245369263	0	0	PAN, JENNY S	8/20/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D53344	N/A	N/A	N/A	N/A	N/A	711 W FLORENCE AVE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
325513	Ordering, Referring, Prescribing	N/A	1245406818	0	0	PENCE, ANNE M LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87658	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	150	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
325524	Ordering, Referring, Prescribing	N/A	1245424126	0	0	PINTO, MELINA D LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116239	N/A	N/A	N/A	N/A	N/A	17450 MAIN ST	101	HESPERIA	CA	92345	6298	00	06000	34.41871211	-117.2821748	San Bernardino County
325550	Ordering, Referring, Prescribing	N/A	1245473099	0	0	PROUTY, WAMBUI LCSW	4/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87581	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	0000	00	06000	38.576331	-121.4791155	Sacramento County
325592	Ordering, Referring, Prescribing	N/A	1245528769	0	0	PAQUIN, STEPHANIE LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87375	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
325616	Ordering, Referring, Prescribing	N/A	1245595529	0	0	PONCIANO, MARTIN A LMFT	7/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96247	N/A	N/A	N/A	N/A	N/A	1428 HIGHLAND AVE.	None	NATIONAL CITY	CA	91950	4624	00	06000	32.67249521	-117.0966282	San Diego County
325658	Ordering, Referring, Prescribing	N/A	1245659457	0	0	PUNATAR, RUCHI MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140033	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
325662	Ordering, Referring, Prescribing	N/A	1245663616	0	0	PROYNOV, KRISTIAN R LMFT	1/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100636	N/A	N/A	N/A	N/A	N/A	2130 STOCKTON BLVD	100	SACRAMENTO	CA	95817	1337	00	06000	38.557593	-121.4616735	Sacramento County
325663	Ordering, Referring, Prescribing	N/A	1245663426	0	0	POLLOCK, LEORA LCSW	4/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75192	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	2ND FLOOR	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
325694	Ordering, Referring, Prescribing	N/A	1245715846	0	0	PADILLA, SUSANA LCSW	8/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW125045	N/A	N/A	N/A	N/A	N/A	3000 NEWBURG RD	SUITE B	FORTUNA	CA	95540	2555	00	06000	40.59450532	-124.1346711	Humboldt County
325711	Ordering, Referring, Prescribing	N/A	1245746023	0	0	PAZ, JOHANNA P LMFT	1/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130652	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
325713	Ordering, Referring, Prescribing	N/A	1245744713	0	0	POPE, AMBER LCSW	12/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106195	N/A	N/A	N/A	N/A	N/A	2121 W. TEMPLE ST.	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
325719	Ordering, Referring, Prescribing	N/A	1245751353	0	0	PATEL, RISHA I	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76051	N/A	N/A	N/A	N/A	N/A	8010 PARKWAY DR	None	LA MESA	CA	91942	2104	00	06000	32.7749024	-117.0246371	San Diego County
325735	Ordering, Referring, Prescribing	N/A	1245767458	0	0	PETZY, MEGHAN E NP	4/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95006614	N/A	N/A	N/A	N/A	N/A	1 HOPE DRIVE	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
325752	Ordering, Referring, Prescribing	N/A	1245781194	0	0	PEDOUIM, TARANEH PHARMD	11/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75240	N/A	N/A	N/A	N/A	N/A	5205 MELROSE AVE	None	LOS ANGELES	CA	90038	3144	00	06000	34.08354051	-118.314009	Los Angeles County
325758	Ordering, Referring, Prescribing	N/A	1245785609	0	0	PUGA, DARIO J LMFT	8/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114540	N/A	N/A	N/A	N/A	N/A	160 E. VIRGINIA ST.	SUITE 280	SAN JOSE	CA	95112	5817	00	06000	37.32582868	-121.8777868	Santa Clara County
325775	Ordering, Referring, Prescribing	N/A	1245829316	0	0	PAYTON, TORRIA LMFT	12/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151694	N/A	N/A	N/A	N/A	N/A	222 EAST MAIN ST.	117	BARSTOW	CA	92311	1603	00	06000	34.89870403	-117.025149	San Bernardino County
325794	Ordering, Referring, Prescribing	N/A	1245855527	0	0	PERS, SUSAN S PA-C	6/5/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58166	N/A	N/A	N/A	N/A	N/A	200 PORTER DR	200	SAN RAMON	CA	94583	1529	00	06000	37.77372204	-121.9911155	Contra Costa County
325797	Ordering, Referring, Prescribing	N/A	1245863869	0	0	PHAM, DAVID M PHARMD	8/25/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82087	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
325798	Ordering, Referring, Prescribing	N/A	1245859909	0	0	POOLA, NIVEDITA MD MPH	3/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194558	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
325804	Ordering, Referring, Prescribing	N/A	1245869874	0	0	PAL, KAMALDEEP NP	3/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014337	N/A	N/A	N/A	N/A	N/A	1014 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	00	06000	35.36769028	-119.1111246	Kern County
325841	Ordering, Referring, Prescribing	N/A	1245986645	0	0	PETROSYAN, ANUSH NP	10/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018482	N/A	N/A	N/A	N/A	N/A	519 EAST BROADWAY BLVD	None	GLENDALE	CA	91205	1110	00	06000	34.14636593	-118.2492244	Los Angeles County
325845	Ordering, Referring, Prescribing	N/A	1255004347	0	0	POPE, LEZAH LMFT	8/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141005	N/A	N/A	N/A	N/A	N/A	2108 N ST	5934	SACRAMENTO	CA	95816	5712	00	06000	38.571579	-121.480182	Sacramento County
325846	Ordering, Referring, Prescribing	N/A	1255002127	0	0	PABLA, JASMEEN K	5/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	106910	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
325859	Ordering, Referring, Prescribing	N/A	1255032314	0	0	PITONES CASTILLO, CRISTINA NP	12/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023591	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
325874	Ordering, Referring, Prescribing	N/A	1255076626	0	0	PADILLA, YI-CHEN CNP	4/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95020585	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	0000	00	06000	34.32450186	-118.4456317	Los Angeles County
325888	Ordering, Referring, Prescribing	N/A	1255170429	0	0	PITTMAN, LYNEEKA NP	10/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027497	N/A	N/A	N/A	N/A	N/A	49-111 CALIFORNIA 111	6A	COACHELLA	CA	92236	0000	00	06000	33.67241866	-116.1673887	Riverside County
325890	Ordering, Referring, Prescribing	N/A	1255330338	0	0	PATEL, KETAN PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH52341	N/A	N/A	N/A	N/A	N/A	2087 E FLORIDA AVE	None	HEMET	CA	92544	4730	00	06000	33.74756549	-116.950833	Riverside County
325920	Ordering, Referring, Prescribing	N/A	1255455549	0	0	POTTER, KAREN M LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17208	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
325948	Ordering, Referring, Prescribing	N/A	1255484010	0	0	PACHAIYAPPAN, KANGEYAN MD	2/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD419234	N/A	N/A	N/A	N/A	N/A	39990 FAURE RD	None	HEMET	CA	92544	9408	00	06000	33.54540303	-116.8982524	Riverside County
325967	Ordering, Referring, Prescribing	N/A	1255510673	0	0	PARRA, GABRIELA LCSW	7/10/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27964	N/A	N/A	N/A	N/A	N/A	731 S HIGHLAND AVE	None	FULLERTON	CA	92832	2753	00	06000	33.863598	-117.928718	Orange County
325972	Ordering, Referring, Prescribing	N/A	1255537155	0	0	PATEL, HEMANTKUMAR V DDS	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	29647	N/A	N/A	N/A	N/A	N/A	725 WEST I STREET	None	LOS BANOS	CA	93635	3478	00	06000	37.06257631	-120.8618873	Merced County
325975	Ordering, Referring, Prescribing	N/A	1255536769	0	0	PURCELL, MARK C PSYD	8/19/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23072	N/A	N/A	N/A	N/A	N/A	1811 SANTA RITA RD.	SUITE 206	PLEASANTON	CA	94566	4746	00	06000	37.67868377	-121.8747331	Alameda County
325986	Ordering, Referring, Prescribing	N/A	1255568366	0	0	PAFFORD, BENNETT W MD	11/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114715	N/A	N/A	N/A	N/A	N/A	72724 29 PALMS HWY	103	29 PALMS	CA	92277	2459	00	06000	34.13547448	-116.076159	San Bernardino County
325988	Ordering, Referring, Prescribing	N/A	1255586293	0	0	PETRIE, JANE NP	1/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	651984	N/A	N/A	N/A	N/A	N/A	50 PHELAN AVE	HC100	SAN FRANCISCO	CA	94112	1821	00	06000	37.72393451	-122.4522812	San Francisco County
326017	Ordering, Referring, Prescribing	N/A	1255632212	0	0	PARK, SOPHIA PHARMD	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53784	N/A	N/A	N/A	N/A	N/A	2684 N TUSTIN ST	None	ORANGE	CA	92865	2438	00	06000	33.83337963	-117.8362596	Orange County
326047	Ordering, Referring, Prescribing	N/A	1255696209	0	0	PADILLA, CLAUDIA S PA-C	3/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	22324	N/A	N/A	N/A	N/A	N/A	268 MCARTHUR WAY	SUITE A	UPLAND	CA	91786	5615	00	06000	34.097031	-117.6793105	San Bernardino County
326050	Ordering, Referring, Prescribing	N/A	1255697314	0	0	PABICO, PAIGE J LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115338	N/A	N/A	N/A	N/A	N/A	2100 N BROADWAY	101	SANTA ANA	CA	92706	2624	00	06000	33.76425305	-117.8695929	Orange County
326067	Ordering, Referring, Prescribing	N/A	1255725644	0	0	PENNY, BRIAN MD	3/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151377	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
326072	Ordering, Referring, Prescribing	N/A	1255730339	0	0	PARODI, JOHANNA LMFT	4/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123371	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
326096	Ordering, Referring, Prescribing	N/A	1255766465	0	0	PATEL, HARSHAL B PHARMD	4/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69339	N/A	N/A	N/A	N/A	N/A	8440 E CHAPMAN AVE	None	ORANGE	CA	92869	2459	00	06000	33.7927103	-117.7632194	Orange County
326103	Ordering, Referring, Prescribing	N/A	1255777132	0	0	PARR-PFITZER, SARAI LPCC	11/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8742	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
326114	Ordering, Referring, Prescribing	N/A	1255799060	0	0	PIRES, CHELSEA LMFT	11/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125256	N/A	N/A	N/A	N/A	N/A	406 SUNRISE AVE	300	ROSEVILLE	CA	95661	0000	00	06000	38.73944898	-121.2720559	Placer County
326134	Ordering, Referring, Prescribing	N/A	1255832952	0	0	PAGAN, DEJA B LCSW	10/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW118371	N/A	N/A	N/A	N/A	N/A	3800 WATT AVE	STE 110	SACRAMENTO	CA	95821	2622	00	06000	38.634417	-121.3818435	Sacramento County
326159	Ordering, Referring, Prescribing	N/A	1255866703	0	0	POURAT, JACOB MD	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156868	N/A	N/A	N/A	N/A	N/A	2010 ZONAL AVE.	SUITE 1P-2	LOS ANGELES	CA	90033	1026	00	06000	34.05986523	-118.2057472	Los Angeles County
326178	Ordering, Referring, Prescribing	N/A	1255869566	0	0	PHAN, HOA MD	3/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180758	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
326190	Ordering, Referring, Prescribing	N/A	1255911053	0	0	PELAYO, BRENDA DO	2/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21280	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
326205	Ordering, Referring, Prescribing	N/A	1255921433	0	0	PONTONI, KAREN R PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78077	N/A	N/A	N/A	N/A	N/A	50 EAGLE ROCK WAY	C	BRENTWOOD	CA	94513	4941	00	06000	37.92409034	-121.7369818	Contra Costa County
326244	Ordering, Referring, Prescribing	N/A	1255999777	0	0	PACAOAN, ANNA-LIZA RN	4/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	610899	N/A	N/A	N/A	N/A	N/A	227 BRIDGE ST	None	ARROYO GRANDE	CA	93420	3311	00	06000	35.120988	-120.577362	San Luis Obispo County
326263	Ordering, Referring, Prescribing	N/A	1265051460	0	0	PIERCE, JAMES MD	3/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184688	N/A	N/A	N/A	N/A	N/A	1515 SPRINGFIELD DR	175	CHICO	CA	95928	5995	00	06000	39.73096434	-121.8089646	Butte County
326269	Ordering, Referring, Prescribing	N/A	1265076996	0	0	PHAN, VICTORIA H CNM	10/25/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236079	N/A	N/A	N/A	N/A	N/A	760 RENZ LN	None	GILROY	CA	95020	9584	00	06000	37.00466254	-121.5555242	Santa Clara County
326271	Ordering, Referring, Prescribing	N/A	1265078042	0	0	PHAM, KIMBERLY DMD	12/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	50671	N/A	N/A	N/A	N/A	N/A	600 W BEVERLY BLVD	B	MONTEBELLO	CA	90640	3660	00	06000	34.01682058	-118.1040845	Los Angeles County
326278	Ordering, Referring, Prescribing	N/A	1265063887	0	0	PEREZ, JESICA LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117566	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
326306	Ordering, Referring, Prescribing	N/A	1265179410	0	0	PALACIOS PRITCHARD, NICOLE D DMD	4/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	107013	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
326323	Ordering, Referring, Prescribing	N/A	1265400824	0	0	PIERSOL, PATRICIA E RN CNM	7/9/2018	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	957	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
326341	Ordering, Referring, Prescribing	N/A	1265471320	0	0	PERSELL, ERIK PA-C	6/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA15960	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
326350	Ordering, Referring, Prescribing	N/A	1265507636	0	0	PEINADO, DIANA H LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47029	N/A	N/A	N/A	N/A	N/A	2370 SKYWAY DR.	104	SANTA MARIA	CA	93455	1133	00	06000	34.917183	-120.453982	Santa Barbara County
326373	Ordering, Referring, Prescribing	N/A	1265561237	0	0	PETITT, SYLVIA LMFT	1/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41532	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
326409	Ordering, Referring, Prescribing	N/A	1265631188	0	0	PEDROZA, SOMMER RN PHN	3/20/2019	Taxonomy not applicable	NA	n/a	000	Unknown	622161	N/A	N/A	N/A	N/A	N/A	1629 S CENTER ST	None	SANTA ANA	CA	92704	4113	00	06000	33.72509144	-117.8980958	Orange County
326438	Ordering, Referring, Prescribing	N/A	1265708424	0	0	PALACIOS, ALISON M DO	8/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11631	N/A	N/A	N/A	N/A	N/A	PLAZA AVE	NEAR LIBRARY CIRCLE	ARCATA	CA	95521	8299	00	06000	40.87718316	-124.0811195	Humboldt County
326446	Ordering, Referring, Prescribing	N/A	1265712897	0	0	PANDEY, RAJEEV N PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65525	N/A	N/A	N/A	N/A	N/A	3010 N DEMAREE ST	None	VISALIA	CA	93291	7147	00	06000	36.357075	-119.331513	Tulare County
326461	Ordering, Referring, Prescribing	N/A	1265718647	0	0	PARK-CHANG, LISA S PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49647	N/A	N/A	N/A	N/A	N/A	1086 W ARROW HWY	None	SAN DIMAS	CA	91773	1773	00	06000	34.10658454	-117.828342	Los Angeles County
326470	Ordering, Referring, Prescribing	N/A	1265742266	0	0	PERRY-DUTTON, ERIKA C LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45323	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	SUITE 201	PACOIMA	CA	91331	1338	00	06000	34.27814981	-118.4055414	Los Angeles County
326478	Ordering, Referring, Prescribing	N/A	1265748941	0	0	PERRY, KEVIN S	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D59566	N/A	N/A	N/A	N/A	N/A	847 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
326482	Ordering, Referring, Prescribing	N/A	1265765465	0	0	PILGRIM, SHEA PHD	7/23/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28339	N/A	N/A	N/A	N/A	N/A	3045 SANTIAGO STREET	None	SAN FRANCISCO	CA	94116	1526	00	06000	37.74380471	-122.5001832	San Francisco County
326491	Ordering, Referring, Prescribing	N/A	1265778815	0	0	PATTERSON, KALA D LCSW	11/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103506	N/A	N/A	N/A	N/A	N/A	1704 W MANCHESTER AVE	202A	LOS ANGELES	CA	90047	3063	00	06000	33.9599425	-118.307079	Los Angeles County
326495	Ordering, Referring, Prescribing	N/A	1265784219	0	0	PALMER, CANDACE CCC-SLP	11/17/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	31650	N/A	N/A	N/A	N/A	N/A	161 THOMAS RD	None	BOLINGBROOK	IL	60440	1352	00	06000	41.71626814	-88.06670745	Will County
326496	Ordering, Referring, Prescribing	N/A	1265785505	0	0	PATTON, KAREN L LCSW	6/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25810	N/A	N/A	N/A	N/A	N/A	2900 S. HARBOR BLVD.	100	SANTA ANA	CA	92704	6429	00	06000	33.70816839	-117.9197655	Orange County
326511	Ordering, Referring, Prescribing	N/A	1265814198	0	0	PEREZ, DAYANA LMFT	2/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124259	N/A	N/A	N/A	N/A	N/A	12099 W. WASHINGTON BLVD	None	LOS ANGELES	CA	90066	0001	00	06000	33.99748876	-118.4239234	Los Angeles County
326512	Ordering, Referring, Prescribing	N/A	1265814412	0	0	PATEL, VARDA D	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	48657	N/A	N/A	N/A	N/A	N/A	940 N TUSTIN ST	None	ORANGE	CA	92867	5956	00	06000	33.803298	-117.837702	Orange County
326514	Ordering, Referring, Prescribing	N/A	1265816110	0	0	PECH, CHRISTINA B	12/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA52771	N/A	N/A	N/A	N/A	N/A	650 META ST	None	OXNARD	CA	93030	7182	00	06000	34.195239	-119.1759535	Ventura County
326548	Ordering, Referring, Prescribing	N/A	1265870646	0	0	PARFYONOVA, ANNA LMFT	1/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123938	N/A	N/A	N/A	N/A	N/A	14624 SHERMAN WAY	SUITE 508	VAN NUYS	CA	91405	1001	00	06000	34.20078354	-118.450843	Los Angeles County
326572	Ordering, Referring, Prescribing	N/A	1265907935	0	0	PFLIBSEN, JESSICA M PA-C	7/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57624	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	115	SAN CLEMENTE	CA	92673	6274	00	06000	33.44951265	-117.6075825	Orange County
326601	Ordering, Referring, Prescribing	N/A	1265960066	0	0	PHAM, JAMES LAC	6/21/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	17605	N/A	N/A	N/A	N/A	N/A	7612 LINDA VISTA RD	113	SAN DIEGO	CA	92111	5313	00	06000	32.80163018	-117.1577046	San Diego County
326604	Ordering, Referring, Prescribing	N/A	1265970156	0	0	PEDERSEN, AMANDA LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114062	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	101	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
326609	Ordering, Referring, Prescribing	N/A	1265976872	0	0	PARK, MICHELLE J	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74948	N/A	N/A	N/A	N/A	N/A	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
326624	Ordering, Referring, Prescribing	N/A	1265998850	0	0	PALMA, DOXIE T NP	1/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010769	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DR	None	HANFORD	CA	93230	1107	00	06000	36.32726257	-119.6663418	Kings County
326632	Ordering, Referring, Prescribing	N/A	1275007742	0	0	PECK, ALEXANDRA NP	8/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	NP95010808	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	SACRAMENTO	CA	95616	9701	00	06000	38.6066487	-121.473802	Sacramento County
326641	Ordering, Referring, Prescribing	N/A	1275042319	0	0	PANDYA, LEENA S	6/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	ND943	N/A	N/A	N/A	N/A	N/A	747 FRONT STREET	None	SAN FRANCISCO	CA	94111	1945	00	06000	37.79808223	-122.399742	San Francisco County
326656	Ordering, Referring, Prescribing	N/A	1275074379	0	0	PACKER, RACHEL LPCC	5/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	4042	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	STE 210	EL CAJON	CA	92021	7417	00	06000	32.80772549	-116.94771	San Diego County
326664	Ordering, Referring, Prescribing	N/A	1275082182	0	0	PATEL, NILAM PHARMD	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75207	N/A	N/A	N/A	N/A	N/A	1530 HAMILTON AVE	None	SAN JOSE	CA	95125	4539	00	06000	37.29440152	-121.911003	Santa Clara County
326687	Ordering, Referring, Prescribing	N/A	1275117020	0	0	PARK, LINDSAY PHARMD	4/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86095	N/A	N/A	N/A	N/A	N/A	2000 W WHITTIER BLVD	None	LA HABRA	CA	90631	3535	00	06000	33.93977553	-117.968895	Orange County
326700	Ordering, Referring, Prescribing	N/A	1275140550	0	0	PASSALACQUA, LISA L PA-C	10/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58543	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
326722	Ordering, Referring, Prescribing	N/A	1275181190	0	0	PRIMACK, SARAH LCSW	12/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119885	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
326744	Ordering, Referring, Prescribing	N/A	1275288284	0	0	PADDEN, LEE A LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123797	N/A	N/A	N/A	N/A	N/A	28441 RANCHO CALIFORNIA	None	TEMECULA	CA	92590	3677	00	06000	33.49792824	-117.1581487	Riverside County
326760	Ordering, Referring, Prescribing	N/A	1275531527	0	0	PUZANTIAN, TALIA PHARD	8/13/2017	Taxonomy not applicable	NA	n/a	000	Unknown	46749	N/A	N/A	N/A	N/A	N/A	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4098	00	06000	34.14950866	-118.2311155	Los Angeles County
326806	Ordering, Referring, Prescribing	N/A	1275659278	0	0	PUSHIN, MARK MD	12/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53464	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
326820	Ordering, Referring, Prescribing	N/A	1275669061	0	0	PARKER, CHRISTOPHER D	1/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D37590	N/A	N/A	N/A	N/A	N/A	12150 NEW YORK RANCH RD	None	JACKSON	CA	95642	9407	00	06000	38.38476766	-120.7396521	Amador County
326834	Ordering, Referring, Prescribing	N/A	1275696379	0	0	PALOS, ANN M PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55682	N/A	N/A	N/A	N/A	N/A	29526 SEQUOIA RD	None	CANYON COUNTRY	CA	91387	6244	00	06000	34.44221533	-118.3800285	Los Angeles County
326844	Ordering, Referring, Prescribing	N/A	1275729071	0	0	PEREZ, MARTA J MSW LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64873	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
326852	Ordering, Referring, Prescribing	N/A	1275755183	0	0	PIERONI, NADINE M	3/15/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D28479	N/A	N/A	N/A	N/A	N/A	215 W BEAMER ST	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
326853	Ordering, Referring, Prescribing	N/A	1275758385	0	0	PARAS, DEMETRA PHD	3/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	17784	N/A	N/A	N/A	N/A	N/A	759 SOUTH VAN NESS AVE	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
326855	Ordering, Referring, Prescribing	N/A	1275759102	0	0	PRINE, REBECCA LCSW	10/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29890	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS ROAD	None	SAN DIEGO	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego
326863	Ordering, Referring, Prescribing	N/A	1275783813	0	0	PARK, JUNG S	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D57278	N/A	N/A	N/A	N/A	N/A	630 DRAKE AVE	None	SAUSALITO	CA	94965	1107	00	06000	37.87340883	-122.515085	Marin County
326941	Ordering, Referring, Prescribing	N/A	1275908832	0	0	PHAM, QUOC T NP	3/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003388	N/A	N/A	N/A	N/A	N/A	451 WEST LINCOLN AVE	SUITE 100	ANAHEIM	CA	92805	0000	00	06000	33.83445082	-117.9189372	Orange County
326954	Ordering, Referring, Prescribing	N/A	1275927691	0	0	PATEL, RUBY V MD	12/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146426	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
326973	Ordering, Referring, Prescribing	N/A	1275951832	0	0	PEREZ, ALEJANDRO L MD	12/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137765	N/A	N/A	N/A	N/A	N/A	1517 W GARVEY AVE N	None	WEST COVINA	CA	91790	2138	00	06000	34.07275646	-117.9386685	Los Angeles County
326996	Ordering, Referring, Prescribing	N/A	1275984494	0	0	PAPAZIAN, CORIANN LMFT	9/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121724	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3394	00	06000	33.7831762	-118.1333125	Los Angeles County
327004	Ordering, Referring, Prescribing	N/A	1275993305	0	0	PAWLAK, ERYKA NP	12/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026230	N/A	N/A	N/A	N/A	N/A	9727 ELK GROVE FLORIN RD	250	ELK GROVE	CA	95624	2264	00	06000	38.404503	-121.370994	Sacramento County
327019	Ordering, Referring, Prescribing	N/A	1285011148	0	0	PATEL, HEMAL Y MD	9/1/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148518	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
327049	Ordering, Referring, Prescribing	N/A	1285053652	0	0	PAYSEN, KERRY A LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94230	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
327055	Ordering, Referring, Prescribing	N/A	1285062596	0	0	PEREZ, NANCY PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70027	N/A	N/A	N/A	N/A	N/A	495 E HOLT AVE	None	POMONA	CA	91767	5539	00	06000	34.06259846	-117.7425045	Los Angeles County
327066	Ordering, Referring, Prescribing	N/A	1285072306	0	0	PORTER, KIMBERLY A LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92889	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
327104	Ordering, Referring, Prescribing	N/A	1285134460	0	0	PIEDADE, CHASTITY A LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27880	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE.	STE. 125-A	OAKLAND	CA	94605	2457	00	06000	37.768221	-122.17608	Alameda County
327123	Ordering, Referring, Prescribing	N/A	1285150714	0	0	PARASHAR, POOJA S LMFT	11/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123337	N/A	N/A	N/A	N/A	N/A	560 S ST LOUIS ST	None	LOS ANGELES	CA	90033	4320	00	06000	34.03924138	-118.2172475	Los Angeles County
327147	Ordering, Referring, Prescribing	N/A	1285214718	0	0	PERCELAY, RACHEL	3/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195099	N/A	N/A	N/A	N/A	N/A	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1001	00	06000	37.71083326	-122.1208841	Alameda County
327164	Ordering, Referring, Prescribing	N/A	1285235713	0	0	PATACA, KELLY	10/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015791	N/A	N/A	N/A	N/A	N/A	6095 N. 1ST STREET	None	FRESNO	CA	93710	0000	00	06000	36.82524765	-119.7723922	Fresno County
327168	Ordering, Referring, Prescribing	N/A	1285243915	0	0	POPE, SANDRA O NP	7/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015037	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
327170	Ordering, Referring, Prescribing	N/A	1285247049	0	0	PHAM, THANH T PA-C	6/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA59381	N/A	N/A	N/A	N/A	N/A	590 N SIERRA WAY	None	SAN BERNARDINO	CA	92410	9019	00	06000	34.109946	-117.2851675	San Bernardino County
327184	Ordering, Referring, Prescribing	N/A	1285263046	0	0	PATEL, SHASHVAT P MD	12/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191096	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	TULARE	CA	93274	4221	00	06000	36.20878419	-119.3415531	Tulare County
327193	Ordering, Referring, Prescribing	N/A	1285277533	0	0	PRINCIPE, JULIA NP	3/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95012871	N/A	N/A	N/A	N/A	N/A	1685 E MAIN ST	301	EL CAJON	CA	92021	5225	00	06000	32.81132509	-116.9192044	San Diego County
327216	Ordering, Referring, Prescribing	N/A	1285352740	0	0	PADRON, BRIANNA PA	11/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	62615	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST.	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
327220	Ordering, Referring, Prescribing	N/A	1285384206	0	0	PARTIDA, JASMINE MD	2/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188768	N/A	N/A	N/A	N/A	N/A	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
327232	Ordering, Referring, Prescribing	N/A	1285483651	0	0	PHI, PHUONG-THU DDS	5/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110061	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
327235	Ordering, Referring, Prescribing	N/A	1285496471	0	0	PALEN, AMANDA LMFT	3/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132573	N/A	N/A	N/A	N/A	N/A	1103 CLARK AVENUE	C	ORCUTT	CA	93455	5144	00	06000	34.86505846	-120.4175385	Santa Barbara County
327245	Ordering, Referring, Prescribing	N/A	1285638106	0	0	PETERSEN, KIRK J	7/26/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D35534	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
327266	Ordering, Referring, Prescribing	N/A	1285712877	0	0	PONG, THOMAS M MD	4/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G39714	N/A	N/A	N/A	N/A	N/A	2574 SAN BRUNO AVE	None	SAN FRANCISCO	CA	94134	1505	00	06000	37.72907852	-122.4042585	San Francisco County
327282	Ordering, Referring, Prescribing	N/A	1285756122	0	0	PRIMOSCH, SANDRA DDS	5/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	45667	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
327283	Ordering, Referring, Prescribing	N/A	1285762831	0	0	PENA, ABEL P LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47298	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
327325	Ordering, Referring, Prescribing	N/A	1285839449	0	0	POLI, RON F	7/16/2015	Taxonomy not applicable	NA	n/a	000	Unknown	12356	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
327362	Ordering, Referring, Prescribing	N/A	1285916288	0	0	PEOPLES, STEPHANIE E LCSW	3/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107268	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	223	WESTMINSTER	CA	92683	9268	00	06000	33.756966	-117.9894915	Orange County
327363	Ordering, Referring, Prescribing	N/A	1285916981	0	0	PADMAWAR, PRASHANT A PHD	8/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61911	N/A	N/A	N/A	N/A	N/A	820 SIR FRANCIS DRAKE BL	None	SAN ANSELMO	CA	94960	1906	00	06000	37.97953974	-122.5646081	Marin County
327417	Ordering, Referring, Prescribing	N/A	1295001592	0	0	PHAN, KIM M DO	8/31/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13018	N/A	N/A	N/A	N/A	N/A	4077 5TH STREET AVENUE	MER 35	SAN DIEGO	CA	92103	2105	00	06000	32.75034388	-117.161023	San Diego County
327418	Ordering, Referring, Prescribing	N/A	1295010072	0	0	PHAM, KELLY PHARMD	3/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	66515	N/A	N/A	N/A	N/A	N/A	23893 CLINTON KEITH RD.	None	WILDOMAR	CA	92595	0000	00	06000	33.595668	-117.241912	Riverside County
327419	Ordering, Referring, Prescribing	N/A	1295013951	0	0	PETER, NEIVEEN M MD	4/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129836	N/A	N/A	N/A	N/A	N/A	1121 AVONOAK TER	None	GLENDALE	CA	91206	1513	00	06000	34.16164657	-118.2312603	Los Angeles County
327420	Ordering, Referring, Prescribing	N/A	1295010023	0	0	PETRONI, JOSEPH L LMFT	12/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99187	N/A	N/A	N/A	N/A	N/A	500 N 9TH ST	None	MODESTO	CA	95350	5814	00	06000	37.65145793	-121.0156971	Stanislaus County
327427	Ordering, Referring, Prescribing	N/A	1295024842	0	0	PEREZ, XOCHITL E LCSW	1/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61810	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
327449	Ordering, Referring, Prescribing	N/A	1295071058	0	0	PREHN DESPOTA, CARA N LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS28374	N/A	N/A	N/A	N/A	N/A	1510 FASHION ISLAND BLVD	SUITE 310	SAN MATEO	CA	94404	1596	00	06000	37.5583415	-122.2861555	San Mateo County
327459	Ordering, Referring, Prescribing	N/A	1295100691	0	0	POSADA, SEAN R MD	12/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180171	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
327463	Ordering, Referring, Prescribing	N/A	1295104289	0	0	PAYE, JACQUELINE E PHARMD	8/20/2019	Taxonomy not applicable	NA	n/a	000	Unknown	73105	N/A	N/A	N/A	N/A	N/A	737 ZION ST	None	NEVADA CITY	CA	95959	2920	00	06000	39.25326438	-121.0260487	Nevada County
327491	Ordering, Referring, Prescribing	N/A	1295154839	0	0	POLASA VENKATA, GOPI KRISHNA MD	11/12/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A156586	N/A	N/A	N/A	N/A	N/A	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	00	06000	37.06343055	-120.8570545	Merced County
327502	Ordering, Referring, Prescribing	N/A	1295168441	0	0	PATHRIA, TAMMY T LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84721	N/A	N/A	N/A	N/A	N/A	777 N 1ST STREET	444	SAN JOSE	CA	95112	6339	00	06000	37.35064564	-121.9015633	Santa Clara County
327519	Ordering, Referring, Prescribing	N/A	1295207447	0	0	PHAM, THANG B PA-C	1/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56470	N/A	N/A	N/A	N/A	N/A	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	00	06000	34.15454904	-118.2429872	Los Angeles County
327524	Ordering, Referring, Prescribing	N/A	1295215630	0	0	PATTON, MELANIE M NP	12/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95010800	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
327528	Ordering, Referring, Prescribing	N/A	1295217602	0	0	PARHAM, DAVID	8/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71838	N/A	N/A	N/A	N/A	N/A	828 NEWVILLE RD	None	ORLAND	CA	95963	1109	00	06000	39.74883854	-122.2008838	Glenn County
327538	Ordering, Referring, Prescribing	N/A	1295231306	0	0	PARKER, HANNAH DO	8/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19023	N/A	N/A	N/A	N/A	N/A	550 E. WASHINGTON BLVD	SUITE 100	CRESCENT CITY	CA	95531	8342	00	06000	41.77274546	-124.19892	Del Norte County
327542	Ordering, Referring, Prescribing	N/A	1295240893	0	0	PAKOZDI-PAST, DORIS Z LMFT	1/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130769	N/A	N/A	N/A	N/A	N/A	222 W 6TH ST	230	SAN PEDRO	CA	90731	9998	00	06000	33.73876969	-118.2824628	Los Angeles County
327552	Ordering, Referring, Prescribing	N/A	1295255800	0	0	PISKLOV, HANNAH PA	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54795	N/A	N/A	N/A	N/A	N/A	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	00	06000	35.11274104	-120.588873	San Luis Obispo County
327560	Ordering, Referring, Prescribing	N/A	1295267813	0	0	PLESCIA, TREVOR MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158530	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
327566	Ordering, Referring, Prescribing	N/A	1295271203	0	0	PENNACCHIO, JONATHAN PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69410	N/A	N/A	N/A	N/A	N/A	21566 TRAIL RIDGE DR	None	ESCONDIDO	CA	92029	4824	00	06000	33.104108	-117.1330171	San Diego County
327575	Ordering, Referring, Prescribing	N/A	1295287613	0	0	PATEL, CHANDNI M NP	1/18/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005761	N/A	N/A	N/A	N/A	N/A	401 LESHER DRIVE	None	MERCED	CA	95341	6572	00	06000	37.29439197	-120.5030408	Merced County
327625	Ordering, Referring, Prescribing	N/A	1295393973	0	0	PATE-TERRY, JOLIE LCSW	12/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93306	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
327638	Ordering, Referring, Prescribing	N/A	1295481448	0	0	PAE, KAREN L PHARMD	2/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85905	N/A	N/A	N/A	N/A	N/A	13052 NEWPORT AVE	None	TUSTIN	CA	92780	3535	00	06000	33.74896613	-117.8112946	Orange County
327688	Ordering, Referring, Prescribing	N/A	1295803666	0	0	PEREZ-ARRIETE, MAYRA A LCSW	3/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27014	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	10	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
327697	Ordering, Referring, Prescribing	N/A	1295817385	0	0	PLOWMAN, YVONNE PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	44866	N/A	N/A	N/A	N/A	N/A	3215 CORTE POCO	None	CARLSBAD	CA	92009	8681	00	06000	33.07659411	-117.2386287	San Diego County
327737	Ordering, Referring, Prescribing	N/A	1295922367	0	0	POTTER, JESSICA L LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71091	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
327739	Ordering, Referring, Prescribing	N/A	1295922391	0	0	PAJOUHI, PEGAH MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104962	N/A	N/A	N/A	N/A	N/A	950 S GLENN DR.	235	FOLSOM	CA	95630	3193	00	06000	38.664684	-121.177917	Sacramento County
327741	Ordering, Referring, Prescribing	N/A	1295923902	0	0	PARSA, SANAZ MD	4/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116887	N/A	N/A	N/A	N/A	N/A	132 SECOND ST	None	SANTA MONICA	CA	90401	9040	00	06000	34.01490387	-118.4970984	Los Angeles County
327762	Ordering, Referring, Prescribing	N/A	1295922870	0	0	PENA, JUAN J LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59897	N/A	N/A	N/A	N/A	N/A	12124 BULLIS RODAD	#H	LYNWOOD	CA	90262	5106	00	06000	33.91614168	-118.2044211	Los Angeles County
327773	Ordering, Referring, Prescribing	N/A	1306002332	0	0	PALAGANAS, ALELI A DDS	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS57115	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
327786	Ordering, Referring, Prescribing	N/A	1306025648	0	0	PRIETTO, MARIO LCSW	1/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24161	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
327797	Ordering, Referring, Prescribing	N/A	1306060629	0	0	PAPENHAGEN, TED A DC	6/22/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	30480	N/A	N/A	N/A	N/A	N/A	2509 PICO BLVD	None	SANTA MONICA	CA	90405	1828	00	06000	34.02287459	-118.4631175	Los Angeles County
327835	Ordering, Referring, Prescribing	N/A	1306127964	0	0	PARK, GRACE W NP	7/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013933	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL	BLDG H	SANTA ANA	CA	92701	5002	00	06000	33.74986153	-117.8429355	Orange County
327862	Ordering, Referring, Prescribing	N/A	1306170196	0	0	PATEL, PAYAL J	1/27/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D58933	N/A	N/A	N/A	N/A	N/A	12451 GAIN ST	None	PACOIMA	CA	91331	1642	00	06000	34.27106318	-118.4045204	Los Angeles County
327865	Ordering, Referring, Prescribing	N/A	1306169073	0	0	PHAM, BICHNGOC	1/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51757	N/A	N/A	N/A	N/A	N/A	11000 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1206	00	06000	33.772446	-117.9407475	Orange County
327875	Ordering, Referring, Prescribing	N/A	1306189659	0	0	PATEL, VISHAL Y MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135129	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3558	00	06000	37.78272203	-122.4433297	San Francisco County
327888	Ordering, Referring, Prescribing	N/A	1306204953	0	0	PHAM, CATHERINE N PHARMD	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	72410	N/A	N/A	N/A	N/A	N/A	14840 HWY 4	None	DISCOVERY BAY	CA	94505	2236	00	06000	37.8894845	-121.621392	Contra Costa County
327892	Ordering, Referring, Prescribing	N/A	1306214754	0	0	POWELL, KRISTAL A LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102202	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	STE 275	BAKERSFIELD	CA	93309	2667	00	06000	35.35413152	-119.058471	Kern County
327893	Ordering, Referring, Prescribing	N/A	1306220033	0	0	PAYMON, HOLLY PHD	1/12/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33092	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	STE 320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
327909	Ordering, Referring, Prescribing	N/A	1306235957	0	0	PORTILLO, MICHAEL R MD	12/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144432	N/A	N/A	N/A	N/A	N/A	900 MONO WAY	None	SONORA	CA	95370	9256	00	06000	37.97560986	-120.3677839	Tuolumne County
327911	Ordering, Referring, Prescribing	N/A	1306239371	0	0	PERDOMO, DIANE LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111288	N/A	N/A	N/A	N/A	N/A	8550 BALBOA BLVD	150	NORTHRIDGE	CA	91325	3562	00	06000	34.225713	-118.5026045	Los Angeles County
327917	Ordering, Referring, Prescribing	N/A	1306245691	0	0	PHELPS, KIMBERLY G	4/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004536	N/A	N/A	N/A	N/A	N/A	818 WEST 7TH STREET	SUITE 930	LOS ANGELES	CA	90017	3407	00	06000	34.04892591	-118.259182	Los Angeles County
327935	Ordering, Referring, Prescribing	N/A	1306279054	0	0	PATEL. NEENA K	7/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D62512	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
327943	Ordering, Referring, Prescribing	N/A	1306297692	0	0	PHAN, YEN H PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72985	N/A	N/A	N/A	N/A	N/A	202 DEVON AVE	None	PLEASANT HILL	CA	94523	2522	00	06000	37.95462022	-122.0966819	Contra Costa County
327945	Ordering, Referring, Prescribing	N/A	1306303532	0	0	PON, CHRISTOPHER	1/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78549	N/A	N/A	N/A	N/A	N/A	1051 HUME WAY	None	VACAVILLE	CA	95687	5558	00	06000	38.35007337	-121.9807606	Solano County
327964	Ordering, Referring, Prescribing	N/A	1306327135	0	0	PHAM, BRYCE PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67429	N/A	N/A	N/A	N/A	N/A	14885 TELEGRAPH RD	None	LA MIRADA	CA	90638	1060	00	06000	33.91748456	-118.0134841	Los Angeles County
328021	Ordering, Referring, Prescribing	N/A	1306452370	0	0	PRADO, JULIAN B OT	12/15/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT20761	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
328055	Ordering, Referring, Prescribing	N/A	1306512934	0	0	PATEL, POONAMBEN PHARMD	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84685	N/A	N/A	N/A	N/A	N/A	10216 BRENTFORD AVE	None	BAKERSFIELD	CA	93311	3589	00	06000	35.35086832	-119.1165589	Kern County
328074	Ordering, Referring, Prescribing	N/A	1306593298	0	0	PENA, ELIZABETH PA-C	7/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64737	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DRIVE	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
328125	Ordering, Referring, Prescribing	N/A	1306936950	0	0	PACIER, MAUREEN B LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85953	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	402	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
328127	Ordering, Referring, Prescribing	N/A	1306938147	0	0	PAK, SANDY	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55607	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
328165	Ordering, Referring, Prescribing	N/A	1316018534	0	0	PAN, SIU M PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53912	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
328193	Ordering, Referring, Prescribing	N/A	1316034671	0	0	PARIKH, SOHINI MD	6/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A44792	N/A	N/A	N/A	N/A	N/A	4211 S. AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
328206	Ordering, Referring, Prescribing	N/A	1316080336	0	0	PHAM-STEPP, PHUONG-ANH H LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50256	N/A	N/A	N/A	N/A	N/A	780 E. GILBERT ST.	None	SAN BERNARDINO	CA	91750	7800	00	06000	34.1268333	-117.2705634	San Bernardino County
328210	Ordering, Referring, Prescribing	N/A	1316089287	0	0	PUEBLO, SHERI PT	6/29/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT18024	N/A	N/A	N/A	N/A	N/A	162 S MAIN ST	None	BISHOP	CA	93514	3415	00	06000	37.3608019	-118.3951979	Inyo County
328245	Ordering, Referring, Prescribing	N/A	1316195886	0	0	POWERS, CHRISTOPHER V LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80901	N/A	N/A	N/A	N/A	N/A	1035 MARKET ST	400	SAN FRANCISCO	CA	94103	1600	00	06000	37.78152549	-122.4111668	San Francisco County
328287	Ordering, Referring, Prescribing	N/A	1316262298	0	0	PAVLOSKI-CARTER, JACKIE K CCC-SLP	3/4/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	9764	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
328298	Ordering, Referring, Prescribing	N/A	1316299241	0	0	PLETCHER, RACHEL L LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89697	N/A	N/A	N/A	N/A	N/A	864 E SANTA CLARA ST	None	VENTURA	CA	93001	2939	00	06000	34.27952351	-119.287537	Ventura County
328342	Ordering, Referring, Prescribing	N/A	1316360001	0	0	PETERS, LILIA LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110570	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
328352	Ordering, Referring, Prescribing	N/A	1316379704	0	0	PAXTON, AUNDREA M PSYD	4/22/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29708	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3778	00	06000	33.63305341	-117.9266303	Orange County
328370	Ordering, Referring, Prescribing	N/A	1316396906	0	0	PARK, JOANN J MD	9/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151063	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
328399	Ordering, Referring, Prescribing	N/A	1316438955	0	0	PAIVA, ARTHUR A LMFT	3/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145566	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
328417	Ordering, Referring, Prescribing	N/A	1316466469	0	0	PIONTEK, HEATHER A LMFT	12/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152032	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	SUITE 100	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
328441	Ordering, Referring, Prescribing	N/A	1316495385	0	0	PORCIUNCULA, STACEY LMFT	4/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118384	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE	STE. A/B	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
328460	Ordering, Referring, Prescribing	N/A	1316520463	0	0	PINEDA, IAMIKA - JO C	4/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	84112	N/A	N/A	N/A	N/A	N/A	5417 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01967692	-118.1536948	Los Angeles County
328496	Ordering, Referring, Prescribing	N/A	1316586316	0	0	PEETE, CHANTAL LMFT	7/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123863	N/A	N/A	N/A	N/A	N/A	224 E 6TH ST	None	LOS ANGELES	CA	90014	2119	00	06000	34.04431784	-118.2485849	Los Angeles County
328497	Ordering, Referring, Prescribing	N/A	1316592793	0	0	PATTERSON, JESSIE LMFT	3/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145693	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	SUITE 280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
328499	Ordering, Referring, Prescribing	N/A	1316597784	0	0	PATTERSON, TANYA N LMFT	9/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134531	N/A	N/A	N/A	N/A	N/A	10722 ARROW RTE	None	RANCHO CUCAMONGA	CA	91730	4808	00	06000	34.09917725	-117.5708877	San Bernardino County
328518	Ordering, Referring, Prescribing	N/A	1316687072	0	0	POPOVA, DIANA PA	6/17/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64664	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0518	00	06000	39.03521526	-120.9755343	Placer County
328519	Ordering, Referring, Prescribing	N/A	1316668551	0	0	POULSEN, MEGAN PA-C	2/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64151	N/A	N/A	N/A	N/A	N/A	8465 OLD REDWOOD HWY	SUITE 320	WINDSOR	CA	95492	9244	00	06000	38.5435006	-122.8006981	Sonoma County
328523	Ordering, Referring, Prescribing	N/A	1316689276	0	0	PARKER, SAMANTHA S LCSW	6/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103409	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
328559	Ordering, Referring, Prescribing	N/A	1326029927	0	0	PATEL, PASHMINA V	9/29/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	52564	N/A	N/A	N/A	N/A	N/A	1051 E GRAND AVE	None	ARROYO GRANDE	CA	93420	7161	00	06000	35.11908066	-120.5952497	San Luis Obispo County
328579	Ordering, Referring, Prescribing	N/A	1326105313	0	0	PACE, GARY J MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52538	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	00	06000	38.62757555	-122.8638141	Sonoma County
328597	Ordering, Referring, Prescribing	N/A	1326125964	0	0	PON, CYNTHIA T LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21096	N/A	N/A	N/A	N/A	N/A	1990 41ST AVE.	None	SAN FRANCISCO	CA	94116	1101	00	06000	37.74984135	-122.4997872	San Francisco County
328604	Ordering, Referring, Prescribing	N/A	1326141979	0	0	PEREZ, NOEL C	9/9/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D49974	N/A	N/A	N/A	N/A	N/A	1125 E CALIFORNIA AVE	None	BAKERSFIELD	CA	93307	1201	00	06000	35.3683725	-118.9882125	Kern County
328607	Ordering, Referring, Prescribing	N/A	1326151465	0	0	PAUL, FRANK A	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7307	N/A	N/A	N/A	N/A	N/A	58375 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	7313	00	06000	34.13141256	-116.3904357	San Bernardino County
328630	Ordering, Referring, Prescribing	N/A	1326176157	0	0	PRENTICE, KATHLEEN M LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40780	N/A	N/A	N/A	N/A	N/A	28494 WESTINGHOUSE PL	STE 201	VALENCIA	CA	91355	0930	00	06000	34.44221561	-118.5989564	Los Angeles County
328642	Ordering, Referring, Prescribing	N/A	1326189127	0	0	PORTER, MELIA B LCSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24472	N/A	N/A	N/A	N/A	N/A	3300 GLENWOOD ST	None	EUREKA	CA	95501	3463	00	06000	40.78641759	-124.1310057	Humboldt County
328672	Ordering, Referring, Prescribing	N/A	1326254525	0	0	PATEL, DASHRATH P MD	9/16/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00081684	N/A	N/A	N/A	N/A	N/A	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
328684	Ordering, Referring, Prescribing	N/A	1326291865	0	0	PHILLIP, TARIK MD	3/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C177977	N/A	N/A	N/A	N/A	N/A	915 N MILPAS ST	None	SANTA BARBARA	CA	93103	2331	00	06000	34.43040726	-119.6909855	Santa Barbara County
328720	Ordering, Referring, Prescribing	N/A	1326322652	0	0	PHAM, CATHY P PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56492	N/A	N/A	N/A	N/A	N/A	8230 SARATOGA WAY	None	EL DORADO HILLS	CA	95762	4581	00	06000	38.65603483	-121.0726726	El Dorado County
328723	Ordering, Referring, Prescribing	N/A	1326328535	0	0	PAIGE, KEVIN T	11/23/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D60716	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
328750	Ordering, Referring, Prescribing	N/A	1326346859	0	0	PHAN, FELISA T	1/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50480	N/A	N/A	N/A	N/A	N/A	2201 SENTER RD	None	SAN JOSE	CA	95112	2627	00	06000	37.31078763	-121.8508228	Santa Clara County
328783	Ordering, Referring, Prescribing	N/A	1326421827	0	0	PHAM, JOHN DO	8/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17004	N/A	N/A	N/A	N/A	N/A	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	00	06000	37.3061289	-121.8119182	Santa Clara County
328796	Ordering, Referring, Prescribing	N/A	1326432626	0	0	PARK, SARAH MD	11/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147001	N/A	N/A	N/A	N/A	N/A	266 S HARVARD BLVD	250	LOS ANGELES	CA	90004	4884	00	06000	34.069221	-118.3041245	Los Angeles County
328824	Ordering, Referring, Prescribing	N/A	1326481946	0	0	PATEL, ATIT PHARMD	8/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67928	N/A	N/A	N/A	N/A	N/A	8980 KNOTT AVE	None	BUENA PARK	CA	90620	4137	00	06000	33.83248287	-118.0108412	Orange County
328837	Ordering, Referring, Prescribing	N/A	1326491457	0	0	PALMER, MARISSA N DC	6/18/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33617	N/A	N/A	N/A	N/A	N/A	13677 FOOTHILL BLVD	STE P	FONTANA	CA	92335	0214	00	06000	34.10632333	-117.5063838	San Bernardino County
328854	Ordering, Referring, Prescribing	N/A	1326536590	0	0	PATEL, NISA K NP	1/24/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008433	N/A	N/A	N/A	N/A	N/A	1450 E. HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
328859	Ordering, Referring, Prescribing	N/A	1326540758	0	0	PIMIENTA, JOSUE LMFT	4/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138673	N/A	N/A	N/A	N/A	N/A	7907 OSTROW ST	None	SAN DIEGO	CA	92111	3635	00	06000	32.81328129	-117.1542832	San Diego County
328870	Ordering, Referring, Prescribing	N/A	1326565722	0	0	PEREZ, AMY C	2/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106723	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
328909	Ordering, Referring, Prescribing	N/A	1326618174	0	0	PRESLEY, LAYNE LCSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120502	N/A	N/A	N/A	N/A	N/A	301 E 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29248035	-120.4730619	Merced County
328932	Ordering, Referring, Prescribing	N/A	1326680299	0	0	PAAMONI, ARIELLE PA-C	9/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57144	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
328958	Ordering, Referring, Prescribing	N/A	1326738766	0	0	PEZESHK, MOJGAN DC	5/10/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	27354	N/A	N/A	N/A	N/A	N/A	1919 W 7TH STREET	SECOND FLOOR	LOS ANGELES	CA	90057	4103	00	06000	34.05575686	-118.2751751	Los Angeles County
328972	Ordering, Referring, Prescribing	N/A	1326789801	0	0	PENA, JOHANA Y MD	8/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189082	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	100	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
328982	Ordering, Referring, Prescribing	N/A	1326877200	0	0	POLLACK, DANA NP	7/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95030954	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
328992	Ordering, Referring, Prescribing	N/A	1336139708	0	0	PALEY, CHRISTINA M NP	9/28/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13546	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
328993	Ordering, Referring, Prescribing	N/A	1336165125	0	0	PENEPACKER, STEPHEN T	7/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C180768	N/A	N/A	N/A	N/A	N/A	2178 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4535	00	06000	35.27488974	-120.6468257	San Luis Obispo County
329012	Ordering, Referring, Prescribing	N/A	1336227438	0	0	PARK, ANTHONY K MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70693	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
329019	Ordering, Referring, Prescribing	N/A	1336248954	0	0	PAUL, TRACI L OD	9/20/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	9695	N/A	N/A	N/A	N/A	N/A	1206 E. 17TH STREET	101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
329035	Ordering, Referring, Prescribing	N/A	1336277508	0	0	PETTEWAY, LINDA D LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49813	N/A	N/A	N/A	N/A	N/A	180 E VIA VERDE ST	None	COVINA	CA	91773	3993	00	06000	34.07767801	-117.8150295	Los Angeles County
329053	Ordering, Referring, Prescribing	N/A	1336312065	0	0	PADRON, MARIA LMFT	10/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84262	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
329083	Ordering, Referring, Prescribing	N/A	1336380955	0	0	PIMENTA, CAROLINA LMFT	10/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98194	N/A	N/A	N/A	N/A	N/A	4875 TUOLUMNE COURT	None	KELSEYVILLE	CA	95451	4875	00	06000	38.9558584	-122.7213606	Lake County
329084	Ordering, Referring, Prescribing	N/A	1336379338	0	0	PEREZ, MELISSA L PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61694	N/A	N/A	N/A	N/A	N/A	21255 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6742	00	06000	34.17331011	-118.5940107	Los Angeles County
329122	Ordering, Referring, Prescribing	N/A	1336437656	0	0	PAYNE, SHEILENA L LMFT	3/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94571	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
329124	Ordering, Referring, Prescribing	N/A	1336449867	0	0	PATTIE, MEGAN E LCSW	3/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73922	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVENUE	SUITE 260	PLEASANT HILL	CA	94523	4358	00	06000	37.93963113	-122.0591644	Contra Costa County
329128	Ordering, Referring, Prescribing	N/A	1336456185	0	0	PEREZ, SILVIA O LCSW	6/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85918	N/A	N/A	N/A	N/A	N/A	725 E. MAIN ST.	3RD FLOOR	SANTA PAULA	CA	93060	2748	00	06000	34.35240876	-119.0649129	Ventura County
329141	Ordering, Referring, Prescribing	N/A	1336484104	0	0	PAYAMI, MADDIHA DO	3/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14012	N/A	N/A	N/A	N/A	N/A	4065 3RD AVE	None	SAN DIEGO	CA	92103	2184	00	06000	32.75123948	-117.1627318	San Diego County
329164	Ordering, Referring, Prescribing	N/A	1336517457	0	0	PTASHINSKY, NATALYA NP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000533	N/A	N/A	N/A	N/A	N/A	54910 NORTH CIRCLE DR.	None	IDYLLWILD	CA	92549	2068	00	06000	33.75231731	-116.7065281	Riverside County
329170	Ordering, Referring, Prescribing	N/A	1336522952	0	0	PARMAR, DEEPIKA D MD	12/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146287	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
329189	Ordering, Referring, Prescribing	N/A	1336538867	0	0	POLONY, JACKIE L LMFT	12/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111156	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH ROAD	SUITE 115	PICO RIVERA	CA	90660	4940	00	06000	33.96454327	-118.1134473	Los Angeles County
329198	Ordering, Referring, Prescribing	N/A	1336541630	0	0	PINEDA, SANDRA J PHARMD	3/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	69204	N/A	N/A	N/A	N/A	N/A	5850 S MAIN ST	None	LOS ANGELES	CA	90003	1215	00	06000	33.988536	-118.2739135	Los Angeles County
329200	Ordering, Referring, Prescribing	N/A	1336553924	0	0	PARK, JOYCE PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81800	N/A	N/A	N/A	N/A	N/A	226 RESERVATION RD	None	MARINA	CA	93933	3083	00	06000	36.68634976	-121.7972217	Monterey County
329206	Ordering, Referring, Prescribing	N/A	1336557859	0	0	PEREZ, NOREIDA LCSW	9/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110613	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
329214	Ordering, Referring, Prescribing	N/A	1336576131	0	0	PELAYO, JESSICA LCSW	12/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89156	N/A	N/A	N/A	N/A	N/A	1900 SYCAMORE CANYON RD.	None	SAN DIMAS	CA	91773	1299	00	06000	34.13204802	-117.7975027	Los Angeles County
329240	Ordering, Referring, Prescribing	N/A	1336622737	0	0	PAVLOV, JAMIE R LCSW	8/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109596	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	180	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
329245	Ordering, Referring, Prescribing	N/A	1336617828	0	0	PHAN, MATTHEW Q	1/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79762	N/A	N/A	N/A	N/A	N/A	160 1ST ST	None	LOS ALTOS	CA	94022	0001	00	06000	37.37917164	-122.118817	Santa Clara County
329260	Ordering, Referring, Prescribing	N/A	1336650415	0	0	PELAYO, CYNTHIA Y LCSW	7/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108308	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
329462	Ordering, Referring, Prescribing	N/A	1346402336	0	0	PRADO, NOE LMFT	3/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105345	N/A	N/A	N/A	N/A	N/A	1327 E EL MONTE WAY	None	DINUBA	CA	93618	1825	00	06000	36.54556162	-119.3810375	Tulare County
329501	Ordering, Referring, Prescribing	N/A	1346478773	0	0	PREJEAN-HICKEY, JO'VEL PHARMD	5/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48475	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD.	None	ROSEVILLE	CA	95661	5737	00	06000	38.746836	-121.250529	Placer County
329520	Ordering, Referring, Prescribing	N/A	1346521382	0	0	PINGORIO, MARIA DOLORES A	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63929	N/A	N/A	N/A	N/A	N/A	2300 OTIS DR	None	ALAMEDA	CA	94501	5722	00	06000	37.75772853	-122.2487248	Alameda County
329523	Ordering, Referring, Prescribing	N/A	1346522257	0	0	PARK, DANIEL PHARMD	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	63436	N/A	N/A	N/A	N/A	N/A	535 N MCKINLEY ST	None	CORONA	CA	92879	1297	00	06000	33.89076759	-117.5213749	Riverside County
329538	Ordering, Referring, Prescribing	N/A	1346546157	0	0	PASIMIO, STACIE A LMFT	1/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79267	N/A	N/A	N/A	N/A	N/A	35912 AVENUE H	None	YUCAIPA	CA	92399	5206	00	06000	34.01032324	-117.0223299	San Bernardino County
329549	Ordering, Referring, Prescribing	N/A	1346559291	0	0	PENALBER, JENIFFER C LCSW	1/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79724	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
329579	Ordering, Referring, Prescribing	N/A	1346618386	0	0	PINEDO, LISETTE LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89127	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE.	2ND FLOOR	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
329621	Ordering, Referring, Prescribing	N/A	1346668837	0	0	PATEL, JASMINE MD	10/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155408	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
329652	Ordering, Referring, Prescribing	N/A	1346732120	0	0	PAZ, LAUREN	8/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127664	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
329658	Ordering, Referring, Prescribing	N/A	1346735578	0	0	PENDER, RACHEL L LMFT	4/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125480	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
329665	Ordering, Referring, Prescribing	N/A	1346745262	0	0	PATEL, ASHRUTA DO	3/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18760	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
329695	Ordering, Referring, Prescribing	N/A	1346798592	0	0	PARKS, LANCE J LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17810	N/A	N/A	N/A	N/A	N/A	1907 BOYS REPUBLIC DR	None	CHINO HILLS	CA	91709	5447	00	06000	33.993846	-117.725661	San Bernardino County
329725	Ordering, Referring, Prescribing	N/A	1346860533	0	0	PEREZ, ERIKA M PSYD	4/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31734	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	None	PARLIER	CA	93648	2666	00	06000	36.60500164	-119.5210273	Fresno County
329760	Ordering, Referring, Prescribing	N/A	1346950748	0	0	PINNICK, EUNICE NP	8/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022334	N/A	N/A	N/A	N/A	N/A	18651 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07044952	-117.3974715	San Bernardino County
329777	Ordering, Referring, Prescribing	N/A	1356015721	0	0	PHAM, ANH THU D CNP	10/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015796	N/A	N/A	N/A	N/A	N/A	2470 ALVIN AVE	60	SAN JOSE	CA	95121	1664	00	06000	37.31946663	-121.8268813	Santa Clara County
329781	Ordering, Referring, Prescribing	N/A	1356018220	0	0	PEREZ, APRIL	10/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60220	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
329783	Ordering, Referring, Prescribing	N/A	1356018444	0	0	PIERCE, PATRICK K DC	1/5/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC34557	N/A	N/A	N/A	N/A	N/A	50100 GOLSH ROAD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
329788	Ordering, Referring, Prescribing	N/A	1356039473	0	0	POWELL, CHARLES NP	6/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025472	N/A	N/A	N/A	N/A	N/A	1701 STINE RD	None	BAKERSFIELD	CA	93309	4827	00	06000	35.33828383	-119.0513543	Kern County
329795	Ordering, Referring, Prescribing	N/A	1356083828	0	0	PADILLA, MICHELE C NP	4/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020636	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
329810	Ordering, Referring, Prescribing	N/A	1356312813	0	0	PURTZ, HARVEY J DPM	4/24/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	3278	N/A	N/A	N/A	N/A	N/A	1310 HANNA AVE	STE 1 & 3	CORCORAN	CA	93212	2314	00	06000	36.09975818	-119.5641426	Kings County
329815	Ordering, Referring, Prescribing	N/A	1356331185	0	0	PATEL, RASHIKLAL MD	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51638	N/A	N/A	N/A	N/A	N/A	5075 S BRADLEY RD	STE 131	SANTA MARIA	CA	93455	5077	00	06000	34.864155	-120.4187955	Santa Barbara County
329818	Ordering, Referring, Prescribing	N/A	1356317739	0	0	PHILLIPS, SHARON J NP	7/2/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	446616	N/A	N/A	N/A	N/A	N/A	821 ST HELENA HWY S.	None	ST HELENA	CA	94574	2266	00	06000	38.48731402	-122.448269	Napa County
329832	Ordering, Referring, Prescribing	N/A	1356402440	0	0	PANDELI, JOSUE LCSW	5/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86270	N/A	N/A	N/A	N/A	N/A	330 MOSS ST	None	CHULA VISTA	CA	91911	2005	00	06000	32.61687155	-117.0714212	San Diego County
329888	Ordering, Referring, Prescribing	N/A	1356536841	0	0	PEREZ-ESPEJO, RAFAEL MD	2/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C140733	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
329900	Ordering, Referring, Prescribing	N/A	1356575989	0	0	PONZO, JOHN LPCC	2/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	13312	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
329940	Ordering, Referring, Prescribing	N/A	1356636138	0	0	PALMER, CHRISTINA S	3/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122592	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
329982	Ordering, Referring, Prescribing	N/A	1356699649	0	0	PYUN, JEONG I LCSW	1/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92739	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
329985	Ordering, Referring, Prescribing	N/A	1356706808	0	0	POSADA, JOANNA LMFT	3/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110259	N/A	N/A	N/A	N/A	N/A	51 ZACA LN	150	SAN LUIS OBISPO	CA	93401	7319	00	06000	35.25121029	-120.673119	San Luis Obispo County
330017	Ordering, Referring, Prescribing	N/A	1356755961	0	0	PHAM, NHUNG PHARMD	10/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	70329	N/A	N/A	N/A	N/A	N/A	2980 E CAPITOL EXPY	None	SAN JOSE	CA	95148	4247	00	06000	37.33024428	-121.8119226	Santa Clara County
330028	Ordering, Referring, Prescribing	N/A	1356766711	0	0	PALACIOS, ROXANNA LMFT	1/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130557	N/A	N/A	N/A	N/A	N/A	202 NORTH 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
330030	Ordering, Referring, Prescribing	N/A	1356768485	0	0	PAINTER, CAITLYN E DO	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14328	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY 4TH FL	SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
330096	Ordering, Referring, Prescribing	N/A	1356884795	0	0	PERRY, RUTH Z CNM	4/6/2022	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NMW235703	N/A	N/A	N/A	N/A	N/A	223 W COLE BLVD	None	CALEXICO	CA	92231	9722	00	06000	32.69401949	-115.5029355	Imperial County
330112	Ordering, Referring, Prescribing	N/A	1356904742	0	0	PHAM, KEVIN PHARMD	8/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	77286	N/A	N/A	N/A	N/A	N/A	4605 MORENA BLVD	None	SAN DIEGO	CA	92117	3650	00	06000	32.82186082	-117.2264619	San Diego County
330154	Ordering, Referring, Prescribing	N/A	1366002867	0	0	PALIVELA, LAKSHMI	2/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56490	N/A	N/A	N/A	N/A	N/A	6898 RALEIGH RD	None	SAN JOSE	CA	95119	1730	00	06000	37.2429835	-121.7845232	Santa Clara County
330160	Ordering, Referring, Prescribing	N/A	1366007635	0	0	PINEROS, DWAN MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1435	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
330166	Ordering, Referring, Prescribing	N/A	1366027245	0	0	PERDOMO, EMILIO R LCSW	5/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108235	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE	SUITE 1000	PLEASANT HILL	CA	94523	4344	00	06000	37.93963113	-122.0591644	Contra Costa County
330171	Ordering, Referring, Prescribing	N/A	1366019911	0	0	PARKER, KEVIN E LCSW	7/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25612	N/A	N/A	N/A	N/A	N/A	141 S CEDER ST	None	GLENDALE	CA	91205	1110	00	06000	34.144785	-118.244358	Los Angeles County
330178	Ordering, Referring, Prescribing	N/A	1366058208	0	0	PACHECO, NANCY	6/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW123021	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE.	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
330210	Ordering, Referring, Prescribing	N/A	1366119711	0	0	PIGAO, PETER JOHN J CNP	1/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014093	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
330221	Ordering, Referring, Prescribing	N/A	1366172157	0	0	PATEL, AINESHA NP	7/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021020	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
330241	Ordering, Referring, Prescribing	N/A	1366228314	0	0	PARK, LYDIA PA-C	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63268	N/A	N/A	N/A	N/A	N/A	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	00	06000	34.04297786	-118.2220181	Los Angeles County
330251	Ordering, Referring, Prescribing	N/A	1366464125	0	0	PAOLETTI, LAURA A NP	3/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12409	N/A	N/A	N/A	N/A	N/A	1325 TRAVIS BLVD	C	FAIRFIELD	CA	94533	4611	00	06000	38.25798926	-122.0518837	Solano County
330252	Ordering, Referring, Prescribing	N/A	1366451833	0	0	PEREIRA, JOAN M	5/16/2003	Taxonomy not applicable	NA	n/a	099	DENTIST	D49789	N/A	N/A	N/A	N/A	N/A	2216 S EL CAMINO REAL	STE 121	OCEANSIDE	CA	92054	6356	00	06000	33.18564585	-117.3279882	San Diego County
330253	Ordering, Referring, Prescribing	N/A	1366480014	0	0	PATRIC, KENNETH W MD	12/27/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G35083	N/A	N/A	N/A	N/A	N/A	7369 MILLIKEN AVE	None	RANCHO CUCAMONGA	CA	91730	6794	00	06000	34.120206	-117.5584215	San Bernardino County
330306	Ordering, Referring, Prescribing	N/A	1366617151	0	0	POWELL, ALICIA M LCSW	1/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29294	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
330315	Ordering, Referring, Prescribing	N/A	1366633141	0	0	PANG, MEI-LIN MD	9/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93591	N/A	N/A	N/A	N/A	N/A	2039 FOREST AVE	SUITE 105	SAN JOSE	CA	95128	4817	00	06000	37.32711929	-121.934266	Santa Clara County
330340	Ordering, Referring, Prescribing	N/A	1366700171	0	0	PEREZ, ROSE MARY	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97744	N/A	N/A	N/A	N/A	N/A	930 F ST	None	WASCO	CA	93280	0000	00	06000	35.590986	-119.3337445	Kern County
330358	Ordering, Referring, Prescribing	N/A	1366724189	0	0	PALO, SHELLY O	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56621	N/A	N/A	N/A	N/A	N/A	4029 43RD ST	STE 700	SAN DIEGO	CA	92105	1510	00	06000	32.75012697	-117.1019424	San Diego County
330360	Ordering, Referring, Prescribing	N/A	1366742132	0	0	PAYNE, VINCENT I PHARMD	4/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41275	N/A	N/A	N/A	N/A	N/A	500 E MANCHESTER BLVD	None	INGLEWOOD	CA	90301	9294	00	06000	33.960258	-118.3491765	Los Angeles County
330365	Ordering, Referring, Prescribing	N/A	1366750192	0	0	PERREIRA, KALANI LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103605	N/A	N/A	N/A	N/A	N/A	3301 E 12TH STREET	SUITE 259	OAKLAND	CA	94601	2904	00	06000	37.77617499	-122.2247899	Alameda County
330386	Ordering, Referring, Prescribing	N/A	1366786964	0	0	PORCAYO MORALES, CESAR LCSW	8/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96233	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	STE. G	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
330395	Ordering, Referring, Prescribing	N/A	1366804965	0	0	PATEL, ROHAN V MD	8/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158085	N/A	N/A	N/A	N/A	N/A	26520 CACTUS AVE.	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
330398	Ordering, Referring, Prescribing	N/A	1366807612	0	0	PEDDADA, KRANTI V MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163833	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
330406	Ordering, Referring, Prescribing	N/A	1366818676	0	0	PARRA, PERLA LCSW	3/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93133	N/A	N/A	N/A	N/A	N/A	2400 WIBLE RD	SUITE 14	BAKERSFIELD	CA	93304	4734	00	06000	35.3328934	-119.0389535	Kern County
330409	Ordering, Referring, Prescribing	N/A	1366822272	0	0	PEREZ, VERONICA H LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115532	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
330428	Ordering, Referring, Prescribing	N/A	1366849663	0	0	POLLACK, ERICA M LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97649	N/A	N/A	N/A	N/A	N/A	16650 SHERMAN WAY	None	VAN NUYS	CA	91406	3782	00	06000	34.20108451	-118.4959755	Los Angeles County
330430	Ordering, Referring, Prescribing	N/A	1366845232	0	0	PACHECO III, MOSES LMFT	11/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127871	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
330447	Ordering, Referring, Prescribing	N/A	1366872434	0	0	PALER, TODD LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35730	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
330465	Ordering, Referring, Prescribing	N/A	1366904963	0	0	PARKER, NATHANIEL DO	4/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19493	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
330499	Ordering, Referring, Prescribing	N/A	1366962854	0	0	PANDYA, JANKEE B LCSW	9/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104313	N/A	N/A	N/A	N/A	N/A	1401 N TUSTIN AVE	225	SANTA ANA	CA	92705	8644	00	06000	33.757254	-117.8341425	Orange County
330534	Ordering, Referring, Prescribing	N/A	1376009480	0	0	PHAM, QUY NP	12/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016206	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
330540	Ordering, Referring, Prescribing	N/A	1376030817	0	0	PHAM, SYLVIE MD	7/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173728	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
330585	Ordering, Referring, Prescribing	N/A	1376112276	0	0	PERSAUD, CHRISTINA PHARMD	2/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81974	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	STE 200	BEVERLY HILLS	CA	90211	2285	00	06000	34.06736471	-118.3763201	Los Angeles County
330637	Ordering, Referring, Prescribing	N/A	1376256305	0	0	PANDJAITAN, EDELWEISS CCC-SLP	11/7/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	36257	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	None	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
330643	Ordering, Referring, Prescribing	N/A	1376279935	0	0	PARK-HEM, REBECCA LCSW	3/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121565	N/A	N/A	N/A	N/A	N/A	12912 BROOKHURST ST	None	GARDEN GROVE	CA	92840	4883	00	06000	33.77487003	-117.9552276	Orange County
330687	Ordering, Referring, Prescribing	N/A	1376633446	0	0	PALAGANAS, ARTEMIO F DDS	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS46917	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
330691	Ordering, Referring, Prescribing	N/A	1376639179	0	0	PEAK, GLORIA A CNP	4/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10745	N/A	N/A	N/A	N/A	N/A	18077 US HIGHWAY 18	SUITE 100	APPLE VALLEY	CA	92307	2168	00	06000	34.54021616	-117.2696677	San Bernardino County
330708	Ordering, Referring, Prescribing	N/A	1376669812	0	0	PARK, SOO MIN LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65000	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
330745	Ordering, Referring, Prescribing	N/A	1376743328	0	0	PHUI, KHUONG DO	10/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11007	N/A	N/A	N/A	N/A	N/A	209 C ST	None	LEMOORE	CA	93245	2930	00	06000	36.30089987	-119.7833254	Kings County
330773	Ordering, Referring, Prescribing	N/A	1376813717	0	0	PRICE, JESSICA LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71145	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
330787	Ordering, Referring, Prescribing	N/A	1376837518	0	0	PATEL, CHANDRA N PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57371	N/A	N/A	N/A	N/A	N/A	49281 GRAPEFRUIT BLVD	STE 2	COACHELLA	CA	92236	1486	00	06000	33.68999567	-116.1828461	Riverside County
330788	Ordering, Referring, Prescribing	N/A	1376836460	0	0	PATEL, RAVI R MD	11/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128340	N/A	N/A	N/A	N/A	N/A	17053 FOOTHILL BLVD	None	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
330823	Ordering, Referring, Prescribing	N/A	1376900431	0	0	PHAM, GIBSON LCSW	1/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95619	N/A	N/A	N/A	N/A	N/A	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
330827	Ordering, Referring, Prescribing	N/A	1376911784	0	0	PATEL, CHRISTINE PHARMD	2/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52357	N/A	N/A	N/A	N/A	N/A	1902 ROYALTY DR.	110	POMONA	CA	91767	3036	00	06000	34.07791925	-117.746146	Los Angeles County
330834	Ordering, Referring, Prescribing	N/A	1376917716	0	0	PERSON, THOMAS PHARMD	8/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73124	N/A	N/A	N/A	N/A	N/A	1717 MING AVE	None	BAKERSFIELD	CA	93304	4595	00	06000	35.33940853	-119.0221515	Kern County
330849	Ordering, Referring, Prescribing	N/A	1376939488	0	0	PEREZ TINOCO, JUAN LCSW	2/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120905	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
330853	Ordering, Referring, Prescribing	N/A	1376946087	0	0	PAGUIA, SHIELA LCSW	5/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85248	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
330861	Ordering, Referring, Prescribing	N/A	1376956391	0	0	PANSARA, BHAVESHKUMAR B PHARMD	2/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76572	N/A	N/A	N/A	N/A	N/A	2813 SOUTH MAIN STREET	None	92882	CA	92882	1901	00	06000	33.84741266	-117.570694	Riverside County
330892	Ordering, Referring, Prescribing	N/A	1376997502	0	0	PERDOMO RODRIGUEZ, MERCY MD	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A175057	N/A	N/A	N/A	N/A	N/A	162 E CARSON ST	SUITE A	COLUSA	CA	95932	2880	00	06000	39.20587882	-122.0061518	Colusa County
330909	Ordering, Referring, Prescribing	N/A	1386021301	0	0	PETERSON, ALEXANDRA LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92906	N/A	N/A	N/A	N/A	N/A	15339 SATICOY ST.	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
330943	Ordering, Referring, Prescribing	N/A	1386076073	0	0	PAHLEVANLOU, GOLNAZ K	9/13/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D62550	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
330960	Ordering, Referring, Prescribing	N/A	1386092229	0	0	PARK, WOOJUNG LAC	7/27/2017	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	16964	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	4375	00	06000	37.54845774	-121.9773463	Alameda County
330985	Ordering, Referring, Prescribing	N/A	1386128585	0	0	PHAN, TAM PHARMD	10/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	78948	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
331020	Ordering, Referring, Prescribing	N/A	1386178408	0	0	PHAM, ANDY T A MD	8/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158075	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
331024	Ordering, Referring, Prescribing	N/A	1386183150	0	0	PAN, SHIUAN-YU DC	10/28/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC33424	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	200	MONTEREY PARK	CA	91754	0000	00	06000	34.05382447	-118.1363489	Los Angeles County
331025	Ordering, Referring, Prescribing	N/A	1386180982	0	0	PHAN, DONALD	4/13/2018	Taxonomy not applicable	NA	n/a	000	Unknown	73274	N/A	N/A	N/A	N/A	N/A	2020 MARKET ST	None	SAN FRANCISCO	CA	94114	1314	00	06000	37.76862999	-122.4276946	San Francisco County
331074	Ordering, Referring, Prescribing	N/A	1386277861	0	0	PHILLIPS, JESSAMYN C NP	1/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013355	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
331105	Ordering, Referring, Prescribing	N/A	1386381804	0	0	PALEGA, RISA LMFT	10/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129975	N/A	N/A	N/A	N/A	N/A	871 ENBORG COURT #400	400	SAN JOSE	CA	95128	2645	00	06000	37.311489	-121.933817	Santa Clara County
331115	Ordering, Referring, Prescribing	N/A	1386394047	0	0	PASTOR, ANDREW MD	9/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190285	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
331153	Ordering, Referring, Prescribing	N/A	1386694404	0	0	PAIKOFF, LAWRENCE S MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G61673	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
331154	Ordering, Referring, Prescribing	N/A	1386705614	0	0	PARK, JAE S LAC	10/17/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	5537	N/A	N/A	N/A	N/A	N/A	17450 MAIN STREET	SUITE D,E,F	HESPERIA	CA	92345	6262	00	06000	34.41871211	-117.2821748	San Bernardino County
331191	Ordering, Referring, Prescribing	N/A	1386776334	0	0	PAGE, KATHERINE M	8/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24000	N/A	N/A	N/A	N/A	N/A	2310 ALDERGROVE AVE	None	ESCONDIDO	CA	92029	1935	00	06000	33.11810947	-117.1147557	San Diego County
331196	Ordering, Referring, Prescribing	N/A	1386778033	0	0	PHAN, CONG T MD	3/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78092	N/A	N/A	N/A	N/A	N/A	8235 ROCHESTER AVE	STE 110	RANCHO CUCAMONGA	CA	91730	0607	00	06000	34.103952	-117.5456935	San Bernardino County
331227	Ordering, Referring, Prescribing	N/A	1386830172	0	0	PADAYACHEE, MELISSA C LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47471	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL	BUILDING H	SANTA ANA	CA	92701	5002	00	06000	33.74986153	-117.8429355	Orange County
331249	Ordering, Referring, Prescribing	N/A	1386876241	0	0	PAYVARPOUR, MEDISA PSYD	6/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31271	N/A	N/A	N/A	N/A	N/A	1333 WILLOW PASS RD	None	CONCORD	CA	94520	7930	00	06000	37.96924618	-122.051411	Contra Costa County
331255	Ordering, Referring, Prescribing	N/A	1386898732	0	0	PHAM, LUYEN D LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53265	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	STE 405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
331270	Ordering, Referring, Prescribing	N/A	1386929115	0	0	PADILLA CORTES, JESSICA RITA LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107653	N/A	N/A	N/A	N/A	N/A	4910 E ASHLAN AVE	118	FRESNO	CA	93726	3020	00	06000	36.79411387	-119.7309194	Fresno County
331280	Ordering, Referring, Prescribing	N/A	1386944379	0	0	PHAN, MARIE M PHARMD	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47496	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
331304	Ordering, Referring, Prescribing	N/A	1386999183	0	0	PALOMARES, JULIA I LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102499	N/A	N/A	N/A	N/A	N/A	12440 FIRESTONE BLVD	#1000	NORWALK	CA	90650	4328	00	06000	33.90523023	-118.0681168	Los Angeles County
331314	Ordering, Referring, Prescribing	N/A	1396004958	0	0	PEREZ TRUJEQUE, MARIBEL OT	11/6/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	14300	N/A	N/A	N/A	N/A	N/A	909 S FAIR OAKS AVE	None	PASADENA	CA	91105	2625	00	06000	34.13056002	-118.1503751	Los Angeles County
331316	Ordering, Referring, Prescribing	N/A	1396015269	0	0	PAN, XIU FEN LAC	3/31/2020	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC14378	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
331322	Ordering, Referring, Prescribing	N/A	1396021366	0	0	PATEL, ARCHANA V	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62145	N/A	N/A	N/A	N/A	N/A	2851 S ROSE AVE	None	OXNARD	CA	93033	3953	00	06000	34.17389279	-119.1601891	Ventura County
331348	Ordering, Referring, Prescribing	N/A	1396072286	0	0	PAUL, VANESSA I LMFT	3/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87229	N/A	N/A	N/A	N/A	N/A	535 E CLARK AVE	A	ORCUTT	CA	93455	5262	00	06000	34.86514147	-120.4416113	Santa Barbara County
331353	Ordering, Referring, Prescribing	N/A	1396089645	0	0	POURREZA, AFSHIN LMFT	5/14/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52366	N/A	N/A	N/A	N/A	N/A	4199 CAMPUS DR	STE 550	IRVINE	CA	92612	4694	00	06000	33.650775	-117.838296	Orange County
331407	Ordering, Referring, Prescribing	N/A	1396170395	0	0	PHAM, HIEU T PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69690	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
331436	Ordering, Referring, Prescribing	N/A	1396199287	0	0	PEREYRA, AUBREE D MD	2/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158358	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
331538	Ordering, Referring, Prescribing	N/A	1396377826	0	0	PAYES, MARGARITA NP	6/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014677	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
331580	Ordering, Referring, Prescribing	N/A	1396491916	0	0	PARSAFAR, ZAHRA PHARMD	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53282	N/A	N/A	N/A	N/A	N/A	8925 MADISON AVE	None	FAIR OAKS	CA	95628	4009	00	06000	38.665152	-121.224105	Sacramento County
331614	Ordering, Referring, Prescribing	N/A	1396772034	0	0	PATEL, GIRISHCHANDRA MD	11/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A30152	N/A	N/A	N/A	N/A	N/A	329 W 8TH ST	STE 109	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
331675	Ordering, Referring, Prescribing	N/A	1396881165	0	0	PARKER, RYAN E LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51701	N/A	N/A	N/A	N/A	N/A	30 PROFESSIONAL CENTER P	None	SAN RAFAEL	CA	94903	2757	00	06000	38.00989519	-122.5391142	Marin County
331708	Ordering, Referring, Prescribing	N/A	1396963997	0	0	PILACZYNSKI, CHRISTOPHER PA	10/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA18727	N/A	N/A	N/A	N/A	N/A	1133 W. SYCAMORE STREET	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
331711	Ordering, Referring, Prescribing	N/A	1396973624	0	0	PORGES, MELANIE L LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110735	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
331715	Ordering, Referring, Prescribing	N/A	1396981452	0	0	PONTING, JENNIFER L LCSW	11/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW15587	N/A	N/A	N/A	N/A	N/A	275 BECK AVENUE	MS5-250	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
331716	Ordering, Referring, Prescribing	N/A	1396980181	0	0	PARK, JOSEPH G PT	7/21/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	36571	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
331731	Ordering, Referring, Prescribing	N/A	1407013105	0	0	PEPPER, EMILIE S	1/31/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	D41981	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	#486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
331732	Ordering, Referring, Prescribing	N/A	1407011661	0	0	PRIETO, YVETTE NP	2/11/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	624637	N/A	N/A	N/A	N/A	N/A	320 JAMES ST	None	SHAFTER	CA	93263	2033	00	06000	35.50330762	-119.2772354	Kern County
331741	Ordering, Referring, Prescribing	N/A	1407036536	0	0	PERSON, RICHARD B PA-C	1/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	19254	N/A	N/A	N/A	N/A	N/A	308 N LA CADENA DR	None	COLTON	CA	92324	2946	00	06000	34.06815282	-117.3240225	San Bernardino County
331745	Ordering, Referring, Prescribing	N/A	1407041700	0	0	PALLAIS, MARCELA A LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78447	N/A	N/A	N/A	N/A	N/A	160 E. VIRGINIA ST	280	SAN JOSE	CA	95112	5817	00	06000	37.32582868	-121.8777868	Santa Clara County
331749	Ordering, Referring, Prescribing	N/A	1407064702	0	0	PONSSA, JOSE G LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49247	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY ST.	E500	FREMONT	CA	94538	1513	00	06000	37.55123907	-121.9828956	Alameda County
331754	Ordering, Referring, Prescribing	N/A	1407066988	0	0	PUNNAM, JYOTHI MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	40129	N/A	N/A	N/A	N/A	N/A	3555 S VAL VISTA DR	None	GILBERT	AZ	85297	7323	00	06000	33.286572	-111.7527525	Maricopa County
331759	Ordering, Referring, Prescribing	N/A	1407079718	0	0	PRICE, ANDREA M	3/8/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA14625	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
331761	Ordering, Referring, Prescribing	N/A	1407101223	0	0	PEREZ, GABRIELA A LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109579	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DRIVE	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
331763	Ordering, Referring, Prescribing	N/A	1407103609	0	0	PALOS, STEVE LMFT	11/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106318	N/A	N/A	N/A	N/A	N/A	1780 VERNON STREET	SUITE 1	ROSEVILLE	CA	95678	6311	00	06000	38.732967	-121.2997685	Placer County
331799	Ordering, Referring, Prescribing	N/A	1407186497	0	0	PEREA, JANET LCSW	12/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65674	N/A	N/A	N/A	N/A	N/A	2500 E FOOTHILL BLVD	300	PASADENA	CA	91107	3464	00	06000	34.14979547	-118.097982	Los Angeles County
331865	Ordering, Referring, Prescribing	N/A	1407300445	0	0	PALOMBIT, RAYNE PSYD	4/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32502	N/A	N/A	N/A	N/A	N/A	200 W. SANTA ANA BLVD	SUITE 801	SANTA ANA	CA	92701	7545	00	06000	33.74970951	-117.8691975	Orange County
331879	Ordering, Referring, Prescribing	N/A	1407317506	0	0	PACHECO, ISIS P LPCC	6/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC14130	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	200	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
331901	Ordering, Referring, Prescribing	N/A	1407341803	0	0	PEREZ, IRMA J LPCC	4/24/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC16388	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	2ND FLOOR	SAN PABLO	CA	94806	2718	00	06000	37.95651393	-122.3371491	Contra Costa County
331918	Ordering, Referring, Prescribing	N/A	1407360464	0	0	PAGE, JILL M LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93625	N/A	N/A	N/A	N/A	N/A	1525 PLUMAS COURT	None	YUBA CITY	CA	95991	2971	00	06000	39.15274768	-121.6184473	Sutter County
331938	Ordering, Referring, Prescribing	N/A	1407395148	0	0	PEREZ, TERESA	5/7/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146786	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
331949	Ordering, Referring, Prescribing	N/A	1407416738	0	0	PICHARDO-GOMEZ, DAVID R MD	7/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180224	N/A	N/A	N/A	N/A	N/A	150 HARBOUR WAY	None	RICHMOND	CA	94801	3554	00	06000	37.933713	-122.3599835	Contra Costa County
331982	Ordering, Referring, Prescribing	N/A	1407511868	0	0	PALOMINO, SERINA LPCC	1/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15660	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
332010	Ordering, Referring, Prescribing	N/A	1407683857	0	0	PEREZ-SANDI, ALEJANDRO NP	8/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031882	N/A	N/A	N/A	N/A	N/A	450 BAUCHET ST	None	LOS ANGELES	CA	90012	2907	00	06000	34.05925347	-118.230941	Los Angeles County
332031	Ordering, Referring, Prescribing	N/A	1407895626	0	0	PARK, SEON J LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42519	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD.	SUITE 200	PACOIMA	CA	91331	1398	00	06000	34.27894489	-118.4044363	Los Angeles County
332032	Ordering, Referring, Prescribing	N/A	1407901093	0	0	PAPION, LUPE B CNP	11/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7444	N/A	N/A	N/A	N/A	N/A	100 W COLUMBUS ST	SUITE 200	BAKERSFIELD	CA	93301	1200	00	06000	35.39748603	-119.0035461	Kern County
332034	Ordering, Referring, Prescribing	N/A	1407906910	0	0	PELFINI, ANDREW LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	31249	N/A	N/A	N/A	N/A	N/A	3150 18TH STREET	325	SAN FRANCISCO	CA	94110	0013	00	06000	37.76218347	-122.4141845	San Francisco County
332035	Ordering, Referring, Prescribing	N/A	1407920903	0	0	PEREZ-JOHNSON, DIANA LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS23254	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVENUE	155	TORRANCE	CA	90502	1351	00	06000	33.84828383	-118.2860386	Los Angeles County
332083	Ordering, Referring, Prescribing	N/A	1407992456	0	0	PAVONE, SUSAN LMFT	1/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24231	N/A	N/A	N/A	N/A	N/A	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	3865	00	06000	34.10486789	-117.5684863	San Bernardino County
332086	Ordering, Referring, Prescribing	N/A	1417003567	0	0	PETERSON, JEFFREY MD	9/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G69213	N/A	N/A	N/A	N/A	N/A	2911 E CORONADO ST	None	ANAHEIM	CA	92806	2525	00	06000	33.85267148	-117.8662804	Orange County
332087	Ordering, Referring, Prescribing	N/A	1417010737	0	0	PARK, CAROLINE H PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58681	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
332116	Ordering, Referring, Prescribing	N/A	1417077561	0	0	PENNINGTON, SUSAN LCSW	8/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21317	N/A	N/A	N/A	N/A	N/A	5425 SIERRA VISTA AVE	None	RIVERSIDE	CA	92505	3113	00	06000	33.92652824	-117.5056425	Riverside County
332132	Ordering, Referring, Prescribing	N/A	1417091083	0	0	PROCTOR, MARY E	9/16/2022	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	1147	N/A	N/A	N/A	N/A	N/A	23413 LYONS AVE	None	SANTA CLARITA	CA	91355	3028	00	06000	34.37974287	-118.5428596	Los Angeles County
332139	Ordering, Referring, Prescribing	N/A	1417104282	0	0	PARSAEI, NAZANIN MD	2/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112838	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
332157	Ordering, Referring, Prescribing	N/A	1417132275	0	0	PARKER, KENNETH P PHD	1/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY9141	N/A	N/A	N/A	N/A	N/A	441 PARK AVENUE	None	SAN JOSE	CA	95110	2615	00	06000	37.32813005	-121.897828	Santa Clara County
332168	Ordering, Referring, Prescribing	N/A	1417145384	0	0	PERRYMAN, CARMEN LCSW	3/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28081	N/A	N/A	N/A	N/A	N/A	950 W D ST	None	ONTARIO	CA	91762	3026	00	06000	34.067304	-117.667098	San Bernardino County
332202	Ordering, Referring, Prescribing	N/A	1417232455	0	0	PHILIPOSIAN, MIREILLE PHARMD	12/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53688	N/A	N/A	N/A	N/A	N/A	2001 N VENTURA RD	None	OXNARD	CA	93036	2861	00	06000	34.22115674	-119.1946857	Ventura County
332203	Ordering, Referring, Prescribing	N/A	1417238775	0	0	PHAM, ERIC M PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63128	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2192	00	06000	38.471625	-122.7259935	Sonoma County
332208	Ordering, Referring, Prescribing	N/A	1417239708	0	0	PATEL, SATYAM V PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62487	N/A	N/A	N/A	N/A	N/A	19266 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91351	3366	00	06000	34.41569352	-118.4717205	Los Angeles County
332234	Ordering, Referring, Prescribing	N/A	1417293168	0	0	PEARCE, CONNOR W	1/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124119	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
332238	Ordering, Referring, Prescribing	N/A	1417303983	0	0	PENG, ALICE	5/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	75933	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
332240	Ordering, Referring, Prescribing	N/A	1417304767	0	0	PATEL, JINESH PHARMD	8/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	73113	N/A	N/A	N/A	N/A	N/A	1004 W FOOTHILL BLVD	SUITE 101	UPLAND	CA	91786	3791	00	06000	34.10647255	-117.665541	San Bernardino County
332263	Ordering, Referring, Prescribing	N/A	1417330622	0	0	PADILLA, JENNIFER F LMFT	3/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118545	N/A	N/A	N/A	N/A	N/A	2310 FIRST	None	NAPA	CA	94559	2239	00	06000	38.29806271	-122.2989388	Napa County
332298	Ordering, Referring, Prescribing	N/A	1417387259	0	0	PARSONS-BARILLAS, ILIANA M LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81514	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LA PULGA	None	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
332317	Ordering, Referring, Prescribing	N/A	1417419680	0	0	PHAN, PAULINE Q DO	11/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19931	N/A	N/A	N/A	N/A	N/A	902 S. MYRTLE AVENUE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
332345	Ordering, Referring, Prescribing	N/A	1417473729	0	0	PAZOS, RAQUEL M LMFT	10/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122575	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	STE 210	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
332361	Ordering, Referring, Prescribing	N/A	1417489154	0	0	PAN, TIFFANY S MD	8/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157554	N/A	N/A	N/A	N/A	N/A	2010 ZONAL AVE	3P40B	LOS ANGELES	CA	90033	1026	00	06000	34.05986523	-118.2057472	Los Angeles County
332374	Ordering, Referring, Prescribing	N/A	1417516253	0	0	PAINTER, BRANDON MD	2/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180745	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
332391	Ordering, Referring, Prescribing	N/A	1417536376	0	0	PUGA, CINDY MD	7/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181862	N/A	N/A	N/A	N/A	N/A	2100 W 3RD ST	220	LOS ANGELES	CA	90057	1944	00	06000	34.06308947	-118.2733326	Los Angeles County
332394	Ordering, Referring, Prescribing	N/A	1417567827	0	0	PIRTLE, KEYSHONE D NP	7/31/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	833097	N/A	N/A	N/A	N/A	N/A	5442 SYCUAN RD	None	EL CAJON	CA	92019	1816	00	06000	32.78885903	-116.8320996	San Diego County
332433	Ordering, Referring, Prescribing	N/A	1417627290	0	0	PAVONE, DANIELLA LMFT	11/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143032	N/A	N/A	N/A	N/A	N/A	2135 PINE ST	None	REDDING	CA	96001	2690	00	06000	40.57860253	-122.3869686	Shasta County
332493	Ordering, Referring, Prescribing	N/A	1427101187	0	0	PERRY, JOHN L MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64394	N/A	N/A	N/A	N/A	N/A	150 W 7TH STREET	None	SAN PEDRO	CA	90731	3320	00	06000	33.73786341	-118.2810362	Los Angeles County
332498	Ordering, Referring, Prescribing	N/A	1427105840	0	0	PARRA-SANCHEZ, LUISA D LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44128	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
332513	Ordering, Referring, Prescribing	N/A	1427123678	0	0	PERKINS, JEFFREY A LCSW	8/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75594	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	18TH FLOOR	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
332516	Ordering, Referring, Prescribing	N/A	1427124965	0	0	PATARIAS, ELODIE H LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37581	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
332522	Ordering, Referring, Prescribing	N/A	1427136308	0	0	PHAM, ANH B PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53819	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
332537	Ordering, Referring, Prescribing	N/A	1427184159	0	0	PELC, ELLIE PSYD	1/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26132	N/A	N/A	N/A	N/A	N/A	1710 SCOTT STREET	None	SAN FRANCISCO	CA	94115	3004	00	06000	37.78570982	-122.4382098	San Francisco County
332539	Ordering, Referring, Prescribing	N/A	1427181528	0	0	PANSTER, PETRA PHD	7/12/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21100	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
332557	Ordering, Referring, Prescribing	N/A	1427228337	0	0	PASCA, DARIA A MD	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109438	N/A	N/A	N/A	N/A	N/A	1922 THE ALAMEDA	440	SAN JOSE	CA	95126	1462	00	06000	37.34128547	-121.9236047	Santa Clara County
332574	Ordering, Referring, Prescribing	N/A	1427269422	0	0	POON, HENRY G LMFT	3/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35772	N/A	N/A	N/A	N/A	N/A	845 JACKSON ST	B1	SAN FRANCISCO	CA	94133	4851	00	06000	37.79571919	-122.4089166	San Francisco County
332590	Ordering, Referring, Prescribing	N/A	1427312099	0	0	PAK, JACLYN G	7/15/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D62615	N/A	N/A	N/A	N/A	N/A	2020 J ST	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
332600	Ordering, Referring, Prescribing	N/A	1427320910	0	0	PAZ, SOFIA E LMFT	7/27/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108037	N/A	N/A	N/A	N/A	N/A	3100 ACTIS RD	None	BAKERSFIELD	CA	93309	5911	00	06000	35.326998	-119.052223	Kern County
332624	Ordering, Referring, Prescribing	N/A	1427366749	0	0	PARKER, VANESSA C NP	9/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP20809	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3617	00	06000	37.03080985	-121.5741639	Santa Clara County
332641	Ordering, Referring, Prescribing	N/A	1427407188	0	0	PETRIE, SARAH E DO	1/24/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16147	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
332651	Ordering, Referring, Prescribing	N/A	1427414242	0	0	PFITZER, VICTORIA A LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50018	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD.	SUITE 6	ELK GROVER	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
332655	Ordering, Referring, Prescribing	N/A	1427420694	0	0	PULIDO, LILIANA LCSW	2/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100290	N/A	N/A	N/A	N/A	N/A	301 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
332656	Ordering, Referring, Prescribing	N/A	1427426527	0	0	PORTNEY, HOPE LMFT	10/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119843	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
332671	Ordering, Referring, Prescribing	N/A	1427453166	0	0	PEREZ, CARLOS J PSYD	11/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32196	N/A	N/A	N/A	N/A	N/A	2325 CRENSHAW BLVD	None	TORRANCE	CA	90501	3325	00	06000	33.82457516	-118.3285598	Los Angeles County
332685	Ordering, Referring, Prescribing	N/A	1427466812	0	0	PARK, ANA M PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70080	N/A	N/A	N/A	N/A	N/A	13550 PAXTON ST	None	PACOIMA	CA	91331	2352	00	06000	34.27263559	-118.4275767	Los Angeles County
332704	Ordering, Referring, Prescribing	N/A	1427491232	0	0	PHILLIPS, NATASHA R DO	9/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19028	N/A	N/A	N/A	N/A	N/A	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
332734	Ordering, Referring, Prescribing	N/A	1427538487	0	0	PRESSWOOD, CORLIE W LCSW	1/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113287	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
332762	Ordering, Referring, Prescribing	N/A	1427583848	0	0	POZOLO, CARA G MD	3/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158185	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
332774	Ordering, Referring, Prescribing	N/A	1427602341	0	0	PAGE, JARAE Q LPCC	12/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	15332	N/A	N/A	N/A	N/A	N/A	8787 COMPLEX DR	None	SAN DIEGO	CA	92123	1111	00	06000	32.83008052	-117.138573	San Diego County
332789	Ordering, Referring, Prescribing	N/A	1427631019	0	0	PHAM, JACQUELINE PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83378	N/A	N/A	N/A	N/A	N/A	2620 CHESTER AVE	305	BAKERSFIELD	CA	93301	2015	00	06000	35.383563	-119.018681	Kern County
332802	Ordering, Referring, Prescribing	N/A	1427644541	0	0	POPE, MATTHEW C NP	3/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017165	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	STE 100	CONCORD	CA	94520	7946	00	06000	37.97055112	-122.0492933	Contra Costa County
332837	Ordering, Referring, Prescribing	N/A	1427786789	0	0	PORTILLO, DIANA LMFT	8/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134109	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	192	CULVER CITY	CA	90230	6582	00	06000	33.98900447	-118.37979	Los Angeles County
332871	Ordering, Referring, Prescribing	N/A	1437212461	0	0	PATRICK, VANESSA PA-C	9/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA13210	N/A	N/A	N/A	N/A	N/A	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
332875	Ordering, Referring, Prescribing	N/A	1437212842	0	0	PHILLIPS, MICHAEL D MD	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11953	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
332881	Ordering, Referring, Prescribing	N/A	1437228855	0	0	PETERSEN, VAGN	1/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14222	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
332897	Ordering, Referring, Prescribing	N/A	1437262219	0	0	POPOCA-LOGUE, ANA J NP	11/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12900	N/A	N/A	N/A	N/A	N/A	5555 RESERVOIR DR	STE 204A	SAN DIEGO	CA	92120	5134	00	06000	32.77628471	-117.0563688	San Diego County
332902	Ordering, Referring, Prescribing	N/A	1437273489	0	0	PEREZ, PERLA I LCSW	7/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29516	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
332924	Ordering, Referring, Prescribing	N/A	1437296597	0	0	PATLA, SUSHMA R LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111093	N/A	N/A	N/A	N/A	N/A	800 SCENIC DRIVE	None	MODESTO	CA	95350	1102	00	06000	37.64722447	-120.9836925	Stanislaus County
332945	Ordering, Referring, Prescribing	N/A	1437331899	0	0	PORTER, SHERLYN R LCSW	3/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24690	N/A	N/A	N/A	N/A	N/A	1055 W. HENDERSON	STE. 2	PORTERVILLE	CA	93257	0907	00	06000	36.08036906	-119.0410926	Tulare County
332965	Ordering, Referring, Prescribing	N/A	1437375276	0	0	PEARSON-RAY, EVELYN	8/18/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN561979	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
332968	Ordering, Referring, Prescribing	N/A	1437377942	0	0	PATTERSON, ANNA-MARY	8/6/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0583337	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
332971	Ordering, Referring, Prescribing	N/A	1437381258	0	0	PARADY, ELIZABETH A LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69749	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
332996	Ordering, Referring, Prescribing	N/A	1437430436	0	0	PAW, IRIS PHARMD	8/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45501	N/A	N/A	N/A	N/A	N/A	2801 ADELINE ST	None	BERKELEY	CA	94703	2204	00	06000	37.85820135	-122.2676316	Alameda County
333026	Ordering, Referring, Prescribing	N/A	1437465564	0	0	PEREZ, NADIA S LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93621	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
333038	Ordering, Referring, Prescribing	N/A	1437495900	0	0	PHAN, ANTHONY V LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113233	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	120	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
333066	Ordering, Referring, Prescribing	N/A	1437534310	0	0	PASCHAL, MONIKA LCSW	3/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73510	N/A	N/A	N/A	N/A	N/A	8233 E STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
333080	Ordering, Referring, Prescribing	N/A	1437556453	0	0	PLESSMAN, KELLY J NP	6/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	1365	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
333082	Ordering, Referring, Prescribing	N/A	1437560927	0	0	PATTERSON, LAKIEYA LCSW	4/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101058	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	STE 628	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
333085	Ordering, Referring, Prescribing	N/A	1437563384	0	0	PANDEY, MIA LPCC	1/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC15492	N/A	N/A	N/A	N/A	N/A	2495 W MARCH LN	125	STOCKTON	CA	95207	8251	00	06000	37.98503238	-121.3384819	San Joaquin County
333093	Ordering, Referring, Prescribing	N/A	1437576006	0	0	PHAM, BRYAN T PHARMD	8/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70261	N/A	N/A	N/A	N/A	N/A	34220 MONT	None	PALM DESERT	CA	92211	4134	00	06000	33.78868678	-116.3748442	Riverside County
333133	Ordering, Referring, Prescribing	N/A	1437621216	0	0	PARRA, CHLOE PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69025	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
333146	Ordering, Referring, Prescribing	N/A	1437632544	0	0	PACHECO, CATALINA LMFT	3/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131875	N/A	N/A	N/A	N/A	N/A	2934 E GARVEY AVE S	None	WEST COVINA	CA	91791	2190	00	06000	34.07157499	-117.8836824	Los Angeles County
333150	Ordering, Referring, Prescribing	N/A	1437637527	0	0	PEREZ, ALISON M	10/26/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	102779	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
333201	Ordering, Referring, Prescribing	N/A	1437717402	0	0	PHAM, BRYAN PHARMD	4/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79245	N/A	N/A	N/A	N/A	N/A	303 LOMA DR	SUITE 202	LOS ANGELES	CA	90017	1103	00	06000	34.0595565	-118.2659336	Los Angeles County
333205	Ordering, Referring, Prescribing	N/A	1437718350	0	0	PROTTER, CAROLYN CNM	9/15/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236139	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
333233	Ordering, Referring, Prescribing	N/A	1437796505	0	0	PHUONG, NAM H PHARMD	4/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81432	N/A	N/A	N/A	N/A	N/A	22280 FOOTHILL BLVD	None	HAYWARD	CA	94541	2731	00	06000	37.67922752	-122.0844431	Alameda County
333247	Ordering, Referring, Prescribing	N/A	1437815412	0	0	POWELL, CHAUNISE LCSW	8/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102907	N/A	N/A	N/A	N/A	N/A	1290 RIDDER PARK DR	None	SAN JOSE	CA	95131	2304	00	06000	37.38284451	-121.9009893	Santa Clara County
333295	Ordering, Referring, Prescribing	N/A	1447030960	0	0	POWLEY, KATRINA RN BS	1/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	708407	N/A	N/A	N/A	N/A	N/A	435 HILLCREST AVE	None	PACIFIC GROVE	CA	93950	4900	00	06000	36.61301677	-121.9172845	Monterey County
333335	Ordering, Referring, Prescribing	N/A	1447339353	0	0	PEZOLDT, ANDREA M	8/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D43072	N/A	N/A	N/A	N/A	N/A	198 N G STREET	None	EMPIRE	CA	95319	5132	00	06000	37.64084134	-120.9011164	Stanislaus County
333365	Ordering, Referring, Prescribing	N/A	1447411038	0	0	PLATONI, LEAH R LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49980	N/A	N/A	N/A	N/A	N/A	545 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4611	00	06000	37.72679439	-122.1491972	Alameda County
333366	Ordering, Referring, Prescribing	N/A	1447402151	0	0	PAULSON, LYNDA LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27988	N/A	N/A	N/A	N/A	N/A	10221 S. COMPTON AVENUE	104	LOS ANGELES	CA	90002	2802	00	06000	33.943518	-118.246236	Los Angeles County
333387	Ordering, Referring, Prescribing	N/A	1447470919	0	0	PINKERTON, TONI M LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45577	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
333388	Ordering, Referring, Prescribing	N/A	1447468137	0	0	PATEL, SHREYA M PA-C	2/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA18719	N/A	N/A	N/A	N/A	N/A	1111 W CHASE AVE	None	EL CAJON	CA	92020	5710	00	06000	32.78161035	-116.9764603	San Diego County
333420	Ordering, Referring, Prescribing	N/A	1447532296	0	0	PATTERSON, WENDY LCSW	12/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93493	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	None	SAN PABLO	CA	94806	2714	00	06000	37.95651393	-122.3371491	Contra Costa County
333447	Ordering, Referring, Prescribing	N/A	1447596432	0	0	PIPER, YVONNE M NP	4/16/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23600	N/A	N/A	N/A	N/A	N/A	356 7TH STREET	None	SAN FRANCISCO	CA	94103	4030	00	06000	37.77603792	-122.4069716	San Francisco County
333478	Ordering, Referring, Prescribing	N/A	1447649769	0	0	PHAM, TAI H MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152821	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333479	Ordering, Referring, Prescribing	N/A	1447639380	0	0	PHAM, HUONG Q PHARMD	3/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53301	N/A	N/A	N/A	N/A	N/A	8880 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	00	06000	33.83457051	-118.0271385	Orange County
333488	Ordering, Referring, Prescribing	N/A	1447659750	0	0	PATEL, SHRUTI LMFT	9/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121868	N/A	N/A	N/A	N/A	N/A	21455 BIRCH ST	None	HAYWARD	CA	94541	2165	00	06000	37.68159734	-122.0935159	Alameda County
333521	Ordering, Referring, Prescribing	N/A	1447699327	0	0	PARK-ASPE, JANE H LMFT	11/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91101	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
333547	Ordering, Referring, Prescribing	N/A	1447735048	0	0	PURCELL, GENEVIEVE A NP	11/29/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010499	N/A	N/A	N/A	N/A	N/A	1104 BUCHANAN ROAD	#C10	ANTIOCH	CA	94509	4205	00	06000	37.99867244	-121.823243	Contra Costa County
333548	Ordering, Referring, Prescribing	N/A	1447746169	0	0	PERLOV, JACK MD	3/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G150878	N/A	N/A	N/A	N/A	N/A	4225 EXECUTIVE SQUARE	600	LA JOLLA	CA	92037	1484	00	06000	32.87406185	-117.2156778	San Diego County
333556	Ordering, Referring, Prescribing	N/A	1447765201	0	0	PEREZ, KARINA LMFT	5/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119210	N/A	N/A	N/A	N/A	N/A	10929 SOUTH ST	208B	CERRITOS	CA	90703	9070	00	06000	33.85836353	-118.101204	Los Angeles County
333577	Ordering, Referring, Prescribing	N/A	1447790084	0	0	PRICE, EMBER LMFT	11/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123050	N/A	N/A	N/A	N/A	N/A	7474 EL CAJON BLVD	None	LA MESA	CA	91942	7420	00	06000	32.76850004	-117.036802	San Diego County
333608	Ordering, Referring, Prescribing	N/A	1447876602	0	0	PREVIC, STEPHANIE T NP	9/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022753	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
333618	Ordering, Referring, Prescribing	N/A	1447896493	0	0	PEZNOWSKI, BRIAN S PHARMD	12/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	89133	N/A	N/A	N/A	N/A	N/A	3150 FOSTORIA WAY	None	DANVILLE	CA	94526	5553	00	06000	37.78145555	-121.9725562	Contra Costa County
333681	Ordering, Referring, Prescribing	N/A	1457178279	0	0	PHAM, FELICIA U PHARMD	9/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH90209	N/A	N/A	N/A	N/A	N/A	3970 RIVERMARK PLZ	None	SANTA CLARA	CA	95054	4155	00	06000	37.39481183	-121.9460207	Santa Clara County
333689	Ordering, Referring, Prescribing	N/A	1457327520	0	0	PINEDA, EDUARDO MD	10/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53030	N/A	N/A	N/A	N/A	N/A	820 N MOUNTAIN AVE	108	UPLAND	CA	91786	4163	00	06000	34.10373359	-117.6701283	San Bernardino County
333694	Ordering, Referring, Prescribing	N/A	1457356958	0	0	POWELL, TRACI E MD	1/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C160062	N/A	N/A	N/A	N/A	N/A	1800 MARINA VILLAGE PKWY	100	ALAMEDA	CA	94501	1078	00	06000	37.7849643	-122.2715973	Alameda County
333697	Ordering, Referring, Prescribing	N/A	1457377269	0	0	PARKER, CHARLOTTE LMFT	1/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38765	N/A	N/A	N/A	N/A	N/A	1255 ALLSTON WAY	None	BERKELEY	CA	94702	1833	00	06000	37.86702492	-122.2865918	Alameda County
333728	Ordering, Referring, Prescribing	N/A	1457465247	0	0	PASCUAL, ROSA M OD	5/2/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT10396	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	STE 100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
333742	Ordering, Referring, Prescribing	N/A	1457494734	0	0	POPE, GEORGE D	7/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW15397	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
333756	Ordering, Referring, Prescribing	N/A	1457509689	0	0	PATHAK, SHIRANI LCSW	5/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28153	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
333757	Ordering, Referring, Prescribing	N/A	1457516510	0	0	PATTERSON, JOANNE L NP	2/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	360402	N/A	N/A	N/A	N/A	N/A	205 SOUTH ST	None	FORT BRAGG	CA	95437	5540	00	06000	39.43009931	-123.8032471	Mendocino County
333762	Ordering, Referring, Prescribing	N/A	1457528440	0	0	PERSAUD, PRIA MD	10/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117322	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
333852	Ordering, Referring, Prescribing	N/A	1457707929	0	0	PHILLIPS, IRVING J MD	2/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167811	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
333882	Ordering, Referring, Prescribing	N/A	1457767303	0	0	PETTY, MCCANDLESS	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90144	N/A	N/A	N/A	N/A	N/A	815 HYDE STREET	100	SAN FRANCISCO	CA	94109	3810	00	06000	37.78855	-122.416917	San Francisco County
333892	Ordering, Referring, Prescribing	N/A	1457774192	0	0	POTENTE, ANTHONY P	6/30/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D40186	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
333908	Ordering, Referring, Prescribing	N/A	1457790016	0	0	PAZ, BELINDA	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	51778	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
333909	Ordering, Referring, Prescribing	N/A	1457792947	0	0	PEREZ, LAURA A	10/4/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0744817	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	2620	00	06000	34.0900257	-118.2916693	Los Angeles County
333910	Ordering, Referring, Prescribing	N/A	1457798233	0	0	POONI, RAJDEEP K MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134346	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
333922	Ordering, Referring, Prescribing	N/A	1457808958	0	0	PEACE, SARAH LPCC	11/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC9863	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
333929	Ordering, Referring, Prescribing	N/A	1457822512	0	0	PLUSS, AJ PT	11/28/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	296057	N/A	N/A	N/A	N/A	N/A	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
333961	Ordering, Referring, Prescribing	N/A	1457858144	0	0	PHAM, ANDREW PHARMD	2/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	79307	N/A	N/A	N/A	N/A	N/A	2121 N D ST	None	SAN BERNARDINO	CA	92405	3915	00	06000	34.13517012	-117.2918777	San Bernardino County
333978	Ordering, Referring, Prescribing	N/A	1457880569	0	0	PHAM, JENNIFER S	9/10/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	103096	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
333986	Ordering, Referring, Prescribing	N/A	1457891673	0	0	PARRISH, SARAH NP	7/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005919	N/A	N/A	N/A	N/A	N/A	1735 JEFFERSON ST	None	NAPA	CA	94559	1702	00	06000	38.30356022	-122.2943872	Napa County
333995	Ordering, Referring, Prescribing	N/A	1457903726	0	0	PARK, JOY PA-C	7/26/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57054	N/A	N/A	N/A	N/A	N/A	12124 BULLIS RD	None	LYNWOOD	CA	90262	5106	00	06000	33.91614168	-118.2044211	Los Angeles County
334060	Ordering, Referring, Prescribing	N/A	1467050146	0	0	PARENTI, ABIGAIL J LMFT	4/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146344	N/A	N/A	N/A	N/A	N/A	9837 FOLSOM BLVD	F	SACRAMENTO	CA	95827	0000	00	06000	38.575764	-121.330647	Sacramento County
334078	Ordering, Referring, Prescribing	N/A	1467082677	0	0	PHAM, KIANA K	1/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57735	N/A	N/A	N/A	N/A	N/A	7060 N RECREATION AVE	None	FRESNO	CA	93720	8022	00	06000	36.8388	-119.7404335	Fresno County
334104	Ordering, Referring, Prescribing	N/A	1467150524	0	0	PATEL, SONIA J NP	8/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022326	N/A	N/A	N/A	N/A	N/A	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	00	06000	34.05710805	-118.2782502	Los Angeles County
334115	Ordering, Referring, Prescribing	N/A	1467209569	0	0	PICCIOTTO, NICOLE MD	8/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15854	N/A	N/A	N/A	N/A	N/A	4601 DALE ROAD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
334141	Ordering, Referring, Prescribing	N/A	1467466581	0	0	POWELL, JAMES R MD	6/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	C196846	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
334179	Ordering, Referring, Prescribing	N/A	1467590158	0	0	PROVENCIO, AUGUSTINE N MD	4/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48099	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
334190	Ordering, Referring, Prescribing	N/A	1467616151	0	0	PEREZ, VANESSA C PHD	2/15/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24925	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
334205	Ordering, Referring, Prescribing	N/A	1467617910	0	0	PEREZ, HANNAH L PSYD	4/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25961	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD, MS#53	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
334207	Ordering, Referring, Prescribing	N/A	1467649848	0	0	PARADA, EVELYN J LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81009	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	101	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
334231	Ordering, Referring, Prescribing	N/A	1467701151	0	0	PRECIADO ROMERO, PAULA V LCSW	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100836	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	STE D	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
334237	Ordering, Referring, Prescribing	N/A	1467714774	0	0	PEARSON, JENNIFER C LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112213	N/A	N/A	N/A	N/A	N/A	190 E HACKETT RD	None	MODESTO	CA	95358	9450	00	06000	37.58759858	-120.9911422	Stanislaus County
334244	Ordering, Referring, Prescribing	N/A	1467726604	0	0	PEJORO, EDRICK C	1/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	PA22130	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
334275	Ordering, Referring, Prescribing	N/A	1467778530	0	0	PENMAN, MARTA A	12/18/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D46363	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
334278	Ordering, Referring, Prescribing	N/A	1467786970	0	0	PERAZA, MARISSA LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99011	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 400	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
334288	Ordering, Referring, Prescribing	N/A	1467798223	0	0	POWERS, DANAE LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52528	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
334368	Ordering, Referring, Prescribing	N/A	1467896183	0	0	PATEL, KAJAL P MD	3/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133788	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
334381	Ordering, Referring, Prescribing	N/A	1467918946	0	0	PADILLA-VALDIVIA, EDGAR PA-C	12/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60449	N/A	N/A	N/A	N/A	N/A	4770 N CEDAR AVE	None	FRESNO	CA	93726	1065	00	06000	36.804717	-119.754103	Fresno County
334393	Ordering, Referring, Prescribing	N/A	1467942060	0	0	PASALLO, CINTHYA I LMFT	6/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133469	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE STE 10	STE 107	NEWPORT BEACH	CA	92663	3307	00	06000	33.62631386	-117.9310576	Orange County
334414	Ordering, Referring, Prescribing	N/A	1467966424	0	0	PAVLIK, KATHY LMFT	9/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124924	N/A	N/A	N/A	N/A	N/A	5905 SOQUEL DRIVE	550	SOQUEL	CA	95073	2861	00	06000	36.98881452	-121.9364193	Santa Cruz County
334437	Ordering, Referring, Prescribing	N/A	1477000149	0	0	PEREZ, NICOLE L LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113620	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	STE 150	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
334439	Ordering, Referring, Prescribing	N/A	1477000875	0	0	PASTOR, DARA D LCSW	3/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101029	N/A	N/A	N/A	N/A	N/A	3780 ROSIN CT	110	SACRAMENTO	CA	95834	1646	00	06000	38.636478	-121.473081	Sacramento County
334464	Ordering, Referring, Prescribing	N/A	1477015113	0	0	PEREZ, HANNA S LCSW	3/29/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107480	N/A	N/A	N/A	N/A	N/A	740 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	00	06000	34.06657391	-118.4451279	Los Angeles County
334465	Ordering, Referring, Prescribing	N/A	1477049831	0	0	PHILLIPS, TAMMIE NP	9/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	632216	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
334466	Ordering, Referring, Prescribing	N/A	1477058329	0	0	PADUA, ILYSSA N NP	1/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008381	N/A	N/A	N/A	N/A	N/A	5440 THORNWOOD DRIVE	SUITE G	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
334482	Ordering, Referring, Prescribing	N/A	1477090793	0	0	PARAYNO, MERILYN NP	1/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005925	N/A	N/A	N/A	N/A	N/A	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	0000	00	06000	33.808185	-118.1850575	Los Angeles County
334506	Ordering, Referring, Prescribing	N/A	1477131258	0	0	PHAN, DAVID H MD	10/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191599	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
334544	Ordering, Referring, Prescribing	N/A	1477223253	0	0	PATEL, PARESHKUMAR N PHARMD	3/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74869	N/A	N/A	N/A	N/A	N/A	1701 E CESAR E CHAVEZ AV	109	LOS ANGELES	CA	90033	2496	00	06000	34.05112725	-118.2173921	Los Angeles County
334545	Ordering, Referring, Prescribing	N/A	1477225399	0	0	PATEL, SEAN PHARMD	10/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	80420	N/A	N/A	N/A	N/A	N/A	1180 E CARSON STREET	None	LONG BEACH	CA	90807	3662	00	06000	33.8324105	-118.177101	Los Angeles County
334550	Ordering, Referring, Prescribing	N/A	1477247427	0	0	PHAM, JULLIANNE	10/30/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65349	N/A	N/A	N/A	N/A	N/A	1441 N TRACY BLVD	None	TRACY	CA	95376	3445	00	06000	37.744731	-121.4350375	San Joaquin County
334578	Ordering, Referring, Prescribing	N/A	1477532034	0	0	PETERSON, MARLA J	5/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	16472	N/A	N/A	N/A	N/A	N/A	2440 W TAHOE AVE	None	CARUTHERS	CA	93609	9476	00	06000	36.54046763	-119.83553	Fresno County
334581	Ordering, Referring, Prescribing	N/A	1477537942	0	0	PEQUENO, JUAN C MD	2/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61571	N/A	N/A	N/A	N/A	N/A	1600 BAILEY AVE.	SUITE 2	NEEDLES	CA	92363	3105	00	06000	34.830963	-114.6183555	San Bernardino County
334588	Ordering, Referring, Prescribing	N/A	1477562320	0	0	POLITANO, MONICA M LMFT	3/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53634	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	None	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
334615	Ordering, Referring, Prescribing	N/A	1477616746	0	0	PEREZ, JUDI A OD	12/1/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13210	N/A	N/A	N/A	N/A	N/A	374 EAST H STREET	None	CHULA VISTA	CA	91910	7484	00	06000	32.64037799	-117.0489675	San Diego County
334628	Ordering, Referring, Prescribing	N/A	1477638492	0	0	PLOSS, DAVID R	11/19/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G66128	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE A	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
334636	Ordering, Referring, Prescribing	N/A	1477656395	0	0	PHAN, DENISE A MD	1/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73973	N/A	N/A	N/A	N/A	N/A	15243 VANOWEN STREET	101	VAN NUYS	CA	91405	3636	00	06000	34.19394848	-118.4654115	Los Angeles County
334662	Ordering, Referring, Prescribing	N/A	1477712081	0	0	PARK, GUN HWA LAC	9/10/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC12502	N/A	N/A	N/A	N/A	N/A	4020 BIRCH ST. SUITE 107	None	NEWPORT BEACH	CA	92660	2225	00	06000	33.66504408	-117.8694436	Orange County
334671	Ordering, Referring, Prescribing	N/A	1477741619	0	0	PACE, MELISSA M LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50445	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BLVD	None	EL MONTE	CA	91731	3229	00	06000	34.06953065	-118.0288485	Los Angeles County
334676	Ordering, Referring, Prescribing	N/A	1477744498	0	0	PABBATHI, SABITHA R MD	5/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C158466	N/A	N/A	N/A	N/A	N/A	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
334719	Ordering, Referring, Prescribing	N/A	1477827186	0	0	PATEL, RAJESHKUMAR B	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47301	N/A	N/A	N/A	N/A	N/A	11121 SIERRA AVE	None	FONTANA	CA	92337	9310	00	06000	34.05159204	-117.4353952	San Bernardino County
334725	Ordering, Referring, Prescribing	N/A	1477836542	0	0	POUPA, DENISE PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63233	N/A	N/A	N/A	N/A	N/A	2177 SUNSET BLVD	None	ROCKLIN	CA	95765	5397	00	06000	38.80527905	-121.2731306	Placer County
334732	Ordering, Referring, Prescribing	N/A	1477841625	0	0	POLIDO, DAISY LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43951	N/A	N/A	N/A	N/A	N/A	2130 N. VENTURA RD	None	OXNARD	CA	93036	2246	00	06000	34.22414993	-119.1944701	Ventura County
334736	Ordering, Referring, Prescribing	N/A	1477841666	0	0	PONCE, JENNIFER D LCSW	4/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71775	N/A	N/A	N/A	N/A	N/A	950 W D ST	None	ONTARIO	CA	91762	3026	00	06000	34.067304	-117.667098	San Bernardino County
334740	Ordering, Referring, Prescribing	N/A	1477846483	0	0	PANAMENO, KARLA M LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80416	N/A	N/A	N/A	N/A	N/A	600 S COMMONWEALTH AVE	2ND FLOOR	LOS ANGELES	CA	90005	4001	00	06000	34.06328086	-118.2856343	Los Angeles County
334742	Ordering, Referring, Prescribing	N/A	1477853406	0	0	PATEL, HEMA	1/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46868	N/A	N/A	N/A	N/A	N/A	5450 DEWEY DR	None	FAIR OAKS	CA	95628	3138	00	06000	38.665161	-121.3070985	Sacramento County
334752	Ordering, Referring, Prescribing	N/A	1477874428	0	0	POESSY, GLORIA LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75047	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
334770	Ordering, Referring, Prescribing	N/A	1477900645	0	0	PADALINSKI, CHRISTOPHER PSYD	2/13/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24177	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
334800	Ordering, Referring, Prescribing	N/A	1477953834	0	0	PETRUZZI, DINO LMFT	7/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119985	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
334801	Ordering, Referring, Prescribing	N/A	1477958791	0	0	PHAM, JENNIFER T PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71069	N/A	N/A	N/A	N/A	N/A	2802 AGUA VISTA DR	None	SAN JOSE	CA	95132	2205	00	06000	37.39860879	-121.8680235	Santa Clara County
334805	Ordering, Referring, Prescribing	N/A	1477959286	0	0	POOL, JULIE LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28247	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	300	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
334845	Ordering, Referring, Prescribing	N/A	1487019584	0	0	PAPAIE, SAMAR LCSW	5/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101411	N/A	N/A	N/A	N/A	N/A	3551 CAMINO MIRA COSTA	T	SAN CLEMENTE	CA	92672	3508	00	06000	33.45549271	-117.6566925	Orange County
334859	Ordering, Referring, Prescribing	N/A	1487035234	0	0	PARRA JAIMES, ALEJANDRA Y LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119837	N/A	N/A	N/A	N/A	N/A	209 E 7TH ST	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
334863	Ordering, Referring, Prescribing	N/A	1487043261	0	0	PHAN, THU A PHARMD	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	72011	N/A	N/A	N/A	N/A	N/A	7201 BOULDER AVE	None	HIGHLAND	CA	92346	3313	00	06000	34.123842	-117.1953945	San Bernardino County
334893	Ordering, Referring, Prescribing	N/A	1487070579	0	0	PARKS, MIRIAM LMFT	2/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105927	N/A	N/A	N/A	N/A	N/A	433 SALINAS STREET	None	SALINAS	CA	93906	8361	00	06000	36.6706468	-121.6557178	Monterey County
334910	Ordering, Referring, Prescribing	N/A	1487105029	0	0	PATEL, ALKESHKUMAR R PHARMD	2/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	75255	N/A	N/A	N/A	N/A	N/A	331 MAIN ST	None	SALINAS	CA	93901	2705	00	06000	36.67295657	-121.6546689	Monterey County
334918	Ordering, Referring, Prescribing	N/A	1487112371	0	0	PAK, REBECCA A CNP	10/15/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010977	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	STE. 110	MISSION VIEJO	CA	92691	6408	00	06000	33.55952733	-117.6645199	Orange County
334920	Ordering, Referring, Prescribing	N/A	1487079307	0	0	PALACIO-SALAZAR, ELIANA	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97273	N/A	N/A	N/A	N/A	N/A	6736 LAUREL CANYON BOULE	STE 200	LOS ANGELES	CA	91606	1538	00	06000	34.193493	-118.3964925	Los Angeles County
334927	Ordering, Referring, Prescribing	N/A	1487126736	0	0	PATTON, HEATHER H CNP	2/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011149	N/A	N/A	N/A	N/A	N/A	721 S 28TH ST	None	SAN DIEGO	CA	92113	0000	00	06000	32.69810788	-117.1337595	San Diego County
335003	Ordering, Referring, Prescribing	N/A	1487248126	0	0	PARK, AMOS	4/14/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC19021	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
335011	Ordering, Referring, Prescribing	N/A	1487267936	0	0	PATTON, CHRISTOPHER J PSYD	4/29/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35020	N/A	N/A	N/A	N/A	N/A	3939 ATLANTIC AVE	103	LONG BEACH	CA	90807	3536	00	06000	33.830073	-118.1851065	Los Angeles County
335074	Ordering, Referring, Prescribing	N/A	1487623468	0	0	PASTIS, LOUIS S DC	1/27/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC25915	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
335091	Ordering, Referring, Prescribing	N/A	1487700829	0	0	PAUL, JANE S LMFT	3/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT25754	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY, #207	None	SANTA ROSA	CA	95407	5478	00	06000	38.425248	-122.75019	Sonoma County
335092	Ordering, Referring, Prescribing	N/A	1487707089	0	0	PHAM-TRUONG, GIAO PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45528	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
335107	Ordering, Referring, Prescribing	N/A	1487725032	0	0	PERKINS, BRETT W	8/8/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	7653	N/A	N/A	N/A	N/A	N/A	118 MAIN STREET	None	PLACERVILLE	CA	95667	5508	00	06000	38.72750767	-120.8058005	El Dorado County
335120	Ordering, Referring, Prescribing	N/A	1487754909	0	0	PIGFORD, JEAN A	5/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	13426	N/A	N/A	N/A	N/A	N/A	810 E D ST	None	LEMOORE	CA	93245	9545	00	06000	36.30069303	-119.7694815	Kings County
335153	Ordering, Referring, Prescribing	N/A	1487803334	0	0	PORTUGES, RAFAEL C LMFT	2/28/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104907	N/A	N/A	N/A	N/A	N/A	1025 ATLANTIC AVE	STE 101	ALAMEDA	CA	94501	1189	00	06000	37.78071789	-122.2658953	Alameda County
335178	Ordering, Referring, Prescribing	N/A	1487886594	0	0	PHAM, TU TRINH T DDS	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59266	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE	STE 202	NEWPORT BEACH	CA	92663	3308	00	06000	33.62631386	-117.9310576	Orange County
335192	Ordering, Referring, Prescribing	N/A	1487901864	0	0	PEREZ, YVETTE LMFT	10/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121685	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92108	4711	00	06000	32.77025942	-117.2017196	San Diego County
335207	Ordering, Referring, Prescribing	N/A	1487940755	0	0	PORTILLO, ROGER A LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87707	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD.,	FIRST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
335246	Ordering, Referring, Prescribing	N/A	1497004196	0	0	PENA, SANDRA LMFT	10/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128977	N/A	N/A	N/A	N/A	N/A	566 S BRAND BLVD	None	SAN FERNANDO	CA	91340	4002	00	06000	34.27861303	-118.4437412	Los Angeles County
335251	Ordering, Referring, Prescribing	N/A	1487979019	0	0	PRIETO, LISA L LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110097	N/A	N/A	N/A	N/A	N/A	1908 S BUSINESS CENTER D	#220	SAN BERNARDINO	CA	92408	3436	00	06000	34.06732096	-117.2801085	San Bernardino County
335257	Ordering, Referring, Prescribing	N/A	1497019558	0	0	PEREZ, MARK A LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91261	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
335258	Ordering, Referring, Prescribing	N/A	1497018196	0	0	PARAMESWARAN, SHANTHA M MD	1/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127743	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
335264	Ordering, Referring, Prescribing	N/A	1497031793	0	0	PONCE, JESSICA MSW LCSW	2/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79843	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD.	#102	VAN NUYS	CA	91405	3937	00	06000	34.19649	-118.448787	Los Angeles County
335269	Ordering, Referring, Prescribing	N/A	1497034854	0	0	PANTOJA, MARCO LMFT	9/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101296	N/A	N/A	N/A	N/A	N/A	2129 E. TULARE AVE.	SUITE C	TULARE	CA	93274	3104	00	06000	36.21114018	-119.3142009	Tulare County
335285	Ordering, Referring, Prescribing	N/A	1497056493	0	0	PATTERSON, RODNEY PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	36989	N/A	N/A	N/A	N/A	N/A	1235 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4121	00	06000	33.99993979	-117.811849	Los Angeles County
335302	Ordering, Referring, Prescribing	N/A	1497092993	0	0	PALACIOS, DENICE LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85139	N/A	N/A	N/A	N/A	N/A	2080 S E ST	250	SAN BERNARDINO	CA	92408	2773	00	06000	34.06448311	-117.2895975	San Bernardino County
335312	Ordering, Referring, Prescribing	N/A	1497113062	0	0	PHORTH, AMY DDS	4/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	100617	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
335316	Ordering, Referring, Prescribing	N/A	1497114458	0	0	PANNU, JASMEET S	12/18/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101737	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
335318	Ordering, Referring, Prescribing	N/A	1497114672	0	0	PATEL, KAYLA NP	9/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015382	N/A	N/A	N/A	N/A	N/A	744 EMPIRE ST	None	FAIRFIELD	CA	94533	5562	00	06000	38.2503715	-122.0429115	Solano County
335342	Ordering, Referring, Prescribing	N/A	1497139158	0	0	PANCHENKO, NATALIYA LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92485	N/A	N/A	N/A	N/A	N/A	3801 3RD ST	SUITE 620	SAN FRANCISCO	CA	93510	0000	00	06000	37.74208019	-122.3880422	San Francisco County
335359	Ordering, Referring, Prescribing	N/A	1497182323	0	0	PATTERSON-HALL, KELSEY	2/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85145	N/A	N/A	N/A	N/A	N/A	2060 CHALLENGER DR	None	ALAMEDA	CA	94501	1037	00	06000	37.78172881	-122.2710941	Alameda County
335371	Ordering, Referring, Prescribing	N/A	1497197503	0	0	PHONSURIN, ALICIA LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71173	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
335383	Ordering, Referring, Prescribing	N/A	1497215354	0	0	PATRICKTHOMPSON, MEGAN A PHD	1/24/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31035	N/A	N/A	N/A	N/A	N/A	536 W VISTA WAY	None	VISTA	CA	92083	5704	00	06000	33.19623486	-117.2520526	San Diego County
335413	Ordering, Referring, Prescribing	N/A	1497269757	0	0	PAL, JAI PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77083	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
335429	Ordering, Referring, Prescribing	N/A	1497294508	0	0	PATEL, PETER PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45777	N/A	N/A	N/A	N/A	N/A	12400 BLOOMFIELD AVE	None	SANTA FE SPRINGS	CA	90670	4750	00	06000	33.91872688	-118.0638495	Los Angeles County
335430	Ordering, Referring, Prescribing	N/A	1497303358	0	0	PELAYO PRECIADO, RUBI LCSW	3/31/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115795	N/A	N/A	N/A	N/A	N/A	1272 HAYES ST	None	NAPA	CA	94559	1711	00	06000	38.30442969	-122.2936442	Napa County
335460	Ordering, Referring, Prescribing	N/A	1497369839	0	0	PEREZ, MICAH LPCC	11/24/2024	Taxonomy not applicable	NA	n/a	000	Unknown	18057	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
335475	Ordering, Referring, Prescribing	N/A	1497395271	0	0	PHAM, AN H	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81106	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	None	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
335490	Ordering, Referring, Prescribing	N/A	1497418198	0	0	PAN, RONALD NP	12/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023673	N/A	N/A	N/A	N/A	N/A	1955 LONG BEACH BLVD	None	LONG BEACH	CA	90806	5501	00	06000	33.79290697	-118.1895017	Los Angeles County
335500	Ordering, Referring, Prescribing	N/A	1497452668	0	0	PENAFLORIDA, CHRISTINE NP	1/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024091	N/A	N/A	N/A	N/A	N/A	809 SOUTH MAIN STREET	STE A	SANTA ANA	CA	92701	6605	00	06000	33.73791434	-117.8676848	Orange County
335533	Ordering, Referring, Prescribing	N/A	1497787865	0	0	PRESTON, KIM U LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48216	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ ROAD	230	MISSION VIEJO	CA	92691	5319	00	06000	33.60038172	-117.6735855	Orange County
335605	Ordering, Referring, Prescribing	N/A	1497943997	0	0	PEERMAHOMED, SHERBANOO A MD	1/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A34293	N/A	N/A	N/A	N/A	N/A	18111 NORDHOFF STREET	None	NORTHRIDGE	CA	91330	8270	00	06000	34.239213	-118.527768	Los Angeles County
335628	Ordering, Referring, Prescribing	N/A	1508008459	0	0	PONT, JORDAN LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77129	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN STREET	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
335644	Ordering, Referring, Prescribing	N/A	1508047614	0	0	PRESTON, SCOTT R PHARMD	5/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	39869	N/A	N/A	N/A	N/A	N/A	1017 ELLINGTON ST	None	DELANO	CA	93215	2621	00	06000	35.76891908	-119.2515219	Kern County
335652	Ordering, Referring, Prescribing	N/A	1508064056	0	0	PAK, SOPHIA	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61546	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
335680	Ordering, Referring, Prescribing	N/A	1508134701	0	0	PHAM, HEIDI T PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58980	N/A	N/A	N/A	N/A	N/A	82900 AVE 42	None	INDIO	CA	92201	2203	00	06000	33.74414625	-116.2174036	Riverside County
335683	Ordering, Referring, Prescribing	N/A	1508140583	0	0	PONTING, GEOFFREY A	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66127	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
335702	Ordering, Referring, Prescribing	N/A	1508160508	0	0	PETERSON, BRITTANY LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109074	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	150	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
335708	Ordering, Referring, Prescribing	N/A	1508167214	0	0	PHAM, STEPHANIE	4/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53053	N/A	N/A	N/A	N/A	N/A	4520 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6057	00	06000	34.09811411	-118.2879528	Los Angeles County
335749	Ordering, Referring, Prescribing	N/A	1508240466	0	0	PHAM, ANTHONY	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73110	N/A	N/A	N/A	N/A	N/A	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
335783	Ordering, Referring, Prescribing	N/A	1508285040	0	0	PINA, JESSICA LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101452	N/A	N/A	N/A	N/A	N/A	525 CABRILLO PARK DRIVE	300	SANTA ANA	CA	92701	0000	00	06000	33.75047365	-117.8404984	Orange County
335795	Ordering, Referring, Prescribing	N/A	1508310673	0	0	PARK, ELLEN	10/17/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	100651	N/A	N/A	N/A	N/A	N/A	250 S G STREET	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
335799	Ordering, Referring, Prescribing	N/A	1508320185	0	0	PACINO, KATY L LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115999	N/A	N/A	N/A	N/A	N/A	2403 KEITH ST	None	SAN FRANCISCO	CA	94124	3231	00	06000	37.7261274	-122.3922206	San Francisco County
335806	Ordering, Referring, Prescribing	N/A	1508331596	0	0	PATEL, PRATIK K PHARMD	1/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77662	N/A	N/A	N/A	N/A	N/A	5450 DEWEY DR	None	FAIR OAKS	CA	95628	3138	00	06000	38.665161	-121.3070985	Sacramento County
335857	Ordering, Referring, Prescribing	N/A	1508407479	0	0	PORTER, ALEXANDER LMFT	5/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146909	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	None	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
335878	Ordering, Referring, Prescribing	N/A	1508459496	0	0	PASTERNAK, ANNA R NP	9/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95225835	N/A	N/A	N/A	N/A	N/A	1963 4TH AVE	None	SAN DIEGO	CA	92101	2394	00	06000	32.72572745	-117.1608615	San Diego County
335884	Ordering, Referring, Prescribing	N/A	1508477183	0	0	PHAM, YVONNE H PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82944	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
335919	Ordering, Referring, Prescribing	N/A	1508579749	0	0	PACHECO-SPITZ, REBECCA LCSW	10/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111474	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
335932	Ordering, Referring, Prescribing	N/A	1508622549	0	0	PAHARIK, GLADYS NP	9/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032367	N/A	N/A	N/A	N/A	N/A	12598 CENTRAL AVE	219	CHINO	CA	91710	3502	00	06000	34.02430506	-117.6894721	San Bernardino County
335951	Ordering, Referring, Prescribing	N/A	1508837352	0	0	PAUL, PETER C MD	5/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40030	N/A	N/A	N/A	N/A	N/A	1890 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4831	00	06000	34.132275	-117.278797	San Bernardino County
335957	Ordering, Referring, Prescribing	N/A	1508848714	0	0	PORQUEZ, MARY J NP	2/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17206	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
335958	Ordering, Referring, Prescribing	N/A	1508875055	0	0	PIKE, ELAINE LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45258	N/A	N/A	N/A	N/A	N/A	1300 WEST LODI AVE	STE G2	LODI	CA	95242	3037	00	06000	38.13001447	-121.289931	San Joaquin County
335979	Ordering, Referring, Prescribing	N/A	1508924507	0	0	PRASAD, NALEEN L DPM	11/27/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4699	N/A	N/A	N/A	N/A	N/A	19845 LAKE CHABOT RD	301	CASTRO VALLEY	CA	94546	4055	00	06000	37.69995352	-122.087795	Alameda County
335998	Ordering, Referring, Prescribing	N/A	1508981168	0	0	PETERSON, RICHARD S LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39664	N/A	N/A	N/A	N/A	N/A	137 CENTRAL AVE.	SUITE 5-E	SALINAS	CA	93901	2656	00	06000	36.67635608	-121.6593534	Monterey County
335999	Ordering, Referring, Prescribing	N/A	1508982554	0	0	PONEC, CHRISTINE M LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40337	N/A	N/A	N/A	N/A	N/A	27200 TOURNEY RD	175	VALENCIA	CA	91355	4990	00	06000	34.41656755	-118.5763161	Los Angeles County
336013	Ordering, Referring, Prescribing	N/A	1508999855	0	0	PATEL, YATIN MD	3/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78614	N/A	N/A	N/A	N/A	N/A	450 BAUCHET ST	None	LOS ANGELES	CA	90012	2907	00	06000	34.05925347	-118.230941	Los Angeles County
336065	Ordering, Referring, Prescribing	N/A	1518090018	0	0	PALACIOS, MARIO LMFT	7/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46078	N/A	N/A	N/A	N/A	N/A	5556 S CENTINELA AVE	None	LOS ANGELES	CA	90066	6912	00	06000	33.98176635	-118.4096349	Los Angeles County
336066	Ordering, Referring, Prescribing	N/A	1518096254	0	0	PEREZ-MARTIN, MARISA LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43997	N/A	N/A	N/A	N/A	N/A	1411 N. GRAND AVE.	None	COVINA	CA	91724	1001	00	06000	34.105149	-117.87435	Los Angeles County
336084	Ordering, Referring, Prescribing	N/A	1518127620	0	0	PATEL, SHAILESH M DO	4/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20654	N/A	N/A	N/A	N/A	N/A	4250 BETHEL ROAD	None	OLIVE BRANCH	MS	38654	8737	00	06000	34.92312605	-89.79484152	DeSoto County
336097	Ordering, Referring, Prescribing	N/A	1518154434	0	0	PAREKH, GIRA B PHARMD	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54653	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
336103	Ordering, Referring, Prescribing	N/A	1518163609	0	0	PANBEHI, BAHRAM	3/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C165357	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	STE 210	EL CAJON	CA	92021	7417	00	06000	32.80772549	-116.94771	San Diego County
336120	Ordering, Referring, Prescribing	N/A	1518198373	0	0	PADILLA, MARISOL LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70210	N/A	N/A	N/A	N/A	N/A	3282 ADELINE ST	None	BERKELEY	CA	94703	2439	00	06000	37.84898491	-122.2715711	Alameda County
336144	Ordering, Referring, Prescribing	N/A	1518249275	0	0	PATEL, CHANDRIKA B PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52280	N/A	N/A	N/A	N/A	N/A	3009 BROADWAY	None	OAKLAND	CA	94611	0213	00	06000	37.81907291	-122.2621457	Alameda County
336191	Ordering, Referring, Prescribing	N/A	1518341833	0	0	PAGE, THEMA S LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29626	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	STE 125 D	OAKLAND	CA	94605	2424	00	06000	37.768221	-122.17608	Alameda County
336209	Ordering, Referring, Prescribing	N/A	1518361815	0	0	PATINO-AYALA, MONICA A LMFT	8/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112421	N/A	N/A	N/A	N/A	N/A	47950 DUNE PALMS RD	None	LA QUINTA	CA	92253	4000	00	06000	33.70220565	-116.2774057	Riverside County
336228	Ordering, Referring, Prescribing	N/A	1518390558	0	0	PORTILLO, BEVERLY LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98912	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
336246	Ordering, Referring, Prescribing	N/A	1518412014	0	0	PATEL, TAPAN PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74789	N/A	N/A	N/A	N/A	N/A	4234 RIVERWALK PKWY	STE 130	RIVERSIDE	CA	92505	3304	00	06000	33.90290859	-117.4941562	Riverside County
336248	Ordering, Referring, Prescribing	N/A	1518415546	0	0	PARADA, JACQUELINE M CNP	6/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	746414	N/A	N/A	N/A	N/A	N/A	1860 MOWRY AVE	None	FREMONT	CA	94538	1730	00	06000	37.55887933	-121.9797796	Alameda County
336253	Ordering, Referring, Prescribing	N/A	1518422252	0	0	PARSONS, ADRIANA T NP	9/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018539	N/A	N/A	N/A	N/A	N/A	4000 S. ROSE AVE	STUDENT HEATLH CENTER	OXNARD	CA	93033	6699	00	06000	34.16469604	-119.1593294	Ventura County
336301	Ordering, Referring, Prescribing	N/A	1518522341	0	0	PANDIAN, ELIZABETH MD	5/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178764	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
336322	Ordering, Referring, Prescribing	N/A	1518572999	0	0	PURNER, JESSICA LCSW	9/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125763	N/A	N/A	N/A	N/A	N/A	11601 S. WESTERN AVENUE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
336356	Ordering, Referring, Prescribing	N/A	1518700418	0	0	PERSAD, SAJNI NP	9/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032102	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
336357	Ordering, Referring, Prescribing	N/A	1518717222	0	0	PATEL, SHAILI J MD MPH	8/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL15358	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
336364	Ordering, Referring, Prescribing	N/A	1518792548	0	0	PEARSON, EMILY B NP	9/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95032043	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE.	SUITE 302	LONG BEACH	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles County
336366	Ordering, Referring, Prescribing	N/A	1518792837	0	0	PEREZ ZUNIGA, JOSE E NP	5/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95030203	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST.	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
336389	Ordering, Referring, Prescribing	N/A	1528049608	0	0	PRATTY, JAMES S MD	2/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A41409	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE	250	TORRANCE	CA	90501	1708	00	06000	33.83886841	-118.3093605	Los Angeles County
336394	Ordering, Referring, Prescribing	N/A	1528072402	0	0	POTTER, GLENN M LMFT	1/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT25774	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
336406	Ordering, Referring, Prescribing	N/A	1528121357	0	0	PEREIRA, VALERIA R	6/23/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D47987	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
336418	Ordering, Referring, Prescribing	N/A	1528048899	0	0	PARONIAN, OGANES MD	8/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54463	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
336436	Ordering, Referring, Prescribing	N/A	1528192937	0	0	PAYNE, TROY LMFT	12/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81535	N/A	N/A	N/A	N/A	N/A	3161 DWIGHT RD	None	ELK GROVE	CA	95758	6456	00	06000	38.427372	-121.4606025	Sacramento County
336439	Ordering, Referring, Prescribing	N/A	1528197647	0	0	PATEL, BIPIN L MD	3/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A46654	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 220	MISSION VIJEO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
336452	Ordering, Referring, Prescribing	N/A	1528229671	0	0	PLAXTON-HENNINGS, CHARITY A PSYD	10/2/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20627	N/A	N/A	N/A	N/A	N/A	47-950 DUNE PALMS ROAD	None	LA QUINTA	CA	92253	7991	00	06000	33.71421874	-116.2774852	Riverside County
336453	Ordering, Referring, Prescribing	N/A	1528241916	0	0	POMEROY, ROXANA C	10/18/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D41097	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BOULEVARD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
336467	Ordering, Referring, Prescribing	N/A	1528275021	0	0	PHAM, KIM T DMD	7/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55500	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	None	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
336486	Ordering, Referring, Prescribing	N/A	1528302734	0	0	PECIULIS, ALEXIS E LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106170	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	SUITE 150	OAKLAND	CA	94621	2027	00	06000	37.74106765	-122.2051051	Alameda County
336505	Ordering, Referring, Prescribing	N/A	1528336039	0	0	PARK, MICHELLE HYUN JOO PHARMD	7/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52127	N/A	N/A	N/A	N/A	N/A	22930 S WESTERN AVE	None	TORRANCE	CA	90501	0000	00	06000	33.81746045	-118.3087871	Los Angeles County
336514	Ordering, Referring, Prescribing	N/A	1528348372	0	0	PATTI, MELISSA LCSW	2/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70048	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
336518	Ordering, Referring, Prescribing	N/A	1528347713	0	0	PATEL, MAYURI P	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	47506	N/A	N/A	N/A	N/A	N/A	3250 W GRANT LINE RD	None	TRACY	CA	95304	8427	00	06000	37.750995	-121.4752365	San Joaquin County
336519	Ordering, Referring, Prescribing	N/A	1528353323	0	0	PETERSEN, RACHEL L MD DO	2/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125735	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
336533	Ordering, Referring, Prescribing	N/A	1528368024	0	0	PROCTOR, JEFFERY R PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	63884	N/A	N/A	N/A	N/A	N/A	2048 E AVENIDA DE LOS AR	None	THOUSAND OAKS	CA	91362	1356	00	06000	34.21127806	-118.8412358	Ventura County
336583	Ordering, Referring, Prescribing	N/A	1528454592	0	0	PRINCE, NICHOLE LMFT	3/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93491	N/A	N/A	N/A	N/A	N/A	3785 S PLAZA DRIVE	None	SANTA ANA	CA	92704	7463	00	06000	33.69733061	-117.8886342	Orange County
336601	Ordering, Referring, Prescribing	N/A	1528479821	0	0	PATEL, PINA J MD	9/2/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140468	N/A	N/A	N/A	N/A	N/A	800 N MAIN ST	None	SANTA ANA	CA	92701	3576	00	06000	33.751332	-117.867639	Orange County
336615	Ordering, Referring, Prescribing	N/A	1528510831	0	0	PRICE, BRITTANY NP	6/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005298	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
336663	Ordering, Referring, Prescribing	N/A	1528595485	0	0	POSADAS, EDLORD LMFT	1/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144220	N/A	N/A	N/A	N/A	N/A	720 SUNRISE AVE	200C	ROSEVILLE	CA	95661	4516	00	06000	38.735307	-121.272048	Placer County
336668	Ordering, Referring, Prescribing	N/A	1528592599	0	0	PARKER, KELLY LMFT	7/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120200	N/A	N/A	N/A	N/A	N/A	995 GATEWAY CENTER WAY	SUITE # 300	SAN DIEGO	CA	92102	4500	00	06000	32.71405516	-117.1158459	San Diego County
336683	Ordering, Referring, Prescribing	N/A	1528622206	0	0	PRECIADO, ABRAHAM LCSW	10/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110968	N/A	N/A	N/A	N/A	N/A	1436 GOODRICH BLVD	None	COMMERCE	CA	90022	5111	00	06000	34.01117577	-118.1585527	Los Angeles County
336703	Ordering, Referring, Prescribing	N/A	1528654605	0	0	PETERSON, DAMIAN PHARMD	3/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83926	N/A	N/A	N/A	N/A	N/A	555 STEVENSON ST	None	SAN FRANCISCO	CA	94103	1606	00	06000	37.78070506	-122.41099	San Francisco County
336709	Ordering, Referring, Prescribing	N/A	1528660826	0	0	PANOZZO, ALYSSA PA-C	12/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58956	N/A	N/A	N/A	N/A	N/A	3225 TIMBER FALL CT	B	EUREKA	CA	95503	4892	00	06000	40.778955	-124.1356445	Humboldt County
336740	Ordering, Referring, Prescribing	N/A	1528742087	0	0	PAN, HUIXIAN PHARMD	5/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87950	N/A	N/A	N/A	N/A	N/A	2300 16TH STREET	None	SAN FRANCISCO	CA	94116	2504	00	06000	37.76569327	-122.4091306	San Francisco County
336773	Ordering, Referring, Prescribing	N/A	1538185954	0	0	PERLSTEIN, MARGARET	10/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	29785	N/A	N/A	N/A	N/A	N/A	1330 LINCOLN AVE	220	SAN RAFAEL	CA	94901	2120	00	06000	37.97629089	-122.5226851	Marin County
336788	Ordering, Referring, Prescribing	N/A	1538208582	0	0	PERKINS, CORRENDA J LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65718	N/A	N/A	N/A	N/A	N/A	5400 E OLYMPIC BLVD	FIRST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
336803	Ordering, Referring, Prescribing	N/A	1538234190	0	0	PEARSON, LAWRENCE MD	8/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G37412	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
336810	Ordering, Referring, Prescribing	N/A	1538259395	0	0	PHEN, CHIAVEN A	7/22/2009	Taxonomy not applicable	NA	n/a	099	DENTIST	D51519	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
336819	Ordering, Referring, Prescribing	N/A	1538281076	0	0	PATTERSON, KATHERINE M LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105960	N/A	N/A	N/A	N/A	N/A	2600 S EL CAMINO REAL	200	SAN MATEO	CA	94403	2380	00	06000	37.54393248	-122.3052118	San Mateo County
336820	Ordering, Referring, Prescribing	N/A	1538283940	0	0	PAPA, MARIA E LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30924	N/A	N/A	N/A	N/A	N/A	1650 K LAS PLUMAS AVE	None	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
336827	Ordering, Referring, Prescribing	N/A	1538288311	0	0	PISIMISIS, GEORGE MD	11/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175395	N/A	N/A	N/A	N/A	N/A	2720 N HARBOR BLVD	STE 140	FULLERTON	CA	92835	2609	00	06000	33.90126238	-117.9292154	Orange County
336840	Ordering, Referring, Prescribing	N/A	1538317508	0	0	PARHAM, DEBORAH E LMFT	1/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88018	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DRIVE	None	HANFORD	CA	93230	5922	00	06000	36.32726257	-119.6663418	Kings County
336844	Ordering, Referring, Prescribing	N/A	1538322367	0	0	PHAM, TRACY PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62238	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
336846	Ordering, Referring, Prescribing	N/A	1538326020	0	0	POPE, REGAN R LMFT	8/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108752	N/A	N/A	N/A	N/A	N/A	9 KPC PKWY	None	CORONA	CA	92879	7102	00	06000	33.88634582	-117.514398	Riverside County
336852	Ordering, Referring, Prescribing	N/A	1538333513	0	0	PODLISKA, REMEDIOS C	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0530430	N/A	N/A	N/A	N/A	N/A	1350 E MAIN STREET	None	GRASS VALLEY	CA	95945	5208	00	06000	39.23235232	-121.0454663	Nevada County
336854	Ordering, Referring, Prescribing	N/A	1538335666	0	0	PESCADOR, ROSIE I LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85657	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
336856	Ordering, Referring, Prescribing	N/A	1538340724	0	0	PALMENO-SERRANO, ZENIA LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52997	N/A	N/A	N/A	N/A	N/A	9400 RUFFIN CT	None	SAN DIEGO	CA	92123	5300	00	06000	32.830713	-117.1230525	San Diego County
336863	Ordering, Referring, Prescribing	N/A	1538365077	0	0	PRAMANN, CALVIN P DC	2/6/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	14725	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
336873	Ordering, Referring, Prescribing	N/A	1538383518	0	0	PADILLA-NOWAKOWSKI, MILENA LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109031	N/A	N/A	N/A	N/A	N/A	520 TULARE AVE	None	VISALIA	CA	93292	1101	00	06000	36.320679	-119.2870845	Tulare County
336923	Ordering, Referring, Prescribing	N/A	1538459631	0	0	PAULSON, LISA M LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84258	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	200	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
336948	Ordering, Referring, Prescribing	N/A	1538503974	0	0	PAMART-TRAN, ISABELLE M	12/11/2017	Taxonomy not applicable	NA	n/a	000	Unknown	23025	N/A	N/A	N/A	N/A	N/A	2801 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	2023	00	06000	34.01966657	-118.2625434	Los Angeles County
336950	Ordering, Referring, Prescribing	N/A	1538511951	0	0	PORTILLO, MELISSA LCSW	1/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99636	N/A	N/A	N/A	N/A	N/A	6681 STEPHENS RANCH RD	None	LA VERNE	CA	91750	1146	00	06000	34.1521293	-117.7455811	Los Angeles County
336953	Ordering, Referring, Prescribing	N/A	1538512546	0	0	PUTNAM, JANE F LCSW	8/11/2016	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25493	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
336989	Ordering, Referring, Prescribing	N/A	1538565965	0	0	PEARMAN, AMANDA M LPCC	4/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	9474	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE	SUITE 260	WALNUT CREEK	CA	94595	0000	00	06000	37.93963113	-122.0591644	Contra Costa County
337027	Ordering, Referring, Prescribing	N/A	1538617006	0	0	PHAN, SUSAN PHARMD	10/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	72007	N/A	N/A	N/A	N/A	N/A	8010 2ND ST	None	PARAMOUNT	CA	90723	3404	00	06000	33.89819155	-118.159623	Los Angeles County
337040	Ordering, Referring, Prescribing	N/A	1538635933	0	0	PAGE, YVONNE LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111238	N/A	N/A	N/A	N/A	N/A	215 JOHN JONES RD	None	WOODLAND	CA	95695	2510	00	06000	38.65742547	-121.7580472	Yolo County
337119	Ordering, Referring, Prescribing	N/A	1538846415	0	0	PAIZ, SHARON PA-C	9/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63375	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
337130	Ordering, Referring, Prescribing	N/A	1538879143	0	0	PAGE, ZETTIE D LCSW	6/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72136	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
337164	Ordering, Referring, Prescribing	N/A	1548044555	0	0	PIAO, FENGJI LAC	8/10/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19839	N/A	N/A	N/A	N/A	N/A	8358 FLORENCE AVE	None	DOWNEY	CA	90240	3917	00	06000	33.95066412	-118.1239685	Los Angeles County
337198	Ordering, Referring, Prescribing	N/A	1548307093	0	0	PEREZ, LINDA M PHD	3/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY12402	N/A	N/A	N/A	N/A	N/A	100 MASONIC AVE	None	SAN FRANCISCO	CA	94118	4415	00	06000	37.78055387	-122.4474128	San Francisco County
337204	Ordering, Referring, Prescribing	N/A	1548323785	0	0	PHAM, KIMTHY PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57331	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
337236	Ordering, Referring, Prescribing	N/A	1548399595	0	0	PRECIADO, CARLOS	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69300	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	0001	00	06000	34.06300636	-118.2054784	Los Angeles County
337255	Ordering, Referring, Prescribing	N/A	1548438377	0	0	PAULEY, MARY F LCSW	10/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104598	N/A	N/A	N/A	N/A	N/A	3801 3RD STREET	#620	SAN FRANCISCO	CA	94124	1446	00	06000	37.74208019	-122.3880422	San Francisco County
337306	Ordering, Referring, Prescribing	N/A	1548557671	0	0	PALEJWALA, SHERI MD	12/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145902	N/A	N/A	N/A	N/A	N/A	2888 LONG BEACH BLVD.	240	LONG BEACH	CA	90806	1570	00	06000	33.809706	-118.189343	Los Angeles County
337325	Ordering, Referring, Prescribing	N/A	1548596828	0	0	PAN, RUTH	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116139	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
337326	Ordering, Referring, Prescribing	N/A	1548598220	0	0	PRUEITT, ASHLEY D PSYD	4/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSYD26650	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD STE	A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
337330	Ordering, Referring, Prescribing	N/A	1548613037	0	0	PEREZ, MELISSA LPCC	11/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7799	N/A	N/A	N/A	N/A	N/A	6386 ALVARADO COURT	SUITE 310	SAN DIEGO	CA	92120	4905	00	06000	32.77666838	-117.0614255	San Diego County
337331	Ordering, Referring, Prescribing	N/A	1548614811	0	0	PLASCENCIA-MARTINEZ, JOSUE R MD	5/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158056	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
337370	Ordering, Referring, Prescribing	N/A	1548662414	0	0	PEREZ, NANCY LCSW	10/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88543	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE 3RD FLO	None	LONG BEACH	CA	90806	2300	00	06000	33.806097	-118.151378	Los Angeles County
337379	Ordering, Referring, Prescribing	N/A	1548692973	0	0	PADSHALA, MEHUL PHARMD	4/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	64364	N/A	N/A	N/A	N/A	N/A	1111 E WASHINGTON AVE	SUITE C	ESCONDIDO	CA	92025	2226	00	06000	33.13209541	-117.0696618	San Diego County
337380	Ordering, Referring, Prescribing	N/A	1548692403	0	0	PIZER-BUSH, SARAH LMFT	8/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107311	N/A	N/A	N/A	N/A	N/A	170 S SPRUCE AVE	200	SOUTH SAN FRANCIS	CA	94080	4557	00	06000	37.64883531	-122.4187311	San Mateo County
337404	Ordering, Referring, Prescribing	N/A	1548731581	0	0	PAINE, JEFFERSON G	12/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56368	N/A	N/A	N/A	N/A	N/A	31180 ROAD 72	None	GOSHEN	CA	93227	9997	00	06000	36.35594779	-119.4124242	Tulare County
337466	Ordering, Referring, Prescribing	N/A	1548850886	0	0	PARK, ESTHER PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83520	N/A	N/A	N/A	N/A	N/A	25533 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2904	00	06000	33.59203067	-117.6600186	Orange County
337538	Ordering, Referring, Prescribing	N/A	1558127134	0	0	PEREZ GORDILLO, NURIA NP	5/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030002	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
337543	Ordering, Referring, Prescribing	N/A	1558138024	0	0	PEREZ, NEREIDA NP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027275	N/A	N/A	N/A	N/A	N/A	42135 10TH STREET WEST	SUITE 201	LANCASTER	CA	93534	6093	00	06000	34.648533	-118.1477975	Los Angeles County
337564	Ordering, Referring, Prescribing	N/A	1558387613	0	0	PITACCIO, NICHOLAS A LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53332	N/A	N/A	N/A	N/A	N/A	1955 LONG BEACH BLVD	200	LONG BEACH	CA	90806	5501	00	06000	33.79290697	-118.1895017	Los Angeles County
337577	Ordering, Referring, Prescribing	N/A	1558411926	0	0	PEREZ, JUAN M OD	4/20/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11092	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
337596	Ordering, Referring, Prescribing	N/A	1558483636	0	0	PABLO, CYREL T LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78539	N/A	N/A	N/A	N/A	N/A	4281 KATELLA	SUITE 201	LOS ALAMITOS	CA	92720	2721	00	06000	33.80315853	-118.058328	Orange County
337621	Ordering, Referring, Prescribing	N/A	1558512699	0	0	PITZER, SALLY NP	11/9/2020	Taxonomy not applicable	NA	n/a	000	Unknown	401381	N/A	N/A	N/A	N/A	N/A	350 N. HILLMONT	None	VENTURA	CA	93003	1651	00	06000	34.27898772	-119.2542673	Ventura County
337633	Ordering, Referring, Prescribing	N/A	1558572875	0	0	POWERS, CASSIE A LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52722	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
337689	Ordering, Referring, Prescribing	N/A	1558659995	0	0	PIPER, SHANNON J LMFT	12/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53966	N/A	N/A	N/A	N/A	N/A	162 E CARSON ST	None	COLUSA	CA	95932	2880	00	06000	39.20587882	-122.0061518	Colusa County
337733	Ordering, Referring, Prescribing	N/A	1558763920	0	0	PIERCE, SOPHIE PSYD	11/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30693	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
337757	Ordering, Referring, Prescribing	N/A	1558801399	0	0	PIERCE, MARCELLA PA-C	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54217	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
337792	Ordering, Referring, Prescribing	N/A	1558847210	0	0	PALAFOX, THERESA LPCC	4/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11435	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3504	00	06000	32.76105674	-117.1609032	San Diego County
337796	Ordering, Referring, Prescribing	N/A	1558867291	0	0	PARTI, AMBIKA DDS	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	102846	N/A	N/A	N/A	N/A	N/A	1970 MAIN ST	None	WATSONVILLE	CA	95076	0000	00	06000	36.91851199	-121.7826495	Santa Cruz County
337823	Ordering, Referring, Prescribing	N/A	1558903427	0	0	PRESTON, JENNIFER LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51130	N/A	N/A	N/A	N/A	N/A	3765 W DAKOTA AVE	None	FRESNO	CA	93722	4784	00	06000	36.78635647	-119.861433	Fresno County
337844	Ordering, Referring, Prescribing	N/A	1558947093	0	0	PEREZ, JESSE MD	7/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187731	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	200	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
337847	Ordering, Referring, Prescribing	N/A	1558952358	0	0	PAGAN, KELLY RN MA	2/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	687050	N/A	N/A	N/A	N/A	N/A	1155 MISTLETOE LANE	None	REDDING	CA	96002	0749	00	06000	40.57839055	-122.349897	Shasta County
337858	Ordering, Referring, Prescribing	N/A	1558985689	0	0	PALISCA, ALI	11/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133474	N/A	N/A	N/A	N/A	N/A	555 SOQUEL AVE	SUITE 245	SANTA CRUZ	CA	95062	2340	00	06000	36.97623386	-122.0170137	Santa Cruz County
337872	Ordering, Referring, Prescribing	N/A	1568018786	0	0	PHAM, LISA LCSW	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124794	N/A	N/A	N/A	N/A	N/A	801 E. CHAPMAN AVE	#203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
337874	Ordering, Referring, Prescribing	N/A	1568015972	0	0	PAK, BRIDGET LPCC	8/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC17254	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
337885	Ordering, Referring, Prescribing	N/A	1568038974	0	0	POLLATOS, KITSA LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24983	N/A	N/A	N/A	N/A	N/A	39959 SIERRA HWY	UNIT 150	PALMDALE	CA	93550	3320	00	06000	34.60850218	-118.1223966	Los Angeles County
337906	Ordering, Referring, Prescribing	N/A	1568083053	0	0	POOT, CARLA CNP	3/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	47285	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
337962	Ordering, Referring, Prescribing	N/A	1568461689	0	0	PON, JOSEPH C DC	12/21/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	27152	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
337967	Ordering, Referring, Prescribing	N/A	1568483675	0	0	PRIEST, JULIE NP	11/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11885	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
337968	Ordering, Referring, Prescribing	N/A	1568470946	0	0	PERERA, MANOJ V LCSW	1/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24260	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA STREE	TEAM D	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
337980	Ordering, Referring, Prescribing	N/A	1568518777	0	0	PUTNEY, DIANE C	11/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	1900	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
337987	Ordering, Referring, Prescribing	N/A	1568520666	0	0	PEOPLES, STEPHANIE ANN PSYD	5/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20062	N/A	N/A	N/A	N/A	N/A	31946 MISSION TRAIL	B	LAKE ELSINORE	CA	92530	4539	00	06000	33.65640803	-117.2979656	Riverside County
338003	Ordering, Referring, Prescribing	N/A	1568554665	0	0	PIETRYGA, MICHELLE MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81762	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
338071	Ordering, Referring, Prescribing	N/A	1568718401	0	0	PURI, SIDDARTH MD	11/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139447	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVENUE	100	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
338072	Ordering, Referring, Prescribing	N/A	1568717361	0	0	POLLOCK, SARA M PSYD	3/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29084	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH STREET	STE. 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
338074	Ordering, Referring, Prescribing	N/A	1568719011	0	0	PARK, ALLYSON J	10/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D61599	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
338109	Ordering, Referring, Prescribing	N/A	1568765972	0	0	PHAM, DUYEN LCSW	2/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77270	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	BUILDING A	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
338111	Ordering, Referring, Prescribing	N/A	1568765345	0	0	PODDER, RUMA LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106082	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	192	CULVER CITY	CA	90230	6582	00	06000	33.98900447	-118.37979	Los Angeles County
338134	Ordering, Referring, Prescribing	N/A	1568808699	0	0	PITTMAN, JESSICA	8/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68292	N/A	N/A	N/A	N/A	N/A	1401 BROADWAY STREET	None	SACRAMENTO	CA	95818	2219	00	06000	38.562516	-121.494375	Sacramento County
338139	Ordering, Referring, Prescribing	N/A	1568815215	0	0	PAIK, EILEEN	11/4/2019	Taxonomy not applicable	NA	n/a	000	Unknown	47075	N/A	N/A	N/A	N/A	N/A	3400 WHITTIER BL.	None	LOS ANGELES	CA	90023	1708	00	06000	34.02767826	-118.2008037	Los Angeles County
338146	Ordering, Referring, Prescribing	N/A	1568821619	0	0	PEREZ, BRITTANY J LMFT	9/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121473	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
338163	Ordering, Referring, Prescribing	N/A	1568847143	0	0	PEREZ, LIZETTE LCSW	11/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98400	N/A	N/A	N/A	N/A	N/A	18350 MT LANGLEY STREET	SUITE 220	FOUNTAIN VALLEY	CA	92708	6929	00	06000	33.69633523	-117.9420534	Orange County
338169	Ordering, Referring, Prescribing	N/A	1568848638	0	0	PERAZA, JESSICA L LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82948	N/A	N/A	N/A	N/A	N/A	3939 ATLANTIC AVE	103	LONG BEACH	CA	90807	3529	00	06000	33.830073	-118.1851065	Los Angeles County
338175	Ordering, Referring, Prescribing	N/A	1568860476	0	0	PEREZ, ALIX LMFT	5/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124439	N/A	N/A	N/A	N/A	N/A	1922 THE ALAMEDA	440	SAN JOSE	CA	95126	1462	00	06000	37.34128547	-121.9236047	Santa Clara County
338192	Ordering, Referring, Prescribing	N/A	1568878478	0	0	PARK, SUNNY H DMD	2/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108575	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
338193	Ordering, Referring, Prescribing	N/A	1568877629	0	0	PLUCKER, DIANA A MD	10/2/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147831	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
338211	Ordering, Referring, Prescribing	N/A	1568901460	0	0	PHUNG, KRISTINE T MD	3/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176982	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
338220	Ordering, Referring, Prescribing	N/A	1568919587	0	0	PEREZ, JENNIFER LCSW	11/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88315	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
338223	Ordering, Referring, Prescribing	N/A	1568919660	0	0	PADVAL, SHEETAL S	1/2/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	100809	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	8778	00	06000	39.03772106	-122.9223338	Lake County
338241	Ordering, Referring, Prescribing	N/A	1568952646	0	0	PADULA, ALLISON LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100903	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER STREET	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
338256	Ordering, Referring, Prescribing	N/A	1568981413	0	0	PERILLA, MANJA L	11/9/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007139	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
338272	Ordering, Referring, Prescribing	N/A	1578009106	0	0	PARK, YUJIN LMFT	11/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129389	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE	8	BUENA PARK	CA	90621	3341	00	06000	33.85890953	-118.007244	Orange County
338301	Ordering, Referring, Prescribing	N/A	1578049987	0	0	PEARSON, JAMES L MD	9/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165345	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
338338	Ordering, Referring, Prescribing	N/A	1578098620	0	0	PANEK, LINDSAY N PA-C	4/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA63107	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
338360	Ordering, Referring, Prescribing	N/A	1578156915	0	0	PARK, AUSTIN J	4/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83833	N/A	N/A	N/A	N/A	N/A	815 CANYON DEL REY BLVD	None	DEL REY OAKS	CA	93940	5525	00	06000	36.59803915	-121.8498048	Monterey County
338386	Ordering, Referring, Prescribing	N/A	1578228219	0	0	PRIETO, CARINA M NP	10/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018711	N/A	N/A	N/A	N/A	N/A	23080 ALESSANDRO BLVD	STE. 202	MORENO VALLEY	CA	92553	9674	00	06000	33.91731429	-117.2599095	Riverside County
338394	Ordering, Referring, Prescribing	N/A	1578256228	0	0	PULIDO, PULMER JACK NP	5/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025259	N/A	N/A	N/A	N/A	N/A	1360 E ANAHEIM ST	SUITE 101	LONG BEACH	CA	90813	5514	00	06000	33.78258054	-118.1744415	Los Angeles County
338396	Ordering, Referring, Prescribing	N/A	1578267472	0	0	POPKE, REBECCA S LMFT	3/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79576	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
338405	Ordering, Referring, Prescribing	N/A	1578297032	0	0	PATEL, BIJAL PA-C	7/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64776	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	STE. A	LOS ANGELES	CA	90021	3082	00	06000	34.02578238	-118.2530622	Los Angeles County
338407	Ordering, Referring, Prescribing	N/A	1578297826	0	0	PALACIO, JENNIFER E CCC-SLP	3/26/2024	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	36989	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST STE A	STE A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
338410	Ordering, Referring, Prescribing	N/A	1578299343	0	0	PAKENHAM, KATE NP	9/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95017963	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
338427	Ordering, Referring, Prescribing	N/A	1578530309	0	0	PATEL, VIJAY M	5/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47035	N/A	N/A	N/A	N/A	N/A	1240 S MAGNOLIA AVE	None	ANAHEIM	CA	92804	5116	00	06000	33.815583	-117.9757915	Orange County
338443	Ordering, Referring, Prescribing	N/A	1578605549	0	0	PHILLIPS, MARVA M LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106798	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
338451	Ordering, Referring, Prescribing	N/A	1578622189	0	0	PRESBY, JOAN E MD	9/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72895	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	SUITE 1109	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
338473	Ordering, Referring, Prescribing	N/A	1578687554	0	0	PARKER, ALLISON L LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43854	N/A	N/A	N/A	N/A	N/A	4760 S. SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
338479	Ordering, Referring, Prescribing	N/A	1578693727	0	0	PAYNE, DENICE	9/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37219	N/A	N/A	N/A	N/A	N/A	27951 SMYTH DR STE 103	None	VALENCIA	CA	91355	4049	00	06000	34.44222202	-118.5700452	Los Angeles County
338492	Ordering, Referring, Prescribing	N/A	1578701306	0	0	PATEL, POOJA D	7/25/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D57631	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
338504	Ordering, Referring, Prescribing	N/A	1578727848	0	0	PAREDES, SARA NP	12/17/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033343	N/A	N/A	N/A	N/A	N/A	3000 COLBY ST STE 202	STE 202	BERKELEY	CA	94705	2058	00	06000	37.85492078	-122.2576101	Alameda County
338576	Ordering, Referring, Prescribing	N/A	1578843736	0	0	PALACIOS, IRMA E LCSW	5/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75130	N/A	N/A	N/A	N/A	N/A	755 SOUTH VAN NESS AVE.	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
338603	Ordering, Referring, Prescribing	N/A	1578878666	0	0	POQUIZ, JESSICA PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62886	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	BUILDING B	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
338605	Ordering, Referring, Prescribing	N/A	1578879912	0	0	PHAN, BETTY T LMFT	10/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103838	N/A	N/A	N/A	N/A	N/A	1887 MONTEREY HWY	205	SAN JOSE	CA	95112	6192	00	06000	37.30869336	-121.8664126	Santa Clara County
338608	Ordering, Referring, Prescribing	N/A	1578895835	0	0	PATEL, PURVI	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67033	N/A	N/A	N/A	N/A	N/A	3902 WASHINGTON BLVD	None	FREMONT	CA	94538	4954	00	06000	37.53267585	-121.9573339	Alameda County
338616	Ordering, Referring, Prescribing	N/A	1578900585	0	0	PHARES, AMANDA MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146286	N/A	N/A	N/A	N/A	N/A	2170 SOUTH AVENUE	9578	SOUTH LAKE TAHOE	CA	96150	7026	00	06000	38.91229842	-119.9978133	El Dorado County
338617	Ordering, Referring, Prescribing	N/A	1578902102	0	0	PUTHUVALIL, LIJAN PHARMD	3/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	61994	N/A	N/A	N/A	N/A	N/A	655 14TH STREET	None	SAN DIEGO	CA	92101	7584	00	06000	32.7120814	-117.1518881	San Diego County
338630	Ordering, Referring, Prescribing	N/A	1578912408	0	0	PROTHRO, GILLIAN L CNP	6/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006182	N/A	N/A	N/A	N/A	N/A	2526 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14934389	-122.2195713	Tehama County
338639	Ordering, Referring, Prescribing	N/A	1578921615	0	0	PHUNG, NGOC LENA PHARMD	6/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71811	N/A	N/A	N/A	N/A	N/A	10810 WARNER AVENUE	SUITE #3	FOUNTAIN VALLEY	CA	92708	7203	00	06000	33.71627054	-117.940176	Orange County
338654	Ordering, Referring, Prescribing	N/A	1578939880	0	0	POPE, MADALYN LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110560	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	SUITE 100	GILROY	CA	95020	2504	00	06000	37.03080985	-121.5741639	Santa Clara County
338659	Ordering, Referring, Prescribing	N/A	1578946984	0	0	PROSEN, KAREN E LMFT	6/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133979	N/A	N/A	N/A	N/A	N/A	6741 SEBASTOPOL AVE	160	SEBASTOPOL	CA	95472	3839	00	06000	38.40277333	-122.819659	Sonoma County
338664	Ordering, Referring, Prescribing	N/A	1578959805	0	0	PATTON, KYLE A MD	7/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163930	N/A	N/A	N/A	N/A	N/A	1035 PLACER STREET	None	REDDING	CA	96001	1125	00	06000	40.58349378	-122.3853903	Shasta County
338683	Ordering, Referring, Prescribing	N/A	1578983037	0	0	PINDER, STEPHANIE J LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99602	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 220	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
338714	Ordering, Referring, Prescribing	N/A	1588018741	0	0	PHAM, NHAN N DO	7/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17378	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
338722	Ordering, Referring, Prescribing	N/A	1588027437	0	0	PANAMENO, KARLA MD	8/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164047	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
338856	Ordering, Referring, Prescribing	N/A	1588223382	0	0	PHUNG, BRIAN C DO	5/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19656	N/A	N/A	N/A	N/A	N/A	227 N. JACKSON AVE	235	SAN JOSE	CA	95116	1635	00	06000	37.36478223	-121.8497978	Santa Clara County
338920	Ordering, Referring, Prescribing	N/A	1588444822	0	0	PAYNE, GABRIELLE	11/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63666	N/A	N/A	N/A	N/A	N/A	317 W EL MONTE WAY	None	DINUBA	CA	93618	1557	00	06000	36.54595565	-119.397867	Tulare County
338953	Ordering, Referring, Prescribing	N/A	1588726319	0	0	PRECIADO GOMEZ, ULICES I LCSW	6/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71268	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
338967	Ordering, Referring, Prescribing	N/A	1588757173	0	0	PULIDO, DAVID R DDS	3/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	35969	N/A	N/A	N/A	N/A	N/A	1811 GRAND CANAL BLVD	STE 1	STOCKTON	CA	95207	8107	00	06000	37.98649588	-121.3277333	San Joaquin County
338989	Ordering, Referring, Prescribing	N/A	1588794945	0	0	PAISO, IRIS M	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D52553	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
339008	Ordering, Referring, Prescribing	N/A	1588839385	0	0	PATTERSON MAYS, SHARON E LMFT	7/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112919	N/A	N/A	N/A	N/A	N/A	151 E CANAL DR	None	TURLOCK	CA	95380	3901	00	06000	37.50051453	-120.8472885	Stanislaus County
339032	Ordering, Referring, Prescribing	N/A	1588904205	0	0	POTTENGER, BRENT C MD	6/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166632	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
339035	Ordering, Referring, Prescribing	N/A	1588911200	0	0	PETERSON, ALICIA G LMFT	8/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115220	N/A	N/A	N/A	N/A	N/A	7177 BROCKTON AVE	445	RIVERSIDE	CA	92506	2615	00	06000	33.94289496	-117.3943941	Riverside County
339036	Ordering, Referring, Prescribing	N/A	1588908719	0	0	PARIKH, JHANKRUTI PHARMD	8/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65562	N/A	N/A	N/A	N/A	N/A	20620 HOMESTEAD RD	None	CUPERTINO	CA	95014	0451	00	06000	37.33745451	-122.03469	Santa Clara County
339055	Ordering, Referring, Prescribing	N/A	1588934772	0	0	PERRIERA, BRIANNE J LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90996	N/A	N/A	N/A	N/A	N/A	3636 N 1ST ST	135 & 154	FRESNO	CA	93726	6800	00	06000	36.78322578	-119.7724022	Fresno County
339073	Ordering, Referring, Prescribing	N/A	1588964365	0	0	PEREZ, DIANE	9/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26852	N/A	N/A	N/A	N/A	N/A	14624 SHERMAN WAY	FLOOR 6	VAN NUYS	CA	91405	2241	00	06000	34.20078354	-118.450843	Los Angeles County
339094	Ordering, Referring, Prescribing	N/A	1588981369	0	0	PALACIOS, BIANCA LMFT	8/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120849	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
339113	Ordering, Referring, Prescribing	N/A	1598015307	0	0	PULLEY, MONICA M LMFT	10/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109683	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	210	SACRAMENTO	CA	95815	3317	00	06000	38.60568	-121.4345385	Sacramento County
339116	Ordering, Referring, Prescribing	N/A	1598019135	0	0	PHAM, TAMMY LCSW	4/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79377	N/A	N/A	N/A	N/A	N/A	9445 FARNHAM ST	100	SAN DIEGO	CA	92123	1399	00	06000	32.83274967	-117.1248508	San Diego County
339142	Ordering, Referring, Prescribing	N/A	1598047037	0	0	POTSELUEFF, ELIZABETH M PHARMD	9/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65533	N/A	N/A	N/A	N/A	N/A	5280 GEARY BLVD	None	SAN FRANCISCO	CA	94118	2818	00	06000	37.7805822	-122.4756271	San Francisco County
339164	Ordering, Referring, Prescribing	N/A	1598084402	0	0	PHAM, QUEENIE Q PHARMD	8/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54304	N/A	N/A	N/A	N/A	N/A	2800 W WARNER AVE.	STE B	SANTA ANA	CA	92704	5466	00	06000	33.71511318	-117.9069097	Orange County
339177	Ordering, Referring, Prescribing	N/A	1598108557	0	0	PATEL, RAVI J DO	11/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17048	N/A	N/A	N/A	N/A	N/A	4434 SW 91ST DR	None	GAINESVILLE	FL	32608	7136	00	06000	29.61158518	-82.43998735	Alachua County
339211	Ordering, Referring, Prescribing	N/A	1598140550	0	0	PARASHETTE, VANI MD	11/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167818	N/A	N/A	N/A	N/A	N/A	N STATE ST	#3	SAN JACINTO	CA	92583	6567	00	06000	33.79984827	-116.9720208	Riverside County
339221	Ordering, Referring, Prescribing	N/A	1598166084	0	0	PHELPS, CHRISTINE R LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100235	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 200	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
339228	Ordering, Referring, Prescribing	N/A	1598173767	0	0	PAYTON, SHAWNTEL A CNP	9/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001052	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
339263	Ordering, Referring, Prescribing	N/A	1598237281	0	0	PETERSEN, KATE LMFT	8/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130200	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S	201	SAN DIEGO	CA	92108	3502	00	06000	32.76105674	-117.1609032	San Diego County
339273	Ordering, Referring, Prescribing	N/A	1598252595	0	0	PHAM, VI T LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122102	N/A	N/A	N/A	N/A	N/A	12912 BROOKHURST ST	480	GARDEN GROVE	CA	92840	4835	00	06000	33.77487003	-117.9552276	Orange County
339338	Ordering, Referring, Prescribing	N/A	1598379596	0	0	PFEIFER-ROSENBLUM, REBECCA NP	8/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015252	N/A	N/A	N/A	N/A	N/A	16 RITTER ST	None	SAN RAFAEL	CA	94901	3323	00	06000	37.97151013	-122.5251246	Marin County
339341	Ordering, Referring, Prescribing	N/A	1598389124	0	0	PHILBIN, AMANDA PA	8/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	59307	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
339351	Ordering, Referring, Prescribing	N/A	1598404048	0	0	PON, MEAGAN C NP	4/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020580	N/A	N/A	N/A	N/A	N/A	795 JOAQUIN ST	None	SUSANVILLE	CA	96130	3628	00	06000	40.42683779	-120.6570864	Lassen County
339381	Ordering, Referring, Prescribing	N/A	1598549511	0	0	PARDUCHO, IRISH D PA	2/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64056	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	#C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
339391	Ordering, Referring, Prescribing	N/A	1598723587	0	0	PACK, JOHN C OD	9/18/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	9684	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	105	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
339410	Ordering, Referring, Prescribing	N/A	1598819708	0	0	PERKINS, MONA J LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT37221	N/A	N/A	N/A	N/A	N/A	1989 VICENTE	None	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
339428	Ordering, Referring, Prescribing	N/A	1598882052	0	0	PARDO, KARINA A LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51363	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
339452	Ordering, Referring, Prescribing	N/A	1598930059	0	0	PARROTT, MEDIE J NP	3/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15259	N/A	N/A	N/A	N/A	N/A	24065 BIGGAR LN	None	COVELO	CA	95428	0000	00	06000	39.80972354	-123.2469688	Mendocino County
339478	Ordering, Referring, Prescribing	N/A	1598979072	0	0	PETEVA, YOANA L MD	1/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A108474	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
339492	Ordering, Referring, Prescribing	N/A	1609008036	0	0	PINEDA, MONICA L PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62720	N/A	N/A	N/A	N/A	N/A	7300 N. FRESNO ST.	None	FRESNO	CA	93720	2942	00	06000	36.84133078	-119.7824983	Fresno County
339511	Ordering, Referring, Prescribing	N/A	1609053024	0	0	PLANCK, MICHAEL MSW LCSW	6/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68953	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
339532	Ordering, Referring, Prescribing	N/A	1609118942	0	0	PARTAMIAN, SANDRA A MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131475	N/A	N/A	N/A	N/A	N/A	11080 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
339551	Ordering, Referring, Prescribing	N/A	1609145085	0	0	PALENCIA, CHRISTINA G LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95304	N/A	N/A	N/A	N/A	N/A	333 S FARRELL DR	None	PALM SPRINGS	CA	92262	7905	00	06000	33.8189007	-116.51811	Riverside County
339585	Ordering, Referring, Prescribing	N/A	1609190479	0	0	PURNELL, VIRGINIA LCSW	6/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66146	N/A	N/A	N/A	N/A	N/A	6060 PARAMOUNT BLVD	None	LONG BEACH	CA	90805	3711	00	06000	33.865083	-118.157517	Los Angeles County
339589	Ordering, Referring, Prescribing	N/A	1609191311	0	0	PAREDES, NANCY E LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91305	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	9TH FLOOR	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
339624	Ordering, Referring, Prescribing	N/A	1609257435	0	0	POYSOPHON, POYRUNG MD	10/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150875	N/A	N/A	N/A	N/A	N/A	1971 UNIVERSITY AVE	None	RIVERSIDE	CA	92501	0000	00	06000	33.97570846	-117.354501	Riverside County
339643	Ordering, Referring, Prescribing	N/A	1609291947	0	0	PENA, ALEXANDRA M LMFT	9/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121647	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
339678	Ordering, Referring, Prescribing	N/A	1609325711	0	0	PHAM, ANH H OD	2/24/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT15202	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
339686	Ordering, Referring, Prescribing	N/A	1609351642	0	0	PAZOS, JULIA NP	5/28/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009892	N/A	N/A	N/A	N/A	N/A	4368 SANTA ANITA AVE	None	EL MONTE	CA	91731	1606	00	06000	34.08572956	-118.0293405	Los Angeles County
339742	Ordering, Referring, Prescribing	N/A	1609443993	0	0	PHAN, KATELYNE C PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60244	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST,	13TH FLOOR	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
339749	Ordering, Referring, Prescribing	N/A	1609452069	0	0	PADLIPSKY, JACQUELINE E MD	10/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7956	N/A	N/A	N/A	N/A	N/A	505 S MAIN ST	STE 525	ORANGE	CA	92868	4553	00	06000	33.78004808	-117.8672472	Orange County
339796	Ordering, Referring, Prescribing	N/A	1609648088	0	0	PAMMA, JASKIRTH DDS	8/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS109179	N/A	N/A	N/A	N/A	N/A	3605 HOSPITAL ROAD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
339797	Ordering, Referring, Prescribing	N/A	1609655992	0	0	PHAM, ALEX PHARMD	9/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88690	N/A	N/A	N/A	N/A	N/A	730 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2515	00	06000	37.74314935	-122.4742736	San Francisco County
339801	Ordering, Referring, Prescribing	N/A	1609637743	0	0	PEREZ, JESSICA J PA-C	2/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64113	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
339803	Ordering, Referring, Prescribing	N/A	1609844539	0	0	PATEL, SARITA P	7/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53741	N/A	N/A	N/A	N/A	N/A	160 EAST VIRGINIA STREET	None	SAN JOSE	CA	95112	5817	00	06000	37.32582868	-121.8777868	Santa Clara County
339824	Ordering, Referring, Prescribing	N/A	1609922129	0	0	PFISTER, BROOKE C LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52748	N/A	N/A	N/A	N/A	N/A	1470 W. HERNDON AVE	SUITE 300	FRESNO	CA	93711	0552	00	06000	36.83746879	-119.8186401	Fresno County
339852	Ordering, Referring, Prescribing	N/A	1609965193	0	0	PACKER, JEFFREY PHARMD	11/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	27537	N/A	N/A	N/A	N/A	N/A	1000 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	3341	00	06000	33.14714527	-117.106754	San Diego County
339854	Ordering, Referring, Prescribing	N/A	1609968098	0	0	PEREZ, RITA M LCSW	5/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18207	N/A	N/A	N/A	N/A	N/A	1050 WISCONSIN ST	None	SAN FRANCISCO	CA	94107	3328	00	06000	37.7540295	-122.3986796	San Francisco County
339913	Ordering, Referring, Prescribing	N/A	1619074309	0	0	PHAM, NGAN-THUY D MD	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G82107	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	300	HAWTHORNE	CA	90250	2240	00	06000	33.92825048	-118.3539285	Los Angeles County
339922	Ordering, Referring, Prescribing	N/A	1619108941	0	0	PARK, SANDY PHARMD	4/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62591	N/A	N/A	N/A	N/A	N/A	4950 SUNSET BLVD	6122	LOS ANGELES	CA	90027	0000	00	06000	34.09812092	-118.2980246	Los Angeles County
339934	Ordering, Referring, Prescribing	N/A	1619122140	0	0	PAPPALARDO, JENNIFER M LMFT	7/31/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105633	N/A	N/A	N/A	N/A	N/A	720 SUNRISE AVE.	D115	ROSEVILLE	CA	95661	4516	00	06000	38.735307	-121.272048	Placer County
339949	Ordering, Referring, Prescribing	N/A	1619170743	0	0	PRICE, DANIELLE K LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47855	N/A	N/A	N/A	N/A	N/A	23550 LYONS AVE.	211	NEWHALL	CA	91321	5756	00	06000	34.37938495	-118.5458635	Los Angeles County
339970	Ordering, Referring, Prescribing	N/A	1619200128	0	0	PRATT, STACEY L PA	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	53299	N/A	N/A	N/A	N/A	N/A	2241 WANKEL WAY	SUITE C	OXNARD	CA	93030	0191	00	06000	34.21679844	-119.1467863	Ventura County
339981	Ordering, Referring, Prescribing	N/A	1619216660	0	0	PENSO, SONIA R LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93239	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	STE K	SANTA FE SPRINGS	CA	90670	6815	00	06000	33.94630253	-118.0832082	Los Angeles County
339987	Ordering, Referring, Prescribing	N/A	1619238417	0	0	PIZARRO, ERIKA PAULA R MD	12/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138289	N/A	N/A	N/A	N/A	N/A	3061 FILLMORE ST	None	SAN FRANCISCO	CA	94123	4009	00	06000	37.79787328	-122.4356778	San Francisco County
340024	Ordering, Referring, Prescribing	N/A	1619290459	0	0	PITTMAN, JILL LMFT	7/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52017	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
340062	Ordering, Referring, Prescribing	N/A	1619353919	0	0	PURCELL, JENNIFER R LCSW	8/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109602	N/A	N/A	N/A	N/A	N/A	375 89TH ST	None	DALY CITY	CA	94015	1802	00	06000	37.69175212	-122.474006	San Mateo County
340067	Ordering, Referring, Prescribing	N/A	1619360658	0	0	PARK, CHAEHO PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72325	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	155	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
340069	Ordering, Referring, Prescribing	N/A	1619363710	0	0	PRALGAUSKAITE, FLORENTINA LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119481	N/A	N/A	N/A	N/A	N/A	2500 E. FOOTHILL BLVD	300	PASADENA	CA	91107	3464	00	06000	34.14979547	-118.097982	Los Angeles County
340145	Ordering, Referring, Prescribing	N/A	1619487378	0	0	PHILLIPS, JAMES M LCSW	5/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101495	N/A	N/A	N/A	N/A	N/A	940 AVENUE 64	None	PASADENA	CA	91105	2711	00	06000	34.124895	-118.174671	Los Angeles County
340154	Ordering, Referring, Prescribing	N/A	1619505625	0	0	POWELL, DAVID P MD	7/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177299	N/A	N/A	N/A	N/A	N/A	2400 WIBLE RD	STE. 14	BAKERSFIELD	CA	93304	4734	00	06000	35.3328934	-119.0389535	Kern County
340204	Ordering, Referring, Prescribing	N/A	1619622446	0	0	PHAM, KIM T	11/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018684	N/A	N/A	N/A	N/A	N/A	8876 HILLERY DRIVE	None	SAN DIEGO	CA	92126	0001	00	06000	32.9117603	-117.1331338	San Diego County
340213	Ordering, Referring, Prescribing	N/A	1619639788	0	0	POINT DU JOUR, HARRY NP	12/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018232	N/A	N/A	N/A	N/A	N/A	1414 NORTH CALIFORNIA ST	SUITE# C	STOCKTON	CA	95202	1616	00	06000	37.96761084	-121.2883234	San Joaquin County
340270	Ordering, Referring, Prescribing	N/A	1629103031	0	0	PLACIDE, ONTSON F LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30456	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
340271	Ordering, Referring, Prescribing	N/A	1629102140	0	0	PISCIONE, JAIME LMFT	8/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44916	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	800	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
340310	Ordering, Referring, Prescribing	N/A	1629166251	0	0	PATEL, TAJINDER K PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48464	N/A	N/A	N/A	N/A	N/A	286 PAUL COURT	None	RIPON	CA	95366	9382	00	06000	37.75479396	-121.1279956	San Joaquin County
340321	Ordering, Referring, Prescribing	N/A	1629194287	0	0	PAZ, GLORIA M LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36754	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE WEST. DR	None	SAN BRUNO	CA	94066	2383	00	06000	37.63134914	-122.4260472	San Mateo County
340324	Ordering, Referring, Prescribing	N/A	1629198437	0	0	PALENCIA, VIVIAN A MSW LCSW	8/22/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21433	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
340351	Ordering, Referring, Prescribing	N/A	1629277132	0	0	PRUITT, KATHRYN E LMFT	5/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97463	N/A	N/A	N/A	N/A	N/A	1620 SANTA CLARA DR.	100	ROSEVILLE	CA	95661	3559	00	06000	38.74243973	-121.2620867	Placer County
340394	Ordering, Referring, Prescribing	N/A	1629350731	0	0	PATEL, SANJAY S	4/30/2019	Taxonomy not applicable	NA	n/a	000	Unknown	48629	N/A	N/A	N/A	N/A	N/A	37323 FREMONT BLVD	None	FREMONT	CA	94536	3702	00	06000	37.55820562	-122.0070406	Alameda County
340426	Ordering, Referring, Prescribing	N/A	1629399258	0	0	PATEL, SHITAL J PHARMD	9/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	50125	N/A	N/A	N/A	N/A	N/A	26024 ACERO	STE 110	MISSION VIEJO	CA	92691	0000	00	06000	33.61784172	-117.6769661	Orange County
340496	Ordering, Referring, Prescribing	N/A	1629523295	0	0	PENATE, KRISTEN M LCSW	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96449	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	223	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
340501	Ordering, Referring, Prescribing	N/A	1629527510	0	0	POKORNEY, MEGAN PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75076	N/A	N/A	N/A	N/A	N/A	250 W PARKCENTER BLVD	None	BOISE	ID	83701	0000	00	06000	43.59868352	-116.180912	Ada County
340504	Ordering, Referring, Prescribing	N/A	1629531785	0	0	PEREZ, MICHELLE R MD	4/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A178155	N/A	N/A	N/A	N/A	N/A	441 E YOSEMITE AVE	None	MADERA	CA	93638	3604	00	06000	36.96460804	-120.055598	Madera County
340519	Ordering, Referring, Prescribing	N/A	1629559125	0	0	PARK, IRENE PHARMD	4/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86114	N/A	N/A	N/A	N/A	N/A	4627 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92130	3310	00	06000	32.92140098	-117.2152705	San Diego County
340524	Ordering, Referring, Prescribing	N/A	1629570726	0	0	PEREZ, MELINNA M LMFT	12/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123816	N/A	N/A	N/A	N/A	N/A	15350 SHERMAN WAY	STE 200	VAN NUYS	CA	91406	4203	00	06000	34.20109649	-118.467432	Los Angeles County
340533	Ordering, Referring, Prescribing	N/A	1629581210	0	0	PRICE, SHARON A LCSW	5/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101462	N/A	N/A	N/A	N/A	N/A	921 WEST AVE J.	None	LANCASTER	CA	93534	3443	00	06000	34.6895043	-118.1463998	Los Angeles County
340567	Ordering, Referring, Prescribing	N/A	1629630470	0	0	PIERCY, AMBER NP	7/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013058	N/A	N/A	N/A	N/A	N/A	1921 18TH ST	None	BAKERSFIELD	CA	93301	4205	00	06000	35.37525954	-119.024586	Kern County
340576	Ordering, Referring, Prescribing	N/A	1629635305	0	0	PHAN, PHAT T PHARMD	2/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	80453	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
340591	Ordering, Referring, Prescribing	N/A	1629658992	0	0	PARK, SEONYEONG PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84173	N/A	N/A	N/A	N/A	N/A	3154 W OLYMPIC BLVD	None	LOS ANGELES	CA	90006	2400	00	06000	34.0525407	-118.3050047	Los Angeles County
340606	Ordering, Referring, Prescribing	N/A	1629698253	0	0	PAREDES, GISELA R NP	1/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016391	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
340633	Ordering, Referring, Prescribing	N/A	1629807201	0	0	PATTERSON, JENNIFER J NP	6/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030838	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
340690	Ordering, Referring, Prescribing	N/A	1639279813	0	0	POSERT, CORAL E DDS	8/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS36610	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	100	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
340720	Ordering, Referring, Prescribing	N/A	1639365265	0	0	PENA, NANCY F LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53655	N/A	N/A	N/A	N/A	N/A	2351 CARDINAL LN	ANNEX B	SAN DIEGO	CA	92123	3743	00	06000	32.7867927	-117.1601935	San Diego County
340744	Ordering, Referring, Prescribing	N/A	1639410665	0	0	PAI, JOSEPH PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67693	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
340782	Ordering, Referring, Prescribing	N/A	1639472418	0	0	PARRISH, ELLIE N LCSW	10/11/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19397	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
340786	Ordering, Referring, Prescribing	N/A	1639475999	0	0	PHAN, QUOC	9/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52386	N/A	N/A	N/A	N/A	N/A	600 E BROADWAY	None	LONG BEACH	CA	90802	5124	00	06000	33.76866146	-118.1843496	Los Angeles County
340857	Ordering, Referring, Prescribing	N/A	1639558224	0	0	PALAGANAS, ROXANNE F NP	1/25/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	760280	N/A	N/A	N/A	N/A	N/A	4800 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	1293	00	06000	33.970626	-117.3826755	Riverside County
340859	Ordering, Referring, Prescribing	N/A	1639569296	0	0	PEREZ, JESSICA A LMFT	1/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110650	N/A	N/A	N/A	N/A	N/A	901 W VICTORIA ST	F/G	COMPTON	CA	90220	5807	00	06000	33.86784006	-118.2368928	Los Angeles County
340878	Ordering, Referring, Prescribing	N/A	1639591779	0	0	PLASCENCIA, CYNTHIA LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119682	N/A	N/A	N/A	N/A	N/A	17862 E. 17TH STREET	SUITE 107	TUSTIN	CA	92780	9998	00	06000	33.75984099	-117.8209448	Orange County
340880	Ordering, Referring, Prescribing	N/A	1639600125	0	0	PUJARE, DEEPTI U	7/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157059	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
340888	Ordering, Referring, Prescribing	N/A	1639613045	0	0	PARK, MICHELLE H PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75736	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC COAST HWY	None	TORRANCE	CA	90505	7038	00	06000	33.79160861	-118.3328475	Los Angeles County
340905	Ordering, Referring, Prescribing	N/A	1639637986	0	0	PLEASANT, KRISTY	11/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	105243	N/A	N/A	N/A	N/A	N/A	808 W.58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
340909	Ordering, Referring, Prescribing	N/A	1639646094	0	0	POWERS, YVONNE T RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	376108	N/A	N/A	N/A	N/A	N/A	4110 GARNSEY LN	None	BAKERSFIELD	CA	93309	1740	00	06000	35.36358148	-119.0484211	Kern County
340926	Ordering, Referring, Prescribing	N/A	1639666365	0	0	PARK, KYUNGHWA PHARMD	10/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75295	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
340931	Ordering, Referring, Prescribing	N/A	1639674336	0	0	PETERS, MATTHEW W MD	2/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164289	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
340934	Ordering, Referring, Prescribing	N/A	1639677982	0	0	PADILLA, SANDRA MSW LCSW	10/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	80208	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
340962	Ordering, Referring, Prescribing	N/A	1639737240	0	0	PANNU, GURJIT MD	1/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183763	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
340966	Ordering, Referring, Prescribing	N/A	1639741499	0	0	PULIDO, VANESSA LMFT	9/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141716	N/A	N/A	N/A	N/A	N/A	18350 MT. LANGLEY ST.	220	FOUNTAIN VALLEY	CA	92708	6912	00	06000	33.69633523	-117.9420534	Orange County
341008	Ordering, Referring, Prescribing	N/A	1639865504	0	0	PALMEA, RHOME CNP	2/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024432	N/A	N/A	N/A	N/A	N/A	1625 CARROLL AVE	None	SAN FRANCISCO	CA	94124	3219	00	06000	37.72518613	-122.3938382	San Francisco County
341015	Ordering, Referring, Prescribing	N/A	1639893845	0	0	PATEL, ZUBIN B PHARMD	9/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86881	N/A	N/A	N/A	N/A	N/A	1440 W 25TH ST	None	SAN PEDRO	CA	90732	4418	00	06000	33.72189523	-118.3111002	Los Angeles County
341033	Ordering, Referring, Prescribing	N/A	1649055880	0	0	PATEL, AESHA NP	7/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026189	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
341035	Ordering, Referring, Prescribing	N/A	1649058421	0	0	POSEY, TINA M	10/4/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37104	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
341045	Ordering, Referring, Prescribing	N/A	1649212846	0	0	PERALTA, JANESSA I MD	5/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110592	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	190	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
341059	Ordering, Referring, Prescribing	N/A	1649300831	0	0	PEREZ, AIDA LMFT	9/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127958	N/A	N/A	N/A	N/A	N/A	3120 FREEBOARD DR.	102	WEST SACRAMENTO	CA	95691	5039	00	06000	38.5746747	-121.552383	Yolo County
341094	Ordering, Referring, Prescribing	N/A	1649348632	0	0	PEREZ, MARISSA LCSW	2/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105829	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
341121	Ordering, Referring, Prescribing	N/A	1649409194	0	0	PHAM, SHERRY PHARMD	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61832	N/A	N/A	N/A	N/A	N/A	21255 BURBANK BLVD	150	WOODLAND HILLS	CA	91364	0000	00	06000	34.17331011	-118.5940107	Los Angeles County
341158	Ordering, Referring, Prescribing	N/A	1649502220	0	0	PITKIN, DOROTHY C LCSW	7/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24219	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
341170	Ordering, Referring, Prescribing	N/A	1649529264	0	0	PACHECO, CASSANDRA R LCSW	9/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80478	N/A	N/A	N/A	N/A	N/A	500 N 9TH STREET	None	MODESTO	CA	95350	5814	00	06000	37.65145793	-121.0156971	Stanislaus County
341173	Ordering, Referring, Prescribing	N/A	1649540626	0	0	PARK, LINDA H PHARMD	8/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49113	N/A	N/A	N/A	N/A	N/A	1663 BRANHAM LN	None	SAN JOSE	CA	95118	2200	00	06000	37.25190008	-121.9076357	Santa Clara County
341188	Ordering, Referring, Prescribing	N/A	1649559618	0	0	PAK, ALLEX G LCSW	8/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69064	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	FL 4	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
341191	Ordering, Referring, Prescribing	N/A	1649564659	0	0	PRIETO, GEMA R LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112278	N/A	N/A	N/A	N/A	N/A	10 55 W HENDERSON AVENUE	4	PORTERVILLE	CA	93257	1490	00	06000	36.08007096	-119.0178839	Tulare County
341235	Ordering, Referring, Prescribing	N/A	1649621335	0	0	PHAM, XUAN MD	2/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170010	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
341243	Ordering, Referring, Prescribing	N/A	1649633207	0	0	PTASNIK, SARA	8/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151567	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	200	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
341274	Ordering, Referring, Prescribing	N/A	1649687104	0	0	PABLA, BALDEEP S LCSW	3/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85202	N/A	N/A	N/A	N/A	N/A	33 ENCINA AVE	None	PALO ALTO	CA	94301	2300	00	06000	37.43913037	-122.1608344	Santa Clara County
341280	Ordering, Referring, Prescribing	N/A	1649698549	0	0	PROCKS, MONICA D	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118978	N/A	N/A	N/A	N/A	N/A	501 N BROOKHURST ST	STE 320	ANAHEIM	CA	92801	5226	00	06000	33.8384428	-117.9590628	Orange County
341283	Ordering, Referring, Prescribing	N/A	1649691940	0	0	PARK, JAMES PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69537	N/A	N/A	N/A	N/A	N/A	21650 US HIGHWAY 18 APP	NA	APPLE VALLEY	CA	92307	9320	00	06000	34.50101847	-117.1914367	San Bernardino County
341297	Ordering, Referring, Prescribing	N/A	1649727066	0	0	PRESTON, JESSICA LCSW	3/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100590	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
341326	Ordering, Referring, Prescribing	N/A	1649783986	0	0	PHAM, LAURA H	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77602	N/A	N/A	N/A	N/A	N/A	4867 SUNSET BLVD	None	LOS ANGELES	CA	90027	0000	00	06000	34.0981755	-118.295055	Los Angeles County
341332	Ordering, Referring, Prescribing	N/A	1649787607	0	0	PAGE, BIANCA M DC	11/29/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33688	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	None	EL CAJON	CA	92020	3309	00	06000	32.79492453	-116.9627861	San Diego County
341376	Ordering, Referring, Prescribing	N/A	1649859604	0	0	PHAM, JULIE K MD	1/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183838	N/A	N/A	N/A	N/A	N/A	1731 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92461329	-118.2426436	Los Angeles County
341398	Ordering, Referring, Prescribing	N/A	1649932732	0	0	PHAM, DENISE	11/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58693	N/A	N/A	N/A	N/A	N/A	1037 W CARSON ST	None	TORRANCE	CA	90502	2005	00	06000	33.83160351	-118.2938715	Los Angeles County
341407	Ordering, Referring, Prescribing	N/A	1649956178	0	0	PEREZ, MARIBEL	7/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026197	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
341408	Ordering, Referring, Prescribing	N/A	1649951344	0	0	PHU, PAULA DMD	7/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109003	N/A	N/A	N/A	N/A	N/A	18700 MAIN ST	203	HUNTINGTON BEACH	CA	92648	1706	00	06000	33.69065401	-117.992907	Orange County
341440	Ordering, Referring, Prescribing	N/A	1659069714	0	0	PAREDES RAMIREZ, GUADALUPE A NP	2/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024378	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
341468	Ordering, Referring, Prescribing	N/A	1659303253	0	0	PADALA, NAGAMANI MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53554	N/A	N/A	N/A	N/A	N/A	N CALIFORNIA AVE,	1212	STOCKTON	CA	95202	1552	00	06000	37.96099285	-121.2866134	San Joaquin County
341471	Ordering, Referring, Prescribing	N/A	1659331320	0	0	PETERSON, STEVEN OD	5/13/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	7554	N/A	N/A	N/A	N/A	N/A	7090 PKWY DR	UNIT A	LA MESA	CA	91942	1596	00	06000	32.77342457	-117.043671	San Diego County
341486	Ordering, Referring, Prescribing	N/A	1659408094	0	0	PERRIN, FRANCINE S LMFT	5/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	27426	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
341490	Ordering, Referring, Prescribing	N/A	1659412666	0	0	PATEL, NARESH G	4/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C42959	N/A	N/A	N/A	N/A	N/A	201 REDLANDS AVE	None	PERRIS	CA	92571	2600	00	06000	33.7876093	-117.2155218	Riverside County
341501	Ordering, Referring, Prescribing	N/A	1659439875	0	0	PANELLI, MICHAEL PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50537	N/A	N/A	N/A	N/A	N/A	2619 KLINE CT	None	DAVIS	CA	95618	7668	00	06000	38.56683909	-121.7184507	Yolo County
341503	Ordering, Referring, Prescribing	N/A	1659447712	0	0	PIOLETTI, DAN J LCSW	10/2/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79464	N/A	N/A	N/A	N/A	N/A	1621 NORTH BROADWAY	None	WALNUT CREEK	CA	94596	4222	00	06000	37.90111363	-122.0605259	Contra Costa County
341531	Ordering, Referring, Prescribing	N/A	1659496495	0	0	PRESLEY, ANNETTE R LCSW	1/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14469	N/A	N/A	N/A	N/A	N/A	209 E 7TH ST.	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
341585	Ordering, Referring, Prescribing	N/A	1659623585	0	0	PAVLICS, ERIC S LCSW	3/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84625	N/A	N/A	N/A	N/A	N/A	439 W. 97TH STREET	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
341601	Ordering, Referring, Prescribing	N/A	1659641348	0	0	PARMELEE, SUSAN R LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75679	N/A	N/A	N/A	N/A	N/A	189 AVENIDA LA CUESTA	None	SAN CLEMENTE	CA	92673	5681	00	06000	33.436368	-117.6169455	Orange County
341656	Ordering, Referring, Prescribing	N/A	1659725653	0	0	PHAN, HOA V	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73406	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
341690	Ordering, Referring, Prescribing	N/A	1659766863	0	0	PACHECO, LISBETH LCSW	11/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127521	N/A	N/A	N/A	N/A	N/A	2620 INDUSTRY WAY	C	LYNWOOD	CA	90262	4024	00	06000	33.92360701	-118.2254995	Los Angeles County
341692	Ordering, Referring, Prescribing	N/A	1659767523	0	0	PAULITSCH-BUCKINGHAM, ANDREA MD	3/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161410	N/A	N/A	N/A	N/A	N/A	6010 HIDDEN VALLEY ROAD	115	CARLSBAD	CA	92011	4213	00	06000	33.12288368	-117.3058276	San Diego County
341744	Ordering, Referring, Prescribing	N/A	1659852168	0	0	PARK, JONATHAN	1/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72372	N/A	N/A	N/A	N/A	N/A	2395 E LACEY BLVD	None	HANFORD	CA	93230	4740	00	06000	36.325962	-119.606697	Kings County
341755	Ordering, Referring, Prescribing	N/A	1659866507	0	0	PARK, MINJU PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78472	N/A	N/A	N/A	N/A	N/A	226 RESERVATION RD	None	MARINA	CA	93933	3083	00	06000	36.68634976	-121.7972217	Monterey County
341763	Ordering, Referring, Prescribing	N/A	1659884484	0	0	PANTOJA, REFUGIO LMFT	10/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120931	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
341764	Ordering, Referring, Prescribing	N/A	1659884617	0	0	PARK, HOON DC	6/11/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	32536	N/A	N/A	N/A	N/A	N/A	8352 COMMONWEALTH AVE	None	BUENA PARK	CA	90621	2526	00	06000	33.8698947	-117.9872467	Orange County
341785	Ordering, Referring, Prescribing	N/A	1659916195	0	0	PASCHALL, KEVIN L PA-C	10/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57280	N/A	N/A	N/A	N/A	N/A	40700 CALIFORNIA OAKS RO	#205	MURRIETA	CA	92562	5795	00	06000	33.57067363	-117.2045035	Riverside County
341828	Ordering, Referring, Prescribing	N/A	1669035523	0	0	PERRY, ELIZABETH E MD	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180831	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
341942	Ordering, Referring, Prescribing	N/A	1669577128	0	0	PIERCE, KENNETH DO	5/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5734	N/A	N/A	N/A	N/A	N/A	1031 AVENIDA PICO	SUITE 103	SAN CLEMENTE	CA	92673	6352	00	06000	33.45715546	-117.5990722	Orange County
341957	Ordering, Referring, Prescribing	N/A	1669605374	0	0	PEREZ LOPEZ, MAYRA LCSW	11/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97377	N/A	N/A	N/A	N/A	N/A	7425 RANCHO LOS GUILICOS	None	SANTA ROSA	CA	95409	6519	00	06000	38.440908	-122.581638	Sonoma County
341978	Ordering, Referring, Prescribing	N/A	1669671202	0	0	PARSA, VIDA MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106451	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 120	OXNARD	CA	93036	2665	00	06000	34.219566	-119.1539365	Ventura County
342037	Ordering, Referring, Prescribing	N/A	1669801338	0	0	PEREDA, NANCY J MSW LCSW	11/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79026	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
342047	Ordering, Referring, Prescribing	N/A	1669808069	0	0	PUTILINA-NAYLOR, ANASTASSIA A LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103042	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
342052	Ordering, Referring, Prescribing	N/A	1669813648	0	0	PORTUGAL, ALNA B NP	8/11/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22793	N/A	N/A	N/A	N/A	N/A	8363 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4623	00	06000	34.22255941	-118.5361155	Los Angeles County
342057	Ordering, Referring, Prescribing	N/A	1669833885	0	0	PETITT, MEGAN A LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112156	N/A	N/A	N/A	N/A	N/A	6707 EMBARCADERO DR	None	STOCKTON	CA	95219	3382	00	06000	38.0025944	-121.3672861	San Joaquin County
342066	Ordering, Referring, Prescribing	N/A	1669829172	0	0	PHITHAYANUKARN, JOLIE P PHARMD	9/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70993	N/A	N/A	N/A	N/A	N/A	420 E 3RD ST	106	LOS ANGELES	CA	90013	0014	00	06000	34.04702011	-118.241912	Los Angeles County
342072	Ordering, Referring, Prescribing	N/A	1669865424	0	0	PETERSON, ROBERT DO	11/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14381	N/A	N/A	N/A	N/A	N/A	1045 W REDONDO BEACH BLV	3RD FLOOR	CITY IS NOT LISTE	CA	90247	4128	00	06000	33.89247044	-118.2931941	Los Angeles County
342081	Ordering, Referring, Prescribing	N/A	1669884490	0	0	PHAM, NHUNG P T MD	8/22/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151290	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
342108	Ordering, Referring, Prescribing	N/A	1669919346	0	0	PEREZ, DEBORAH LMFT	4/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132357	N/A	N/A	N/A	N/A	N/A	540 S EREMLAND DR	None	COVINA	CA	91723	3186	00	06000	34.079904	-117.8863235	Los Angeles County
342124	Ordering, Referring, Prescribing	N/A	1669951679	0	0	PICHEL, KARIN NP	12/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007459	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
342169	Ordering, Referring, Prescribing	N/A	1679036644	0	0	POLLEY, INDYANA	11/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57094	N/A	N/A	N/A	N/A	N/A	1431 MCHENRY AVE	100	MODESTO	CA	95350	4534	00	06000	37.664811	-120.993969	Stanislaus County
342212	Ordering, Referring, Prescribing	N/A	1679082515	0	0	PASELI, PAUL G PSYD	5/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31834	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
342215	Ordering, Referring, Prescribing	N/A	1679088991	0	0	PHAN, ALAIN PHARMD	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77900	N/A	N/A	N/A	N/A	N/A	23893 CLINTON KEITH RD	None	WILDOMAR	CA	92595	7894	00	06000	33.595668	-117.241912	Riverside County
342226	Ordering, Referring, Prescribing	N/A	1679105092	0	0	PHAM, KIM NGAN T PHARMD	9/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	48001	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	#110	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
342237	Ordering, Referring, Prescribing	N/A	1679130330	0	0	PEREZ, ROXANNA PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79616	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
342257	Ordering, Referring, Prescribing	N/A	1679180863	0	0	PANGANIBAN, JANNELYN M NP	7/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014874	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
342265	Ordering, Referring, Prescribing	N/A	1679198204	0	0	PRASAD, SHEENA S LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117622	N/A	N/A	N/A	N/A	N/A	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1392	00	06000	37.23418124	-121.7818366	Santa Clara County
342345	Ordering, Referring, Prescribing	N/A	1679648059	0	0	PIGEON, MARAL G PHARMD	4/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42694	N/A	N/A	N/A	N/A	N/A	411 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.8531521	-117.8160824	Orange County
342378	Ordering, Referring, Prescribing	N/A	1679731079	0	0	PADILLA, MARIA E LMFT	12/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129687	N/A	N/A	N/A	N/A	N/A	1411 NORTH GRAND AVENUE	100	COVINA	CA	91724	1005	00	06000	34.105149	-117.87435	Los Angeles County
342391	Ordering, Referring, Prescribing	N/A	1679750830	0	0	PARIS-POMBO, ALICIA MD	3/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110131	N/A	N/A	N/A	N/A	N/A	225 SPRUCE ST	None	GRIDLEY	CA	95948	2215	00	06000	39.36695351	-121.68954	Butte County
342402	Ordering, Referring, Prescribing	N/A	1679779425	0	0	PORSHIN, MARSHA LMFT	1/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT21761	N/A	N/A	N/A	N/A	N/A	10832 LAUREL ST	SUITE 102	RANCHO CUCAMONGA	CA	91730	3865	00	06000	34.10486789	-117.5684863	San Bernardino County
342450	Ordering, Referring, Prescribing	N/A	1679867154	0	0	PEMPLETON, KAYTASHA M NP	12/26/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	574684	N/A	N/A	N/A	N/A	N/A	1215 JEFFERSON ST	None	DELANO	CA	93215	1730	00	06000	35.77250027	-119.2451029	Kern County
342452	Ordering, Referring, Prescribing	N/A	1679867865	0	0	PAI, SUCHETA PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64506	N/A	N/A	N/A	N/A	N/A	13111 PEYTON DR	None	CHINO HILLS	CA	91709	6002	00	06000	34.014636	-117.741339	San Bernardino County
342475	Ordering, Referring, Prescribing	N/A	1679930127	0	0	PEREZ, JESSICA LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83060	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DR	None	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
342477	Ordering, Referring, Prescribing	N/A	1679924724	0	0	PHAN, TRAM H NP	12/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016189	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
342478	Ordering, Referring, Prescribing	N/A	1679937114	0	0	PERRY, LAUREN M MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151820	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
342483	Ordering, Referring, Prescribing	N/A	1679938419	0	0	PALAZZOLO, LYNNEA LMFT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120742	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
342484	Ordering, Referring, Prescribing	N/A	1679940969	0	0	POLOVETSKY, LINDA LMFT	7/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120134	N/A	N/A	N/A	N/A	N/A	1266 14TH STREET	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
342492	Ordering, Referring, Prescribing	N/A	1679955512	0	0	PHAN, KATHY T PHARMD	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61845	N/A	N/A	N/A	N/A	N/A	7201 YORKTOWN AVE	None	HUNTINGTON BEACH	CA	92648	2465	00	06000	33.67933951	-118.0027992	Orange County
342525	Ordering, Referring, Prescribing	N/A	1679996755	0	0	PEARCE, ELSA O LMFT	1/27/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152851	N/A	N/A	N/A	N/A	N/A	572 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1251	00	06000	34.109667	-117.289669	San Bernardino County
342570	Ordering, Referring, Prescribing	N/A	1689068629	0	0	PENA, ORLANDO I DO	12/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16913	N/A	N/A	N/A	N/A	N/A	42135 10TH STREET WEST	SUITE 101	LANCASTER	CA	93534	7099	00	06000	34.648533	-118.1477975	Los Angeles County
342603	Ordering, Referring, Prescribing	N/A	1689132235	0	0	PATEL-JOSHI, NIDHI PA	6/10/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64588	N/A	N/A	N/A	N/A	N/A	540 N MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	3662	00	06000	34.01856818	-118.105579	Los Angeles County
342605	Ordering, Referring, Prescribing	N/A	1689135071	0	0	PINTO, VANESSA DO	10/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20372	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
342618	Ordering, Referring, Prescribing	N/A	1689152712	0	0	PLATER, SIDNI LPCC	11/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	12750	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
342630	Ordering, Referring, Prescribing	N/A	1689167751	0	0	PALMER, JACQUELINE NP	3/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009676	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
342654	Ordering, Referring, Prescribing	N/A	1689201915	0	0	PARAD, JASON MD	11/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4664	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
342691	Ordering, Referring, Prescribing	N/A	1689264731	0	0	PATTERSON, LANCE P PHARMD	12/28/2020	Taxonomy not applicable	NA	n/a	000	Unknown	84040	N/A	N/A	N/A	N/A	N/A	250 PARKCENTER BLVD. MS	None	BOISE	ID	95642	9373	00	06000	43.59860438	-116.1806635	Ada County
342700	Ordering, Referring, Prescribing	N/A	1689292914	0	0	PHAM, THUY TIEN NP	1/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024031	N/A	N/A	N/A	N/A	N/A	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	00	06000	32.68298968	-117.1005464	San Diego County
342719	Ordering, Referring, Prescribing	N/A	1689349623	0	0	PILLAI, ANGELICA K OT	7/9/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	22564	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
342730	Ordering, Referring, Prescribing	N/A	1689371403	0	0	PHAM, ANDY D PHARMD	11/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87418	N/A	N/A	N/A	N/A	N/A	1414 EL CAMINO REAL	None	SAN JOSE	CA	94070	5102	00	06000	37.49716574	-122.2485578	San Mateo County
342732	Ordering, Referring, Prescribing	N/A	1689414914	0	0	PARK, TIFFANY	5/22/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35679	N/A	N/A	N/A	N/A	N/A	5460 E LA PALMA AVE	None	ANAHEIM	CA	92807	2023	00	06000	33.85983003	-117.7966383	Orange County
342738	Ordering, Referring, Prescribing	N/A	1689480782	0	0	PETERSEN, HALEY DDS	10/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110940	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
342746	Ordering, Referring, Prescribing	N/A	1689626483	0	0	PADUA, DANIEL N	5/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55584	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA RD.	None	VICTORVILLE	CA	92395	3850	00	06000	34.48058899	-117.2907353	San Bernardino County
342752	Ordering, Referring, Prescribing	N/A	1689640955	0	0	POTTER, MARK K MD	5/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G86920	N/A	N/A	N/A	N/A	N/A	6 WOODLAND RD	STE 205	ST HELENA	CA	94574	9501	00	06000	38.54297115	-122.4754501	Napa County
342787	Ordering, Referring, Prescribing	N/A	1689764029	0	0	PYEVICH, DANIELLE MD	1/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83010	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
342837	Ordering, Referring, Prescribing	N/A	1689891020	0	0	PENDURKAR, SHAKALPI R	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D50345	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
342856	Ordering, Referring, Prescribing	N/A	1689926297	0	0	PATEL, BELA R	10/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D61823	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
342883	Ordering, Referring, Prescribing	N/A	1689958845	0	0	PHAM, LILY A PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	55352	N/A	N/A	N/A	N/A	N/A	2680 REYNOLDS RANCH PKWY	None	LODI	CA	95240	6848	00	06000	38.1006	-121.263147	San Joaquin County
343001	Ordering, Referring, Prescribing	N/A	1699174953	0	0	PAREDES, ANGELICA M LCSW	3/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86983	N/A	N/A	N/A	N/A	N/A	14371 CLARK AVE	None	BELLFLOWER	CA	90706	2901	00	06000	33.90323754	-118.134141	Los Angeles County
343056	Ordering, Referring, Prescribing	N/A	1699272666	0	0	PICAZO, ANNAY LCSW	5/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115292	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
343086	Ordering, Referring, Prescribing	N/A	1699330845	0	0	PINON, JOHANNA	6/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011603	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	None	YREKA	CA	96097	3463	00	06000	41.71860037	-122.6467317	Siskiyou County
343119	Ordering, Referring, Prescribing	N/A	1699391631	0	0	PARK, IRENE M OD	6/23/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34547	N/A	N/A	N/A	N/A	N/A	1131 W 6TH ST	STE 150	ONTARIO	CA	91762	1116	00	06000	34.084404	-117.6717015	San Bernardino County
343146	Ordering, Referring, Prescribing	N/A	1699439927	0	0	PAK, CHRISTIAN D PHARMD	1/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85375	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
343171	Ordering, Referring, Prescribing	N/A	1699702456	0	0	PIENWONG, JENNIFER H MD	11/25/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80003	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
343173	Ordering, Referring, Prescribing	N/A	1699719369	0	0	PETRUNCIO, CLAUDIA M DO	11/7/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15732	N/A	N/A	N/A	N/A	N/A	3 MARCELA DR	None	WILLITS	CA	95490	5769	00	06000	39.38994445	-123.3393497	Mendocino County
343239	Ordering, Referring, Prescribing	N/A	1699882118	0	0	PHAN, VU H NP	11/13/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	786685	N/A	N/A	N/A	N/A	N/A	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92801	5927	00	06000	33.77746612	-117.9151381	Orange County
343251	Ordering, Referring, Prescribing	N/A	1699910232	0	0	POPLIN, SHERI A CNP	3/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003662	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
343262	Ordering, Referring, Prescribing	N/A	1699934497	0	0	PEVERIERI, SONJA S LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84724	N/A	N/A	N/A	N/A	N/A	1405 SPRUCE ST	A	RIVERSIDE	CA	92507	2410	00	06000	33.99027151	-117.34227	Riverside County
343321	Ordering, Referring, Prescribing	N/A	1700100641	0	0	PARDI, MEGHAN V	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53704	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
343360	Ordering, Referring, Prescribing	N/A	1700161130	0	0	PI, DANIEL	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42314	N/A	N/A	N/A	N/A	N/A	2680 UNION AVE	None	SAN JOSE	CA	95124	1348	00	06000	37.27315615	-121.9331705	Santa Clara County
343397	Ordering, Referring, Prescribing	N/A	1700207206	0	0	PELAYO-HICKLIN, ANGELICA LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75353	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
343469	Ordering, Referring, Prescribing	N/A	1700319043	0	0	PARK, CATHLEEN	7/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173521	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
343492	Ordering, Referring, Prescribing	N/A	1700351897	0	0	PIRZAI, TAMANA A	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79008	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
343500	Ordering, Referring, Prescribing	N/A	1700364155	0	0	PALOS KESSLER, ROSE M	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23639	N/A	N/A	N/A	N/A	N/A	699 SERRAMONTE BLVD	None	DALY CITY	CA	94015	4132	00	06000	37.66926686	-122.4773018	San Mateo County
343538	Ordering, Referring, Prescribing	N/A	1700402773	0	0	POON, VINCENT PA-C	10/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58539	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
343541	Ordering, Referring, Prescribing	N/A	1700432515	0	0	POWLEY, MATTHEW C NP	8/15/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012486	N/A	N/A	N/A	N/A	N/A	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	00	06000	34.02749142	-118.486063	Los Angeles County
343554	Ordering, Referring, Prescribing	N/A	1700443538	0	0	PEREZ, JESSICA J	2/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145048	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
343566	Ordering, Referring, Prescribing	N/A	1700453040	0	0	PRICE, DAVID	7/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95161156	N/A	N/A	N/A	N/A	N/A	205 N PARK AVE	None	AVENAL	CA	93204	1425	00	06000	36.00828573	-120.1255809	Kings County
343597	Ordering, Referring, Prescribing	N/A	1700545902	0	0	PETERSON, MICHELLE LCSW	11/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119345	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
343620	Ordering, Referring, Prescribing	N/A	1700654217	0	0	POOL, COURTNEY NP	5/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025233	N/A	N/A	N/A	N/A	N/A	15791 BEAR VALLEY RD	None	HESPERIA	CA	92345	1746	00	06000	34.47063553	-117.3190095	San Bernardino County
343637	Ordering, Referring, Prescribing	N/A	1700866571	0	0	PERERA, JOSEPH C MD	12/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48006	N/A	N/A	N/A	N/A	N/A	303 NORTH EAST ST	None	ANAHEIM	CA	92805	3341	00	06000	33.84042094	-117.9034309	Orange County
343640	Ordering, Referring, Prescribing	N/A	1700885977	0	0	PUTTLER, OLIVER L MD	6/6/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G13904	N/A	N/A	N/A	N/A	N/A	3798 JANES RD	15	ARCATA	CA	95521	4746	00	06000	40.89649119	-124.0930501	Humboldt County
343644	Ordering, Referring, Prescribing	N/A	1700900925	0	0	PEMBERTON, JENNIFER V PHD	12/17/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15438	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
343651	Ordering, Referring, Prescribing	N/A	1700925328	0	0	PITRE, TANISHA PSYD	4/17/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26007	N/A	N/A	N/A	N/A	N/A	8540 ALONDRA BLVD	SUITE B-2	PARAMOUNT	CA	90723	5200	00	06000	33.88915049	-118.1500515	Los Angeles County
343675	Ordering, Referring, Prescribing	N/A	1700968955	0	0	POURZAND-SIAHKAL, HAMIDEH NP	7/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	9629	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	SUITE 300	LOS ANGELES	CA	90250	2240	00	06000	33.92825048	-118.3539285	Los Angeles
343677	Ordering, Referring, Prescribing	N/A	1700968328	0	0	POTTS, RONNIE LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84486	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD STE	STE 100	CONCORD	CA	94520	7946	00	06000	37.97055112	-122.0492933	Contra Costa County
343726	Ordering, Referring, Prescribing	N/A	1710089321	0	0	PARRILLA, LEON R	12/4/2000	Taxonomy not applicable	NA	n/a	099	DENTIST	D44979	N/A	N/A	N/A	N/A	N/A	114 J ST	None	BRAWLEY	CA	92227	2328	00	06000	32.97418523	-115.5413549	Imperial County
343727	Ordering, Referring, Prescribing	N/A	1710092895	0	0	PARISH, GREGORY S	1/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D32377	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
343750	Ordering, Referring, Prescribing	N/A	1710156484	0	0	PIERCE, TIMOTHY S LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52328	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
343758	Ordering, Referring, Prescribing	N/A	1710178702	0	0	PATEL, DIVYANSU D MD	11/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175434	N/A	N/A	N/A	N/A	N/A	3400 DOUGLAS BLVD	225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
343778	Ordering, Referring, Prescribing	N/A	1710217823	0	0	PATEL, VIKRAM J	6/10/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	65187	N/A	N/A	N/A	N/A	N/A	16137 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10653119	-117.453131	San Bernardino County
343812	Ordering, Referring, Prescribing	N/A	1710264395	0	0	PARIKH, JAY N PHARMD	11/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	65714	N/A	N/A	N/A	N/A	N/A	1510 SAN PABLO ST.	SUITE 144	LOS ANGELES	CA	90033	4586	00	06000	34.06287152	-118.2029433	Los Angeles County
343818	Ordering, Referring, Prescribing	N/A	1710274170	0	0	PARRA, MARIA E DO	8/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12590	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
343823	Ordering, Referring, Prescribing	N/A	1710281316	0	0	PADALA, SHANTHI S	11/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62884	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
343849	Ordering, Referring, Prescribing	N/A	1710321500	0	0	PATEL-ROSS, SAPNA M CP	5/20/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25447	N/A	N/A	N/A	N/A	N/A	5266 HOLLISTER AVENUE	SUITE 200	SANTA BARBARA	CA	93111	4038	00	06000	34.43497016	-119.8071895	Santa Barbara County
343866	Ordering, Referring, Prescribing	N/A	1710356852	0	0	PEREZ, ELIZABETH T LCSW	5/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108170	N/A	N/A	N/A	N/A	N/A	1620 CUMMINS DR	None	MODESTO	CA	95358	6400	00	06000	37.658709	-121.036333	Stanislaus County
343874	Ordering, Referring, Prescribing	N/A	1710361712	0	0	PINEDO, YANELI M LCSW	10/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91103	N/A	N/A	N/A	N/A	N/A	302 N MIDWAY DR	None	ESCONDIDO	CA	92027	2708	00	06000	33.13619959	-117.0509061	San Diego County
343933	Ordering, Referring, Prescribing	N/A	1710453709	0	0	PORCHIA, TARINA LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100237	N/A	N/A	N/A	N/A	N/A	420 E CANAL DR	None	TURLOCK	CA	95380	3936	00	06000	37.50031455	-120.8439045	Stanislaus County
343938	Ordering, Referring, Prescribing	N/A	1710464011	0	0	PORTILLO, CHRISTIAN J LCSW	4/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100896	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
343941	Ordering, Referring, Prescribing	N/A	1710460357	0	0	PATEL, PAVAN J	8/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72575	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
343971	Ordering, Referring, Prescribing	N/A	1710518998	0	0	PIZENO, MAYRA K LCSW	12/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112887	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
343988	Ordering, Referring, Prescribing	N/A	1710552773	0	0	PANCHUMARTHI, CHANDRA SEKHAR PHARMD	4/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65850	N/A	N/A	N/A	N/A	N/A	7072 N CEDAR AVE	None	FRESNO	CA	93720	3300	00	06000	36.83844242	-119.7540735	Fresno County
344010	Ordering, Referring, Prescribing	N/A	1710639240	0	0	PESQUEDA, JOSE PA-C	12/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA60664	N/A	N/A	N/A	N/A	N/A	4723 W MAIN ST.	SUITE H	GUADALUPE	CA	93434	1787	00	06000	34.9576413	-120.5778803	Santa Barbara County
344041	Ordering, Referring, Prescribing	N/A	1710936166	0	0	PALMER, ROLF G MD	4/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A39999	N/A	N/A	N/A	N/A	N/A	817 MEADOW CREEK CT	None	WALNUT CREEK	CA	94596	5346	00	06000	37.892466	-122.050341	Contra Costa County
344068	Ordering, Referring, Prescribing	N/A	1720066954	0	0	PECK, JOHN W DC	2/20/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	28417	N/A	N/A	N/A	N/A	N/A	1201 INDUSTRIAL ST	None	REDDING	CA	96002	0757	00	06000	40.57469253	-122.349645	Shasta County
344071	Ordering, Referring, Prescribing	N/A	1720090640	0	0	PINTO, REGINA M PHD	8/16/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19582	N/A	N/A	N/A	N/A	N/A	1704 CAPE HORN AVE	None	JULIAN	CA	92036	0000	00	06000	33.07703283	-116.5974387	San Diego County
344096	Ordering, Referring, Prescribing	N/A	1720140759	0	0	POYAN, FARZANA	8/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	61742	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
344099	Ordering, Referring, Prescribing	N/A	1720154370	0	0	PIEDRA, ISABELLA N	7/2/2002	Taxonomy not applicable	NA	n/a	099	DENTIST	D47307	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BOULEVARD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
344102	Ordering, Referring, Prescribing	N/A	1720154909	0	0	PATEL, AKSHAI PHARMD	3/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	49388	N/A	N/A	N/A	N/A	N/A	331 MAIN ST	None	SALINAS	CA	93901	2705	00	06000	36.67295657	-121.6546689	Monterey County
344155	Ordering, Referring, Prescribing	N/A	1720266984	0	0	PEDRIQUEZ, LAREINA R MD	4/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C177699	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA	101	HARBOR CITY	CA	90710	2067	00	06000	33.79785936	-118.3016552	Los Angeles County
344167	Ordering, Referring, Prescribing	N/A	1720304447	0	0	PURI, SANJEEV N MD	7/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116772	N/A	N/A	N/A	N/A	N/A	50 BELLEFONTAINE ST	SUITE 304	PASADENA	CA	91105	3132	00	06000	34.13155953	-118.1517525	Los Angeles County
344177	Ordering, Referring, Prescribing	N/A	1720309529	0	0	PINTO, CHRISTINA A DO	2/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11049	N/A	N/A	N/A	N/A	N/A	4723 W MAIN ST	STE. H	GUADALUPE	CA	93434	1787	00	06000	34.9576413	-120.5778803	Santa Barbara County
344190	Ordering, Referring, Prescribing	N/A	1720336803	0	0	PHUNG, YEN PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67300	N/A	N/A	N/A	N/A	N/A	11290 DONNER PASS RD	None	TRUCKEE	CA	96161	4808	00	06000	39.32610429	-120.2065557	Nevada County
344199	Ordering, Referring, Prescribing	N/A	1720340896	0	0	PETRIE, LY N	5/2/2014	Taxonomy not applicable	NA	n/a	099	DENTIST	D63273	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
344257	Ordering, Referring, Prescribing	N/A	1720418684	0	0	PEREZCHICA, GABRIELA LCSW	1/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106621	N/A	N/A	N/A	N/A	N/A	241 EAST LAKE AVE	None	WATSONVILLE	CA	95076	4717	00	06000	36.91439331	-121.7546492	Santa Cruz County
344265	Ordering, Referring, Prescribing	N/A	1720423031	0	0	PAOLONE, DANIELA LMFT	10/9/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90752	N/A	N/A	N/A	N/A	N/A	5655 LINDERO CANYON RD	225	WESTLAKE VILLAGE	CA	91362	4044	00	06000	34.15322429	-118.7996645	Los Angeles County
344269	Ordering, Referring, Prescribing	N/A	1720436660	0	0	PORTILLO, BRYAN S LMFT	2/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137724	N/A	N/A	N/A	N/A	N/A	1950 MARKET STREET	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
344282	Ordering, Referring, Prescribing	N/A	1720449218	0	0	PLEASANT, DAPHNE LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108192	N/A	N/A	N/A	N/A	N/A	3428 BUSKIRK #260	None	PLEASANT HILL	CA	94523	0187	00	06000	37.93879813	-122.0595437	Contra Costa County
344314	Ordering, Referring, Prescribing	N/A	1720490253	0	0	POLIVKA, STEVEN C LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90877	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	SUITE 100	CONCORD	CA	94520	4817	00	06000	37.98393807	-122.0466953	Contra Costa County
344316	Ordering, Referring, Prescribing	N/A	1720492135	0	0	PARKER-COLE, ALISON A	12/12/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D64338	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
344326	Ordering, Referring, Prescribing	N/A	1720508542	0	0	PHAM, KHANH PA-C	7/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA54587	N/A	N/A	N/A	N/A	N/A	12586 AVENUE 408	None	OROSI	CA	93647	9454	00	06000	36.53030229	-119.2915122	Tulare County
344343	Ordering, Referring, Prescribing	N/A	1720522766	0	0	PARK, JUNE P	12/19/2016	Taxonomy not applicable	NA	n/a	000	Unknown	54071	N/A	N/A	N/A	N/A	N/A	400 W 30TH STREET	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
344392	Ordering, Referring, Prescribing	N/A	1720593411	0	0	PARDO, MALISSA S LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113715	N/A	N/A	N/A	N/A	N/A	768 PLEASANT VALLEY RD,	STE 201	DIAMOND SPRINGS	CA	95619	9260	00	06000	38.69498433	-120.8070771	El Dorado County
344413	Ordering, Referring, Prescribing	N/A	1720636376	0	0	PAYNE, BRIDGETTE LCSW	9/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112652	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST	# 103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
344425	Ordering, Referring, Prescribing	N/A	1720646938	0	0	PATALANO, MARY P LMFT	10/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128833	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
344433	Ordering, Referring, Prescribing	N/A	1720664287	0	0	PADGETT, NATALIE MD	8/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184882	N/A	N/A	N/A	N/A	N/A	4460 BROAD ST	STE 110	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.24211197	-120.6389543	San Luis Obispo County
344447	Ordering, Referring, Prescribing	N/A	1720722614	0	0	PONCE, JESSLYN OT	10/5/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	25554	N/A	N/A	N/A	N/A	N/A	2650 E FOOTHILL BLVD	None	PASADENA	CA	91107	1002	00	06000	34.14982934	-118.0957459	Los Angeles County
344464	Ordering, Referring, Prescribing	N/A	1720776768	0	0	PARIZHER, JACQUELINE PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86495	N/A	N/A	N/A	N/A	N/A	101 GROVE STREET	None	SAN FRANCISCO	CA	94102	4505	00	06000	37.77838012	-122.4187191	San Francisco County
344518	Ordering, Referring, Prescribing	N/A	1730219379	0	0	PINON-CHAVEZ, SANDRA A LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47630	N/A	N/A	N/A	N/A	N/A	18780 AMAR ROAD	SUITE 204	WALNUT	CA	91789	4559	00	06000	34.02807335	-117.8924765	Los Angeles County
344530	Ordering, Referring, Prescribing	N/A	1730233818	0	0	PRUYN, ANGELICA	3/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27874	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
344573	Ordering, Referring, Prescribing	N/A	1730329780	0	0	PED, RYAN RALPH C	3/29/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0648463	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
344587	Ordering, Referring, Prescribing	N/A	1730374893	0	0	PAPAZYAN, AGNESA PSYD	2/13/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27872	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
344605	Ordering, Referring, Prescribing	N/A	1730420399	0	0	PURI, SANJEEV DO	2/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15903	N/A	N/A	N/A	N/A	N/A	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
344606	Ordering, Referring, Prescribing	N/A	1730420068	0	0	PADILLA, DANIELLE B LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86392	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST.	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
344612	Ordering, Referring, Prescribing	N/A	1730428988	0	0	PAYNE, SACHI LMFT	11/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52938	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
344650	Ordering, Referring, Prescribing	N/A	1730487257	0	0	PHAM, WENDY LCSW	12/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77963	N/A	N/A	N/A	N/A	N/A	21201 INDEPENDENT SCHOOL	None	CASTRO VALLEY	CA	94552	4826	00	06000	37.6991119	-122.0498492	Alameda County
344657	Ordering, Referring, Prescribing	N/A	1730501644	0	0	PATEL, SONAL B PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64788	N/A	N/A	N/A	N/A	N/A	1051 W BURBANK BLVD	None	BURBANK	CA	91506	1421	00	06000	34.186032	-118.324359	Los Angeles County
344692	Ordering, Referring, Prescribing	N/A	1730556150	0	0	PATEL, DAVE U PHARMD	4/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70775	N/A	N/A	N/A	N/A	N/A	1240 S MAGNOLIA AVE	None	ANAHEIM	CA	92804	5116	00	06000	33.815583	-117.9757915	Orange County
344711	Ordering, Referring, Prescribing	N/A	1730595950	0	0	PECK, EMILY A LCSW	1/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106502	N/A	N/A	N/A	N/A	N/A	200 24TH ST	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
344749	Ordering, Referring, Prescribing	N/A	1730666074	0	0	PADILLA, MELISSA LMFT	7/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139083	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	00	06000	33.966333	-118.3439975	Los Angeles County
344764	Ordering, Referring, Prescribing	N/A	1730686148	0	0	PYNES, MALISSA L MD	5/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178272	N/A	N/A	N/A	N/A	N/A	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
344773	Ordering, Referring, Prescribing	N/A	1730692542	0	0	PIRITZ, TAYLOR C LCSW	11/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105489	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
344784	Ordering, Referring, Prescribing	N/A	1730709940	0	0	PATEL, POOJA PA-C	12/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA58916	N/A	N/A	N/A	N/A	N/A	1414 S GRAND AVE	SUITE 210	LOS ANGELES	CA	90015	3067	00	06000	34.03661142	-118.2657227	Los Angeles County
344792	Ordering, Referring, Prescribing	N/A	1730731555	0	0	PASCAL, CLAUDIE R	8/28/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104002	N/A	N/A	N/A	N/A	N/A	1454 E SECOND STREET	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
344823	Ordering, Referring, Prescribing	N/A	1730796434	0	0	PAO, WILLIAM PHARMD	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	81672	N/A	N/A	N/A	N/A	N/A	800 REDWOOD HWY	None	MILL VALLEY	CA	94941	2350	00	06000	37.89689494	-122.5157635	Marin County
344825	Ordering, Referring, Prescribing	N/A	1730798273	0	0	PHUNG, JENNY LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117713	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5418	00	06000	38.425482	-122.75262	Sonoma County
344829	Ordering, Referring, Prescribing	N/A	1730836842	0	0	PANG, JASMINE K OT	7/7/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT23088	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
344865	Ordering, Referring, Prescribing	N/A	1730968124	0	0	PHILLIPS, MALIA L LCSW	11/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97066	N/A	N/A	N/A	N/A	N/A	1225 W. 190TH ST.	255	GARDENA	CA	90248	4342	00	06000	33.85835623	-118.2987754	Los Angeles County
344902	Ordering, Referring, Prescribing	N/A	1740309889	0	0	PEREZ-TESTO, ANNA LMFT	8/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52444	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA STREET	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
344910	Ordering, Referring, Prescribing	N/A	1740314152	0	0	PRYCE, JAMES D LCSW	6/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19347	N/A	N/A	N/A	N/A	N/A	4545 N WEST AVE	None	FRESNO	CA	93705	0946	00	06000	36.799623	-119.8264355	Fresno County
344932	Ordering, Referring, Prescribing	N/A	1740371780	0	0	POULSEN, MARIE PHD	3/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	10183	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MAILSTOP 53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
344946	Ordering, Referring, Prescribing	N/A	1740415850	0	0	PAU, CANDACE Y MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113354	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
344949	Ordering, Referring, Prescribing	N/A	1740419126	0	0	PARK, SHERIE L LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45397	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
344982	Ordering, Referring, Prescribing	N/A	1740508068	0	0	PEREZ, CRISTINA LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93541	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	0009	00	06000	34.54007429	-117.2744761	San Bernardino County
344983	Ordering, Referring, Prescribing	N/A	1740516806	0	0	PHILLIPS, ERIN M PHARMD	4/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63384	N/A	N/A	N/A	N/A	N/A	13652 CANTARA ST	MOB4 AREA 105	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
345016	Ordering, Referring, Prescribing	N/A	1740575513	0	0	PADILLA, JAZMIN LCSW	10/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	63581	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
345051	Ordering, Referring, Prescribing	N/A	1740623438	0	0	PLASCENCIA, VERONICA LCSW	5/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115563	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	0000	00	06000	34.09693522	-117.2986838	San Bernardino County
345087	Ordering, Referring, Prescribing	N/A	1740689348	0	0	PERALTA, QUINN LCSW	11/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127409	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
345112	Ordering, Referring, Prescribing	N/A	1740716687	0	0	PHAN, THOMAS MD	9/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170266	N/A	N/A	N/A	N/A	N/A	180 NEWPORT CENTER DR	235	NEWPORT BEACH	CA	92660	6972	00	06000	33.61250509	-117.8753746	Orange County
345121	Ordering, Referring, Prescribing	N/A	1740730050	0	0	PANG, KAYLA S PHARMD	6/15/2019	Taxonomy not applicable	NA	n/a	000	Unknown	74849	N/A	N/A	N/A	N/A	N/A	604 ROSE AVE	None	VENICE	CA	90291	2767	00	06000	33.99891527	-118.4714129	Los Angeles County
345134	Ordering, Referring, Prescribing	N/A	1740748102	0	0	PATEL, SOHILKUMAR P PHARMD	11/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81059	N/A	N/A	N/A	N/A	N/A	13085 CENTRAL AVE	2	CHINO	CA	91761	6724	00	06000	34.015761	-117.6891735	San Bernardino County
345154	Ordering, Referring, Prescribing	N/A	1740780030	0	0	PHAN, THANH TAM L PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78257	N/A	N/A	N/A	N/A	N/A	342 W CALAVERAS BLVD	None	MILPITAS	CA	95035	5131	00	06000	37.426839	-121.9117873	Santa Clara County
345180	Ordering, Referring, Prescribing	N/A	1740819531	0	0	PAK, MARCUS	1/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183832	N/A	N/A	N/A	N/A	N/A	18220 S BROADWAY	None	GARDENA	CA	90248	3534	00	06000	33.864894	-118.278473	Los Angeles County
345213	Ordering, Referring, Prescribing	N/A	1740893015	0	0	PEREZ, MAYRA A LCSW	4/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114860	N/A	N/A	N/A	N/A	N/A	300 FRANKLIN ST	None	ARVIN	CA	93203	1913	00	06000	35.20183593	-118.826895	Kern County
345219	Ordering, Referring, Prescribing	N/A	1740922251	0	0	PATEL, KHUSHALI	11/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65412	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
345222	Ordering, Referring, Prescribing	N/A	1740933399	0	0	PASHAYI-MARANDI, MINA DC	2/1/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36244	N/A	N/A	N/A	N/A	N/A	8527 SEPULVEDA BLVD	None	NORTH HILLS	CA	91343	5824	00	06000	34.225524	-118.4677265	Los Angeles County
345246	Ordering, Referring, Prescribing	N/A	1750016374	0	0	PUGLIESE, MADONNA LMFT	8/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148916	N/A	N/A	N/A	N/A	N/A	23461 S. POINTE DR.	100	LAGUNA HILLS	CA	92653	1523	00	06000	33.62535142	-117.7206568	Orange County
345284	Ordering, Referring, Prescribing	N/A	1750348025	0	0	POPLI, GAGANDEEP S MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90262	N/A	N/A	N/A	N/A	N/A	1620 CUMMINS DR	None	MODESTO	CA	95358	6400	00	06000	37.658709	-121.036333	Stanislaus County
345285	Ordering, Referring, Prescribing	N/A	1750318432	0	0	PAULE, WILLIAM J MD	6/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G84131	N/A	N/A	N/A	N/A	N/A	628 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	4131	00	06000	34.41910081	-119.7158618	Santa Barbara County
345290	Ordering, Referring, Prescribing	N/A	1750370904	0	0	PERLAS, JANE NP	9/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9080	N/A	N/A	N/A	N/A	N/A	3505 LONE TREE WAY STE 1	None	ANTIOCH	CA	94509	6067	00	06000	37.98725411	-121.8065036	Contra Costa County
345292	Ordering, Referring, Prescribing	N/A	1750392361	0	0	PARVEZ, ZAFAR MD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	C50247	N/A	N/A	N/A	N/A	N/A	35324 HWY 41	None	COARSEGOLD	CA	93614	0000	00	06000	37.26242065	-119.6987402	Madera County
345293	Ordering, Referring, Prescribing	N/A	1750391678	0	0	PEDERSON, JILL A LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20622	N/A	N/A	N/A	N/A	N/A	18350 MT LANGLEY ST.	#200	FOUNTAIN VALLEY	CA	92708	6904	00	06000	33.69633523	-117.9420534	Orange County
345303	Ordering, Referring, Prescribing	N/A	1750406500	0	0	PRINTUP-KHAN, TRACI R LCSW	1/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS16706	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	SUITE 500	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
345325	Ordering, Referring, Prescribing	N/A	1750424016	0	0	PREHODA, KAMI J LMFT	1/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47988	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY 49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
345329	Ordering, Referring, Prescribing	N/A	1750443594	0	0	PHEN, BOPHAL LCSW	6/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29401	N/A	N/A	N/A	N/A	N/A	160 EAST VIRGINIA STREET	100	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
345388	Ordering, Referring, Prescribing	N/A	1750598603	0	0	PEARSON, DENISE R NP	2/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	503284	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	0781	00	06000	40.157883	-122.2250685	Tehama County
345390	Ordering, Referring, Prescribing	N/A	1750605721	0	0	PATEL, NARESH R	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111561	N/A	N/A	N/A	N/A	N/A	631 COOPER RD	None	OXNARD	CA	93030	5427	00	06000	34.20454837	-119.1719737	Ventura County
345415	Ordering, Referring, Prescribing	N/A	1750663613	0	0	PATEL, MINAL S	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48314	N/A	N/A	N/A	N/A	N/A	1160 BROADWAY	None	BURLINGAME	CA	94010	3422	00	06000	37.58671897	-122.364233	San Mateo County
345436	Ordering, Referring, Prescribing	N/A	1750698924	0	0	PELK, JAMES B LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	16442	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD.	2000	LOS ANGELES	CA	90010	2151	00	06000	34.06170677	-118.302787	Los Angeles County
345437	Ordering, Referring, Prescribing	N/A	1750703385	0	0	PHIPPEN, DARIN E LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99747	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	STE B	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
345439	Ordering, Referring, Prescribing	N/A	1750683215	0	0	PAGLINAWAN, RICA PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55811	N/A	N/A	N/A	N/A	N/A	2720 41ST AVE	None	SOQUEL	CA	95073	2111	00	06000	36.986112	-121.9649115	Santa Cruz County
345460	Ordering, Referring, Prescribing	N/A	1750723011	0	0	PIERSANTE, TRACY L	8/12/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0529524	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
345465	Ordering, Referring, Prescribing	N/A	1750738217	0	0	PHAM, AN B PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71359	N/A	N/A	N/A	N/A	N/A	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	00	06000	38.57535	-121.407633	Sacramento County
345470	Ordering, Referring, Prescribing	N/A	1750746053	0	0	PALMA LIMA, MARINA BARCELLOS MD	1/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174749	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
345495	Ordering, Referring, Prescribing	N/A	1750767935	0	0	PITZER, LAUREN LCSW	11/17/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112133	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
345514	Ordering, Referring, Prescribing	N/A	1750806956	0	0	PEREGRINO, KARLA LMFT	4/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139118	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
345523	Ordering, Referring, Prescribing	N/A	1750819454	0	0	PALENIK, GRACE H LMFT	6/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126531	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
345524	Ordering, Referring, Prescribing	N/A	1750825212	0	0	PACHECO, YANIRA L NP	12/4/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	706589	N/A	N/A	N/A	N/A	N/A	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	00	06000	36.60787518	-119.4523704	Fresno County
345550	Ordering, Referring, Prescribing	N/A	1750865143	0	0	PEREZ, CHRISTY NP	7/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009385	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK STREET	SUITE C	MORENO VALLEY	CA	92553	5226	00	06000	33.932655	-117.261383	Riverside County
345552	Ordering, Referring, Prescribing	N/A	1750866141	0	0	PLASENCIA, NATALIE NP	9/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95171884	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
345601	Ordering, Referring, Prescribing	N/A	1750974549	0	0	PEREGRINE, SARAH LCSW	9/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104167	N/A	N/A	N/A	N/A	N/A	600 A STREET, STE A	None	DAVIS	CA	95616	3648	00	06000	38.5479381	-121.7477157	Yolo County
345616	Ordering, Referring, Prescribing	N/A	1750991220	0	0	PACK, ALYSSA T OD	8/7/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34608	N/A	N/A	N/A	N/A	N/A	890 EASTLAKE PARKWAY	102	CHULA VISTA	CA	91915	4520	00	06000	32.65223126	-116.9677279	San Diego County
345659	Ordering, Referring, Prescribing	N/A	1760098032	0	0	PHUNG, TAI T NP	12/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95019571	N/A	N/A	N/A	N/A	N/A	9353 VALLEY BLVD.	None	ROSEMEAD	CA	91770	1934	00	06000	34.08115618	-118.0651957	Los Angeles County
345698	Ordering, Referring, Prescribing	N/A	1760293807	0	0	PONCIANO, MEAGAN PA-C	1/16/2025	Taxonomy not applicable	NA	n/a	000	Unknown	PA65719	N/A	N/A	N/A	N/A	N/A	2813 S MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
345700	Ordering, Referring, Prescribing	N/A	1760422067	0	0	PARIKH, JAGDISH	7/29/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C00050485	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
345701	Ordering, Referring, Prescribing	N/A	1760269997	0	0	PAULI, TARA CNM	9/6/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236400	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
345715	Ordering, Referring, Prescribing	N/A	1760500912	0	0	PARRA, JESUS A LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42150	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
345717	Ordering, Referring, Prescribing	N/A	1760512982	0	0	PROULX, RACHEL M LMFT	2/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51022	N/A	N/A	N/A	N/A	N/A	2502 HUNTINGTON DR	None	DUARTE	CA	91010	2221	00	06000	34.13967149	-117.9511686	Los Angeles County
345724	Ordering, Referring, Prescribing	N/A	1760515886	0	0	PARK, ELIZABETH A PSYD	8/15/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27404	N/A	N/A	N/A	N/A	N/A	250 SOUTH G STREET	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
345727	Ordering, Referring, Prescribing	N/A	1760516173	0	0	PEREYRA, GLORIA A LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76273	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
345742	Ordering, Referring, Prescribing	N/A	1760549364	0	0	PAI, JACOB P	5/23/1994	Taxonomy not applicable	NA	n/a	099	DENTIST	D42080	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
345755	Ordering, Referring, Prescribing	N/A	1760569313	0	0	PINGITORE, MARGHERITA G LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39553	N/A	N/A	N/A	N/A	N/A	201 N COURT ST	None	VISALIA	CA	93291	4918	00	06000	36.331218	-119.292561	Tulare County
345771	Ordering, Referring, Prescribing	N/A	1760629729	0	0	PRESTLER, JEFFREY W PSYD	10/5/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24220	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
345801	Ordering, Referring, Prescribing	N/A	1760692339	0	0	PEREZ, DEANNA PA	7/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14650	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
345813	Ordering, Referring, Prescribing	N/A	1760714919	0	0	POWERS, NICHOLAS A LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80013	N/A	N/A	N/A	N/A	N/A	3125 MYERS STREET	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
345819	Ordering, Referring, Prescribing	N/A	1760711501	0	0	PADILLA, PABLO J LMFT	12/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122091	N/A	N/A	N/A	N/A	N/A	362 3RD ST	None	LAGUNA BEACH	CA	92651	2307	00	06000	33.54392197	-117.780894	Orange County
345823	Ordering, Referring, Prescribing	N/A	1760734032	0	0	PETERSON, JENYFFER PSYD	12/6/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28968	N/A	N/A	N/A	N/A	N/A	3939 ATLANTIC AVE	103	LONG BEACH	CA	90807	3529	00	06000	33.830073	-118.1851065	Los Angeles County
345835	Ordering, Referring, Prescribing	N/A	1760758007	0	0	PEREDIA, LISA M LMFT	1/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98988	N/A	N/A	N/A	N/A	N/A	1812 W. PARK AVE	None	REDLANDS	CA	92373	8014	00	06000	34.05931058	-117.216243	San Bernardino County
345845	Ordering, Referring, Prescribing	N/A	1760765085	0	0	PHAM, HUNG T	9/21/2017	Taxonomy not applicable	NA	n/a	000	Unknown	21904	N/A	N/A	N/A	N/A	N/A	12116 BEACH BLVD	None	STATON	CA	90680	3704	00	06000	33.78629892	-117.9927526	Orange County
345846	Ordering, Referring, Prescribing	N/A	1760768105	0	0	PHAM, VY T PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60920	N/A	N/A	N/A	N/A	N/A	7560 TOPANGA CYNYON	None	CANOGA PARK	CA	91303	1213	00	06000	34.207596	-118.605942	Los Angeles County
345866	Ordering, Referring, Prescribing	N/A	1760809610	0	0	PATEL, MINAL C MD	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140517	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
345891	Ordering, Referring, Prescribing	N/A	1760844047	0	0	PHAM, TRACY D T MD	7/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156867	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5731	00	06000	37.8237837	-122.2590026	Alameda County
345901	Ordering, Referring, Prescribing	N/A	1760852321	0	0	PASHEN, RIKKI S PSYD	3/5/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29477	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DRIVE	#210	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
345906	Ordering, Referring, Prescribing	N/A	1760845846	0	0	PALOMINO VARGAS, JORGE D MD	2/20/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159750	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
345913	Ordering, Referring, Prescribing	N/A	1760867345	0	0	PARK, JOANN PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72188	N/A	N/A	N/A	N/A	N/A	1405 W CAMERON AVE	None	VISALIA	CA	93277	9527	00	06000	36.292698	-119.306538	Tulare County
345924	Ordering, Referring, Prescribing	N/A	1760889646	0	0	PUGASHETTI, JANELLE V MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153996	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
345937	Ordering, Referring, Prescribing	N/A	1760898670	0	0	PACHECO-RAMIREZ, SANDY A LCSW	9/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104247	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
345940	Ordering, Referring, Prescribing	N/A	1760902696	0	0	PACE, BRADLEY B PA-C	4/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA54542	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
345944	Ordering, Referring, Prescribing	N/A	1760912497	0	0	POCHINI, CANDICE T LMFT	10/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122584	N/A	N/A	N/A	N/A	N/A	126 W 25TH AVE	200	SAN MATEO	CA	94403	2208	00	06000	37.54372082	-122.3074883	San Mateo County
345947	Ordering, Referring, Prescribing	N/A	1760918247	0	0	PHAN, HUY MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158351	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
345951	Ordering, Referring, Prescribing	N/A	1760920797	0	0	PATEL, BRIJESH N	10/3/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	616131	N/A	N/A	N/A	N/A	N/A	308 N LA CADENA DR	None	COLTON	CA	92324	2946	00	06000	34.06815282	-117.3240225	San Bernardino County
345963	Ordering, Referring, Prescribing	N/A	1760933808	0	0	PARELLA, STEVEN PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81358	N/A	N/A	N/A	N/A	N/A	10725 INTERNATIONAL DR	110	RANCHO CORDOVA	CA	95670	7967	00	06000	38.576079	-121.2938325	Sacramento County
345981	Ordering, Referring, Prescribing	N/A	1760959845	0	0	PARENTEAU, LINDSAY A PHARMD	4/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79820	N/A	N/A	N/A	N/A	N/A	1006 W WABASH AVE	None	EUREKA	CA	95501	2121	00	06000	40.79158228	-124.1830134	Humboldt County
345989	Ordering, Referring, Prescribing	N/A	1760963540	0	0	PAUL, RAJENA PHARMD	12/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76921	N/A	N/A	N/A	N/A	N/A	2901 RAILROAD AVE	None	PITTSBURG	CA	94565	0000	00	06000	38.00974746	-121.8920249	Contra Costa County
345993	Ordering, Referring, Prescribing	N/A	1760966410	0	0	PHUNG, STEPHANIE T	8/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55916	N/A	N/A	N/A	N/A	N/A	10700 MACARTHUR BLVD	None	OAKLAND	CA	94605	5298	00	06000	37.74201242	-122.151048	Alameda County
346011	Ordering, Referring, Prescribing	N/A	1770023335	0	0	PUN, LUCY K DO	10/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15258	N/A	N/A	N/A	N/A	N/A	18800 DELAWARE ST	800	HUNTINGTON BEACH	CA	92648	6019	00	06000	33.68911733	-117.9931535	Orange County
346015	Ordering, Referring, Prescribing	N/A	1770028029	0	0	PHAM, KATIE PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75859	N/A	N/A	N/A	N/A	N/A	27975 BRADLEY RD	None	MENIFEE	CA	92586	2273	00	06000	33.71488653	-117.1922164	Riverside County
346045	Ordering, Referring, Prescribing	N/A	1770073702	0	0	PHILLIPS, TRACY LMFT	12/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143790	N/A	N/A	N/A	N/A	N/A	809 PLUMAS ST	None	YUBA CITY	CA	95991	4437	00	06000	39.13989097	-121.6173645	Sutter County
346118	Ordering, Referring, Prescribing	N/A	1770295131	0	0	PEREZ CASTILLO, DAHLIA E NP	11/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95023348	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	SUITE K	SACRAMENTO	CA	95820	4717	00	06000	38.526282	-121.471398	Sacramento County
346119	Ordering, Referring, Prescribing	N/A	1770291346	0	0	PEARSON, KHYLE A NP	11/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023274	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8517	00	06000	32.773176	-115.5270465	Imperial County
346138	Ordering, Referring, Prescribing	N/A	1770554503	0	0	PUSSER, BENJAMIN DO	12/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23684	N/A	N/A	N/A	N/A	N/A	795 JOAQUIN ST	None	SUSANVILLE	CA	96130	9998	00	06000	40.42683779	-120.6570864	Lassen County
346154	Ordering, Referring, Prescribing	N/A	1770614869	0	0	PAVICH, TOM LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44489	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
346158	Ordering, Referring, Prescribing	N/A	1770617755	0	0	PONCE, DUNIA L NP	12/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9739	N/A	N/A	N/A	N/A	N/A	1403 W. LOMITA BLVD.	100	HARBOR CITY	CA	90710	2084	00	06000	33.79785936	-118.3016552	Los Angeles County
346167	Ordering, Referring, Prescribing	N/A	1770638736	0	0	POWERS, KAREN E LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39152	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	SUITE 200	CONCORD	CA	94520	4886	00	06000	37.98393807	-122.0466953	Contra Costa County
346174	Ordering, Referring, Prescribing	N/A	1770651770	0	0	PETERS, KATRINA D MD MPH	6/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G65513	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
346189	Ordering, Referring, Prescribing	N/A	1770693723	0	0	POPE, AISHA D LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23510	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
346201	Ordering, Referring, Prescribing	N/A	1770720104	0	0	PEREZ, JENNIFER V LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73390	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
346202	Ordering, Referring, Prescribing	N/A	1770723553	0	0	PERATT, KWITKA D MD	1/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106788	N/A	N/A	N/A	N/A	N/A	6301 BEACH BLVD	245	BUENA PARK	CA	90621	2840	00	06000	33.86880928	-117.9983013	Orange County
346229	Ordering, Referring, Prescribing	N/A	1770779613	0	0	PHILLIPS, SETH LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72291	N/A	N/A	N/A	N/A	N/A	39959 SIERRA HWY	150	PALMDALE	CA	93550	3320	00	06000	34.60850218	-118.1223966	Los Angeles County
346232	Ordering, Referring, Prescribing	N/A	1770782260	0	0	PFEIFFER, RICHARD D	2/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D15110	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
346236	Ordering, Referring, Prescribing	N/A	1770793200	0	0	PAYNE, ANDREA M PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59056	N/A	N/A	N/A	N/A	N/A	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
346287	Ordering, Referring, Prescribing	N/A	1770895930	0	0	PEGLOWSKI, JUSTIN J LCSW	7/26/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	R0789451	N/A	N/A	N/A	N/A	N/A	39990 FAURE RD	None	HEMET	CA	92544	9408	00	06000	33.54540303	-116.8982524	Riverside County
346289	Ordering, Referring, Prescribing	N/A	1770896052	0	0	PINEDA, GILLIAN H PHARMD	4/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60501	N/A	N/A	N/A	N/A	N/A	7112 N FRESNO ST	460	FRESNO	CA	93720	2940	00	06000	36.84013339	-119.7816198	Fresno County
346292	Ordering, Referring, Prescribing	N/A	1770900276	0	0	PARKER, BRIAN LPCC	12/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10882	N/A	N/A	N/A	N/A	N/A	124 MAIN ST	None	ROZEVILLE	CA	95678	2232	00	06000	38.75196548	-121.2861465	Placer County
346310	Ordering, Referring, Prescribing	N/A	1770930075	0	0	PALMER, ROSS MD	11/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154113	N/A	N/A	N/A	N/A	N/A	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	00	06000	32.99058739	-117.0752486	San Diego County
346325	Ordering, Referring, Prescribing	N/A	1770952418	0	0	PHAM, LISA T PHARMD	12/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	73465	N/A	N/A	N/A	N/A	N/A	11234 ANDERSON ST	LEVEL 1	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
346330	Ordering, Referring, Prescribing	N/A	1770962144	0	0	PHAM, HOA	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS101401	N/A	N/A	N/A	N/A	N/A	307 PLACENTIA AVE	None	NEWPORT BEACH	CA	92663	3310	00	06000	33.62631386	-117.9310576	Orange County
346350	Ordering, Referring, Prescribing	N/A	1770986952	0	0	PARKER, KAMALA R LPCC	12/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	11539	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD	None	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
346363	Ordering, Referring, Prescribing	N/A	1780006221	0	0	PAK, JINAH LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81188	N/A	N/A	N/A	N/A	N/A	11050 E ARTESIA BLVD	STE F	CERRITOS	CA	90703	2542	00	06000	33.8728535	-118.097847	Los Angeles County
346367	Ordering, Referring, Prescribing	N/A	1780018259	0	0	PELLEGRINI, MARION G NP	8/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010221	N/A	N/A	N/A	N/A	N/A	470 CASTRO ST	None	SAN FRANCISCO	CA	94114	2020	00	06000	37.76132744	-122.4350734	San Francisco County
346382	Ordering, Referring, Prescribing	N/A	1780045484	0	0	PERELL, JAMIE S	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104396	N/A	N/A	N/A	N/A	N/A	5980 WEBB STREET	None	LOOMIS	CA	95650	7625	00	06000	38.8221281	-121.1921002	Placer County
346402	Ordering, Referring, Prescribing	N/A	1780074039	0	0	PAOLINO, JULIA PA-C	6/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61176	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
346405	Ordering, Referring, Prescribing	N/A	1780081992	0	0	PEREZ, RENATO LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80282	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
346453	Ordering, Referring, Prescribing	N/A	1780135285	0	0	POWELL, GI ONTE NP	3/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029321	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE #A, B, C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
346456	Ordering, Referring, Prescribing	N/A	1780144907	0	0	PHU, LOAN PHARMD	5/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46648	N/A	N/A	N/A	N/A	N/A	2034 W PICO BLVD	None	LOS ANGELES	CA	90006	5011	00	06000	34.04706445	-118.2822723	Los Angeles County
346460	Ordering, Referring, Prescribing	N/A	1780155085	0	0	PARKER, AMY N NP	7/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4738	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
346476	Ordering, Referring, Prescribing	N/A	1780191312	0	0	PARK, MINJUNG K PHD	12/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60990	N/A	N/A	N/A	N/A	N/A	4881 LA PALMA AVE	None	LA PALMA	CA	90623	2019	00	06000	33.84635449	-118.0476675	Orange County
346502	Ordering, Referring, Prescribing	N/A	1780255745	0	0	PATEL, SMINU D DDS	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	106507	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
346512	Ordering, Referring, Prescribing	N/A	1780289306	0	0	POLMAN, KAYLA R PHARMD	12/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84356	N/A	N/A	N/A	N/A	N/A	2955 N TEGNER RD	None	TURLOCK	CA	95380	9401	00	06000	37.518768	-120.888963	Stanislaus County
346518	Ordering, Referring, Prescribing	N/A	1780296384	0	0	PORTILLO, MAYRA NP	1/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013841	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
346561	Ordering, Referring, Prescribing	N/A	1780466862	0	0	PHAM, HILARY H PHARMD	10/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88766	N/A	N/A	N/A	N/A	N/A	3970 RIVERMARK PLZ	None	SANTA CLARA	CA	95054	4155	00	06000	37.39481183	-121.9460207	Santa Clara County
346570	Ordering, Referring, Prescribing	N/A	1780661512	0	0	PUITA, SHARON L CNP	3/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14148	N/A	N/A	N/A	N/A	N/A	1551 BISHOP ST	None	SAN LUIS OBISPO	CA	93401	4635	00	06000	35.27475609	-120.6454494	San Luis Obispo County
346596	Ordering, Referring, Prescribing	N/A	1780716332	0	0	PRECIADO, JOHANNE LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45443	N/A	N/A	N/A	N/A	N/A	221 N ARDMORE AVE	6	LOS ANGELES	CA	90004	4503	00	06000	34.0759476	-118.301939	Los Angeles County
346597	Ordering, Referring, Prescribing	N/A	1780718890	0	0	POBLANO, MARLISA LMFT	11/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46805	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
346605	Ordering, Referring, Prescribing	N/A	1780730051	0	0	PASION, ALICE S	7/13/1992	Taxonomy not applicable	NA	n/a	099	DENTIST	D38111	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
346606	Ordering, Referring, Prescribing	N/A	1780747618	0	0	POWERS, VANDANA M PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46542	N/A	N/A	N/A	N/A	N/A	17284 SLOVER AVE	None	FONTANA	CA	92337	7584	00	06000	34.065396	-117.4277475	San Bernardino County
346608	Ordering, Referring, Prescribing	N/A	1780753731	0	0	PANDURO-MORALES, MARIA LMSW	1/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68024	N/A	N/A	N/A	N/A	N/A	20800 SHERMAN VAY	None	WINNETKA	CA	91306	1930	00	06000	34.20097455	-118.586502	Los Angeles County
346636	Ordering, Referring, Prescribing	N/A	1780816082	0	0	POLHEBER, AMELIA S NP	7/20/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	720327	N/A	N/A	N/A	N/A	N/A	4290 POLK AVENUE	None	SAN DIEGO	CA	92105	1524	00	06000	32.75143219	-117.1023434	San Diego County
346654	Ordering, Referring, Prescribing	N/A	1780854760	0	0	PETERSON, STEPHANIE A NP	3/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95020435	N/A	N/A	N/A	N/A	N/A	21449 ROUGHOUT RD	None	REDDING	CA	96003	8209	00	06000	40.62787196	-122.2606275	Shasta County
346663	Ordering, Referring, Prescribing	N/A	1780878488	0	0	PATIENCE, SYLVIA B	9/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	236190	N/A	N/A	N/A	N/A	N/A	250 LOCUST ST	None	SANTA CRUZ	CA	95060	3813	00	06000	36.97493323	-122.028799	Santa Cruz County
346674	Ordering, Referring, Prescribing	N/A	1780910612	0	0	PLATT, FELICIA G LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75075	N/A	N/A	N/A	N/A	N/A	2550 E. FOOTHILL BLVD.	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
346719	Ordering, Referring, Prescribing	N/A	1780981928	0	0	PEREZ, LYNNETTE CCC-SLP	7/25/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	35520	N/A	N/A	N/A	N/A	N/A	1277 BLOSSER LN	None	WILLITS	CA	95490	4163	00	06000	39.40108579	-123.3596637	Mendocino County
346769	Ordering, Referring, Prescribing	N/A	1790066058	0	0	PANTIC, LORRAINE R LMFT	2/20/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90972	N/A	N/A	N/A	N/A	N/A	260 HOSPITAL DRIVE	SUITE 101	UKIAH	CA	95482	4568	00	06000	39.15349918	-123.2039443	Mendocino County
346780	Ordering, Referring, Prescribing	N/A	1790068724	0	0	PADWAL, MADHURI	8/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80827	N/A	N/A	N/A	N/A	N/A	45 S EL CAMINO REAL	None	MILLBRAE	CA	94030	3124	00	06000	37.59720935	-122.3865478	San Mateo County
346798	Ordering, Referring, Prescribing	N/A	1790090264	0	0	PATCHA, PRASANTH MD FACS	7/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150993	N/A	N/A	N/A	N/A	N/A	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	00	06000	34.22073847	-118.532988	Los Angeles County
346805	Ordering, Referring, Prescribing	N/A	1790107597	0	0	PHAM, PETERSON Q LCSW	4/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101148	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	None	LONG BEACH	CA	90813	3271	00	06000	33.779655	-118.1880065	Los Angeles County
346812	Ordering, Referring, Prescribing	N/A	1790120053	0	0	PARK, CHRISTINE J MD	2/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133839	N/A	N/A	N/A	N/A	N/A	3727 MARCONI AVE	None	SACRAMENTO	CA	95821	5303	00	06000	38.618118	-121.376988	Sacramento County
346827	Ordering, Referring, Prescribing	N/A	1790150571	0	0	PATEL, KUNJAL R DDS	11/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS34037	N/A	N/A	N/A	N/A	N/A	36977 PARK AVENUE	None	BURNEY	CA	96013	4067	00	06000	40.87640189	-121.6730441	Shasta County
346837	Ordering, Referring, Prescribing	N/A	1790158038	0	0	POWELL, UTAH LCSW	5/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88734	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
346867	Ordering, Referring, Prescribing	N/A	1790195311	0	0	PEARLMAN, SANFORD H LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119327	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT	125 B	OAKLAND	CA	94605	2456	00	06000	37.768221	-122.17608	Alameda County
346880	Ordering, Referring, Prescribing	N/A	1790213494	0	0	PANG, HEIDI DO	6/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17268	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	None	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
346881	Ordering, Referring, Prescribing	N/A	1790211837	0	0	PUOY, LINH	1/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70941	N/A	N/A	N/A	N/A	N/A	745 W NAOMI AVE	None	ARCADIA	CA	91007	7517	00	06000	34.12373262	-118.0574689	Los Angeles County
346889	Ordering, Referring, Prescribing	N/A	1790227353	0	0	PAPINEAU, STACIE L PHD	7/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	5288	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	STE 300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
346893	Ordering, Referring, Prescribing	N/A	1790231231	0	0	PETERSON, DEBRA A	4/10/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100607	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
346911	Ordering, Referring, Prescribing	N/A	1790259687	0	0	PHILLIPS, ROSALYN LMFT	10/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT142179	N/A	N/A	N/A	N/A	N/A	180 VIA VERDE	200	SAN DIMAS	CA	91773	3993	00	06000	34.07767801	-117.8150295	Los Angeles County
346948	Ordering, Referring, Prescribing	N/A	1790312783	0	0	PENTAGULIO, CELENA D MD	3/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178633	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	None	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
346956	Ordering, Referring, Prescribing	N/A	1790327625	0	0	PADILLA, EMILY T LCSW	4/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114899	N/A	N/A	N/A	N/A	N/A	123 W GUTIERREZ ST	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
346962	Ordering, Referring, Prescribing	N/A	1790339158	0	0	POLLARD, SUSAN L LMFT	4/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139360	N/A	N/A	N/A	N/A	N/A	676 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3945	00	06000	35.27640631	-120.6628883	San Luis Obispo County
346986	Ordering, Referring, Prescribing	N/A	1790393825	0	0	PETERSON, ANDERS	6/12/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030546	N/A	N/A	N/A	N/A	N/A	1315 S ADAMS ST	None	FORT WORTH	TX	76104	4404	00	06000	32.72994159	-97.33672572	Tarrant County
346996	Ordering, Referring, Prescribing	N/A	1790443851	0	0	PIANO, KHARYL ANNE B CCC-SLP	12/7/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	29896	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
347040	Ordering, Referring, Prescribing	N/A	1790786341	0	0	PARK, CHRISTINE MD	8/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A74636	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
347073	Ordering, Referring, Prescribing	N/A	1790844512	0	0	PHAOUDOM, PUKAN LCSW	3/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25857	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
347109	Ordering, Referring, Prescribing	N/A	1790934453	0	0	PEREZ, SCOTT	9/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	19932	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE #A	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
347125	Ordering, Referring, Prescribing	N/A	1790970366	0	0	PITLUK, JESSICA D MD	11/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115360	N/A	N/A	N/A	N/A	N/A	5000 MACARTHUR BLVD	STE 117	OAKLAND	CA	94613	1301	00	06000	37.78221179	-122.1877	Alameda County
347145	Ordering, Referring, Prescribing	N/A	1801000732	0	0	PALACIOS, RICHARD	3/19/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT12213	N/A	N/A	N/A	N/A	N/A	9301 TAMPA AVE	SPACE 62	NORTHRIDGE	CA	91324	5694	00	06000	34.237512	-118.5535875	Los Angeles County
347183	Ordering, Referring, Prescribing	N/A	1801084561	0	0	PFLAUMER, EDWARD B PHD	2/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	10385	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
347191	Ordering, Referring, Prescribing	N/A	1801093307	0	0	POLTL, GINA LMFT	11/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123041	N/A	N/A	N/A	N/A	N/A	330 RANCHEROS DR	STE 106	SAN MARCOS	CA	92069	2965	00	06000	33.1388667	-117.1563523	San Diego County
347212	Ordering, Referring, Prescribing	N/A	1801136411	0	0	PARRAGA, AN-TONIA LMFT	6/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147520	N/A	N/A	N/A	N/A	N/A	12810 HEACOCK ST	B-202	MORENO VALLEY	CA	92553	2873	00	06000	33.934851	-117.2437635	Riverside County
347247	Ordering, Referring, Prescribing	N/A	1801182787	0	0	PAIS, RICHARD J LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85237	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
347249	Ordering, Referring, Prescribing	N/A	1801178140	0	0	PEREZ, KARLA M LCSW	4/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76673	N/A	N/A	N/A	N/A	N/A	3303 N. BROADWAY	None	LOS ANGELES	CA	90031	2830	00	06000	34.07380397	-118.20586	Los Angeles County
347286	Ordering, Referring, Prescribing	N/A	1801245527	0	0	PLOTTIER-RAMIREZ, LAURA S LMFT	10/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135458	N/A	N/A	N/A	N/A	N/A	499 LOMA ALTA AVE	None	LOS GATOS	CA	95030	6227	00	06000	37.21747493	-121.9662128	Santa Clara County
347292	Ordering, Referring, Prescribing	N/A	1801252226	0	0	PURDUE, CRYSTAL N LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74066	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
347340	Ordering, Referring, Prescribing	N/A	1801308747	0	0	PENA, BLANCA E LMFT	3/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138765	N/A	N/A	N/A	N/A	N/A	800 N STATE ST	None	UKIAH	CA	95482	3410	00	06000	39.15774044	-123.2085769	Mendocino County
347365	Ordering, Referring, Prescribing	N/A	1801346499	0	0	PREESHL, RUSSHELLE LMFT	3/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131772	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
347394	Ordering, Referring, Prescribing	N/A	1801406095	0	0	PARK, JANICE F PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80746	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	None	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
347410	Ordering, Referring, Prescribing	N/A	1801443080	0	0	PANIAGUA DE LEON, RHINA M LCSW	4/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107742	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
347415	Ordering, Referring, Prescribing	N/A	1801449152	0	0	PAL, PAYAL LCSW	10/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118804	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
347427	Ordering, Referring, Prescribing	N/A	1801476049	0	0	POON, SUK YI CHLOE OT	1/8/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	21456	N/A	N/A	N/A	N/A	N/A	215 W MISSION ST	None	SANTA BARBARA	CA	93101	2820	00	06000	34.42816282	-119.7173341	Santa Barbara County
347469	Ordering, Referring, Prescribing	N/A	1801674320	0	0	PEREZ, KERWIN PA	2/27/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64172	N/A	N/A	N/A	N/A	N/A	5549 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2068	00	06000	33.939216	-117.453893	Riverside County
347472	Ordering, Referring, Prescribing	N/A	1801809470	0	0	PERSON, DAWNETTE C NP	1/2/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14949	N/A	N/A	N/A	N/A	N/A	515 S FAIRMONT AVE	None	LODI	CA	95240	3834	00	06000	38.12786821	-121.2859247	San Joaquin County
347503	Ordering, Referring, Prescribing	N/A	1801927736	0	0	PEREZ-CORDERO, LIZ A PSYD	5/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21935	N/A	N/A	N/A	N/A	N/A	1000 SOUTH MAIN STREET	None	SALINAS	CA	93901	0000	00	06000	36.66226091	-121.6578913	Monterey County
347522	Ordering, Referring, Prescribing	N/A	1801974795	0	0	PHILIPPE, KATHRYN L LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97202	N/A	N/A	N/A	N/A	N/A	10 INDEPENDENCE CIRCLE	None	CHICO	CA	95973	0381	00	06000	39.77093631	-121.8750587	Butte County
347577	Ordering, Referring, Prescribing	N/A	1811079569	0	0	PLATT, STEPHANIE L LCSW	11/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25593	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
347595	Ordering, Referring, Prescribing	N/A	1811132152	0	0	PAGE, PAUL N MD	9/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99154	N/A	N/A	N/A	N/A	N/A	8100 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2353	00	06000	38.46078	-121.4177895	Sacramento County
347653	Ordering, Referring, Prescribing	N/A	1811250939	0	0	PIERCY, CYNTHIA A LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96854	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	2002	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
347690	Ordering, Referring, Prescribing	N/A	1811296288	0	0	PRINCE, JENNIFER L DO	2/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14479	N/A	N/A	N/A	N/A	N/A	30195 FRASER DR	None	LAKE ELSINORE	CA	92530	7006	00	06000	33.68444711	-117.3679692	Riverside County
347698	Ordering, Referring, Prescribing	N/A	1811323777	0	0	PUGASHETTI, NEIL B MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152222	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
347728	Ordering, Referring, Prescribing	N/A	1811370513	0	0	PHUNG, DUY PHARMD	9/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	CA66527	N/A	N/A	N/A	N/A	N/A	12475 RANCHO BERNARDO RD	None	SAN DIEGO	CA	92128	2143	00	06000	33.0185611	-117.0619766	San Diego County
347730	Ordering, Referring, Prescribing	N/A	1811377963	0	0	PHAM, BRIAN	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157599	N/A	N/A	N/A	N/A	N/A	4501 X STREET	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
347757	Ordering, Referring, Prescribing	N/A	1811410020	0	0	PADILLA JARDON, JESUS LCSW	2/8/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW128570	N/A	N/A	N/A	N/A	N/A	625 FAIR OAKS AVE	300	SOUTH PASADENA	CA	91030	2630	00	06000	34.117947	-118.1503575	Los Angeles County
347765	Ordering, Referring, Prescribing	N/A	1811416829	0	0	PICKERING, ELIZABETH F LCSW	7/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW108996	N/A	N/A	N/A	N/A	N/A	3400 MONTGOMERY DRIVE	None	SNAT ROSA	CA	95405	5142	00	06000	38.450268	-122.6774925	Sonoma County
347789	Ordering, Referring, Prescribing	N/A	1811454135	0	0	PENA, SUZANNE F NP	11/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95010396	N/A	N/A	N/A	N/A	N/A	315 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
347802	Ordering, Referring, Prescribing	N/A	1811480940	0	0	PI, JUNG HSIEN	7/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120143	N/A	N/A	N/A	N/A	N/A	16360 ROSCOE BLVD	None	VAN NUYS	CA	91406	3782	00	06000	34.22126852	-118.490805	Los Angeles County
347835	Ordering, Referring, Prescribing	N/A	1811539646	0	0	PAISLEY, BROOKE L LMFT	9/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134867	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
347864	Ordering, Referring, Prescribing	N/A	1811609100	0	0	PARK, YOUNG NP	10/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023005	N/A	N/A	N/A	N/A	N/A	8316 FOOTHILL BLVD	None	SUNLAND	CA	91040	2850	00	06000	34.25966652	-118.314342	Los Angeles County
347868	Ordering, Referring, Prescribing	N/A	1811621915	0	0	PHILLIPS, SHAUNTIE NP	3/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95020508	N/A	N/A	N/A	N/A	N/A	200 PORTER DR	200	SAN RAMON	CA	94583	1587	00	06000	37.77372204	-121.9911155	Contra Costa County
347872	Ordering, Referring, Prescribing	N/A	1811645294	0	0	PHAM, JOHNNY CHIEU OD	3/21/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35396	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
347895	Ordering, Referring, Prescribing	N/A	1811720162	0	0	PROCTOR, KYLE DDS	8/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110631	N/A	N/A	N/A	N/A	N/A	18144 SECO ST	None	JAMESTOWN	CA	95327	9498	00	06000	37.95208073	-120.4216785	Tuolumne County
347921	Ordering, Referring, Prescribing	N/A	1821021890	0	0	PUEN, ROYANNA J	1/8/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D45959	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LN	None	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
347964	Ordering, Referring, Prescribing	N/A	1821138116	0	0	PARRA, MARTHA D LCSW	11/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26484	N/A	N/A	N/A	N/A	N/A	21101 DALE EVANS PKWY	None	APPLE VALLEY	CA	92307	9356	00	06000	34.636896	-117.2026665	San Bernardino County
348024	Ordering, Referring, Prescribing	N/A	1821258252	0	0	PHAM, DUY LCSW	6/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS27878	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE #300	None	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
348036	Ordering, Referring, Prescribing	N/A	1821296658	0	0	PAN, ELVIRA C LCSW	12/18/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15279	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
348048	Ordering, Referring, Prescribing	N/A	1821318882	0	0	PHANGRATH, VICKI	1/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022650	N/A	N/A	N/A	N/A	N/A	5288 W NORMAL AVE	None	FRESNO	CA	93722	8720	00	06000	36.76705115	-119.8861311	Fresno County
348069	Ordering, Referring, Prescribing	N/A	1821359605	0	0	PATEL, AMAR V MD	3/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158295	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
348080	Ordering, Referring, Prescribing	N/A	1821370297	0	0	PATEL, ASHISH V PHARMD	2/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	63446	N/A	N/A	N/A	N/A	N/A	2121 N D ST	None	SAN BERNARDINO	CA	92405	3915	00	06000	34.13517012	-117.2918777	San Bernardino County
348095	Ordering, Referring, Prescribing	N/A	1821400490	0	0	PRIOR, JENNIFER M PA-C	1/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51663	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	300	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
348106	Ordering, Referring, Prescribing	N/A	1821411265	0	0	PRESLAR, SARAH E CNP	6/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95000243	N/A	N/A	N/A	N/A	N/A	9001 S H ST	None	BAKERSFIELD	CA	93307	5948	00	06000	35.27289	-119.0212895	Kern County
348115	Ordering, Referring, Prescribing	N/A	1821436882	0	0	PRASAD, AMITHA MD	2/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158657	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	None	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
348124	Ordering, Referring, Prescribing	N/A	1821442666	0	0	POWELL, KELLY DO	5/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18870	N/A	N/A	N/A	N/A	N/A	900 E MAIN ST.	SUITE 106	GRASS VALLEY	CA	95945	5853	00	06000	39.22827201	-121.0517684	Nevada County
348169	Ordering, Referring, Prescribing	N/A	1821512427	0	0	PELAEZ TORRES, YUDIER MD	7/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157318	N/A	N/A	N/A	N/A	N/A	250 W. 5TH ST.	None	HANFORD	CA	93230	4533	00	06000	36.32439821	-119.6472235	Kings County
348186	Ordering, Referring, Prescribing	N/A	1821530700	0	0	PATEL, RAHUL A	12/20/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100951	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
348208	Ordering, Referring, Prescribing	N/A	1821571043	0	0	PERRY, STEVEN T OD	9/10/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34101TLG	N/A	N/A	N/A	N/A	N/A	1800 FOURTH ST	None	LIVERMORE	CA	94550	4454	00	06000	37.67808567	-121.7724653	Alameda County
348222	Ordering, Referring, Prescribing	N/A	1821577222	0	0	PLANTAK, NATASHA S PA-C	3/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57944	N/A	N/A	N/A	N/A	N/A	264 N. HIGHLAND SPRINGS	None	BANNING	CA	92220	3045	00	06000	33.93063	-116.946864	Riverside County
348233	Ordering, Referring, Prescribing	N/A	1821616608	0	0	PEREZ, MELISSA	9/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA58553	N/A	N/A	N/A	N/A	N/A	33025 ROAD 159	None	IVANHOE	CA	93235	1234	00	06000	36.38892365	-119.2180107	Tulare County
348237	Ordering, Referring, Prescribing	N/A	1821616624	0	0	PALAGANAS, KAREN PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80418	N/A	N/A	N/A	N/A	N/A	1661 W FLORIDA AVE	None	HEMET	CA	92543	3818	00	06000	33.74737153	-116.988629	Riverside County
348303	Ordering, Referring, Prescribing	N/A	1821849522	0	0	PARASKEVAS, ANGELINE NP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025907	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE # A, B AND C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
348369	Ordering, Referring, Prescribing	N/A	1831303346	0	0	PEREIRA, EMILY C LCSW	5/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29693	N/A	N/A	N/A	N/A	N/A	130 W. 6TH STREET	None	CHICO	CA	95928	5508	00	06000	39.72719868	-121.8378568	Butte County
348393	Ordering, Referring, Prescribing	N/A	1831348440	0	0	POSALSKI, RICHARD LCSW	7/18/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	7191	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	4329	00	06000	34.41078438	-118.510775	Los Angeles County
348418	Ordering, Referring, Prescribing	N/A	1831408657	0	0	PHAM, JULIE T PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51532	N/A	N/A	N/A	N/A	N/A	1099 E HOSPITALITY LN	None	SAN BERNARDINO	CA	92408	2813	00	06000	34.06887134	-117.2625206	San Bernardino County
348478	Ordering, Referring, Prescribing	N/A	1831519701	0	0	PRUNTY, BARBARA LCSW	1/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77654	N/A	N/A	N/A	N/A	N/A	1620 N CARPENTER RD	D 49	MODESTO	CA	95351	1153	00	06000	37.65976262	-121.0310604	Stanislaus County
348479	Ordering, Referring, Prescribing	N/A	1831523729	0	0	PAN, LAURA M LMFT	8/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99864	N/A	N/A	N/A	N/A	N/A	3303 N. BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
348483	Ordering, Referring, Prescribing	N/A	1831525583	0	0	PHAM, HELEN N PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69674	N/A	N/A	N/A	N/A	N/A	40663 CALIFORNIA OAKS RD	None	MURRIETA	CA	92562	5729	00	06000	33.57229056	-117.2037807	Riverside County
348512	Ordering, Referring, Prescribing	N/A	1831572833	0	0	PENN, EMILY B LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109189	N/A	N/A	N/A	N/A	N/A	6850 MORRO RD	None	ASTASCADERO	CA	93422	4123	00	06000	35.48202343	-120.6660628	San Luis Obispo County
348525	Ordering, Referring, Prescribing	N/A	1831593375	0	0	PEREDA, DAISY LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109384	N/A	N/A	N/A	N/A	N/A	315 W HALEY ST	102	SANTA BARBARA	CA	93101	3471	00	06000	34.41320534	-119.6993554	Santa Barbara County
348542	Ordering, Referring, Prescribing	N/A	1831623495	0	0	PARK, BYEONG HO LAC	1/13/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	16548	N/A	N/A	N/A	N/A	N/A	1529 E. PALMDALE BLVD SU	None	PALMDALE	CA	93550	2029	00	06000	34.57966052	-118.102275	Los Angeles County
348578	Ordering, Referring, Prescribing	N/A	1831668987	0	0	PHAN, CHRISTINA	5/31/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56836	N/A	N/A	N/A	N/A	N/A	912 FREMONT STREET	None	DELANO	CA	93215	4827	00	06000	35.76763031	-119.2498143	Kern County
348597	Ordering, Referring, Prescribing	N/A	1831686377	0	0	PERRY, CHRISTINE LMFT	3/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115985	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
348619	Ordering, Referring, Prescribing	N/A	1831703552	0	0	PETROS, DIANA NP	12/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015383	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD GRAS	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
348620	Ordering, Referring, Prescribing	N/A	1831712249	0	0	PADILLA, MIRIAM MD	2/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184548	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
348635	Ordering, Referring, Prescribing	N/A	1831748938	0	0	PORTER, DENISSE A	9/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012709	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
348662	Ordering, Referring, Prescribing	N/A	1831814748	0	0	POUDYAL, SITASHI DMD	5/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107459	N/A	N/A	N/A	N/A	N/A	65 S HOCKETT ST	None	PORTERVILLE	CA	93257	4728	00	06000	36.06415362	-119.0171608	Tulare County
348710	Ordering, Referring, Prescribing	N/A	1841016508	0	0	PATEL, HIMALI M CNP	9/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95032283	N/A	N/A	N/A	N/A	N/A	12162 COUNTRY CLUB LN	None	GRAND TERRACE	CA	92313	5341	00	06000	34.03275319	-117.3067568	San Bernardino County
348719	Ordering, Referring, Prescribing	N/A	1841076684	0	0	PARQUE, CHERRYN PA	9/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63331	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
348729	Ordering, Referring, Prescribing	N/A	1841231263	0	0	PAVIA-SANCHEZ, ORESTES A MD	4/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C139299	N/A	N/A	N/A	N/A	N/A	8787 HALL RD	None	LAMONT	CA	93241	1953	00	06000	35.25969451	-118.908099	Kern County
348731	Ordering, Referring, Prescribing	N/A	1841240181	0	0	PANMAN, LEE M MD	1/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A23774	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	300	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
348733	Ordering, Referring, Prescribing	N/A	1841272218	0	0	PATEL, MANOJ K MD	8/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52248	N/A	N/A	N/A	N/A	N/A	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
348744	Ordering, Referring, Prescribing	N/A	1841315009	0	0	PARK, JUNE K LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42545	N/A	N/A	N/A	N/A	N/A	11100 ARTESIA BLVD	STE A	CERRITOS	CA	90703	2547	00	06000	33.87288108	-118.097253	Los Angeles County
348767	Ordering, Referring, Prescribing	N/A	1841365863	0	0	PONNALA, SRIDEVI J	4/27/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D53026	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
348784	Ordering, Referring, Prescribing	N/A	1841384922	0	0	PARK, SUSIE K PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53746	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
348836	Ordering, Referring, Prescribing	N/A	1841484789	0	0	PRICE, STACY H LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80098	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	8TH FLOOR	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
348885	Ordering, Referring, Prescribing	N/A	1841562733	0	0	PORTNOY, PAMELA S NP	4/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21608	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	WEST SACRAMENTO	CA	95605	2494	00	06000	38.58811316	-121.5270471	Yolo County
348890	Ordering, Referring, Prescribing	N/A	1841569860	0	0	PHAM, THUY T PHARMD	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53964	N/A	N/A	N/A	N/A	N/A	10990 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	3849	00	06000	33.7162557	-117.9373439	Orange County
348920	Ordering, Referring, Prescribing	N/A	1841607124	0	0	PATEL, ARATI LMFT	6/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105734	N/A	N/A	N/A	N/A	N/A	28310 ROADSIDE DR	SUITE 111	AGOURA HILLS	CA	91301	4923	00	06000	34.14271418	-118.7432847	Los Angeles County
348938	Ordering, Referring, Prescribing	N/A	1841646981	0	0	PIMENTEL, NORIANNE M MD	5/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140310	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS 82	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
348953	Ordering, Referring, Prescribing	N/A	1841671591	0	0	PHAM, DAVID V MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152624	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
348954	Ordering, Referring, Prescribing	N/A	1841666716	0	0	PAEK, CYNTHIA M	6/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89570	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
349016	Ordering, Referring, Prescribing	N/A	1841755931	0	0	PRIESKORN, ERIN L LMFT	1/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137457	N/A	N/A	N/A	N/A	N/A	16390 MAIN ST	None	GUERNEVILLE	CA	95446	9677	00	06000	38.5020015	-123.0000255	Sonoma County
349018	Ordering, Referring, Prescribing	N/A	1841766920	0	0	PAPPAS, KELSEY C PA	10/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56147	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVENUE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
349024	Ordering, Referring, Prescribing	N/A	1841772597	0	0	PEINADO, VERONICA MSW LCSW	5/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88148	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5486	00	06000	38.425266	-122.749875	Sonoma County
349036	Ordering, Referring, Prescribing	N/A	1841786498	0	0	PATIMETEEPORN, TANYA LCSW	4/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101111	N/A	N/A	N/A	N/A	N/A	1520 N RAYMOND AVE	None	PASADENA	CA	91103	1819	00	06000	34.171812	-118.1490725	Los Angeles County
349089	Ordering, Referring, Prescribing	N/A	1841916145	0	0	PUCCI, NICOYA CNM	11/29/2022	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236317	N/A	N/A	N/A	N/A	N/A	14671 OLYMPIC DR	None	CLEARLAKE	CA	95422	9516	00	06000	38.9618304	-122.6382453	Lake County
349130	Ordering, Referring, Prescribing	N/A	1851019368	0	0	PRAKASH, SEEMA R DMD MSD	8/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107779	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
349181	Ordering, Referring, Prescribing	N/A	1851423156	0	0	PONCE, ARCELIA LCSW	4/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24567	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
349215	Ordering, Referring, Prescribing	N/A	1851467617	0	0	POWELL, PATRICIA M LCSW	4/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16794	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD.	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
349216	Ordering, Referring, Prescribing	N/A	1851471916	0	0	PRADA-QUAN, GLORIA C LCSW	11/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS18653	N/A	N/A	N/A	N/A	N/A	19231 VICTORY BLVD	SUITE 110	RESEDA	CA	91335	6321	00	06000	34.18659852	-118.552221	Los Angeles County
349232	Ordering, Referring, Prescribing	N/A	1851518096	0	0	PRAVEEN, MEENA C	1/22/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D48169	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	5826	00	06000	37.00852861	-121.5694352	Santa Clara County
349253	Ordering, Referring, Prescribing	N/A	1851572127	0	0	PAREDES, MONICA S PA-C	1/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	19275	N/A	N/A	N/A	N/A	N/A	4129 E. GAGE AVE	None	BELL	CA	90201	1128	00	06000	33.97868838	-118.1928157	Los Angeles County
349303	Ordering, Referring, Prescribing	N/A	1851653059	0	0	POTTER, MARLA K MD	5/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137121	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
349363	Ordering, Referring, Prescribing	N/A	1851737407	0	0	PROSE, ELLEN I LCSW	7/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88612	N/A	N/A	N/A	N/A	N/A	242 N VILLA AVE	None	WILLOWS	CA	95988	2641	00	06000	39.52243848	-122.208844	Glenn County
349371	Ordering, Referring, Prescribing	N/A	1851739528	0	0	PEREZ, MICHELLE A LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102144	N/A	N/A	N/A	N/A	N/A	3221 COHASSET RD	100	CHICO	CA	95973	5405	00	06000	39.77553102	-121.8437686	Butte County
349377	Ordering, Referring, Prescribing	N/A	1851763783	0	0	PUN, STACEY MD	7/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160550	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	600	LOS ANGELES	CA	90017	3907	00	06000	34.05270508	-118.2641005	Los Angeles County
349381	Ordering, Referring, Prescribing	N/A	1851765192	0	0	PINTADO HERNANDEZ, VALERIE PSYD	9/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32076	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
349435	Ordering, Referring, Prescribing	N/A	1851836324	0	0	PINEDA, ISRAEL LMFT	10/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135126	N/A	N/A	N/A	N/A	N/A	1612 FIRST ST.	None	COACHELLA	CA	92236	1407	00	06000	33.68337881	-116.1784614	Riverside County
349446	Ordering, Referring, Prescribing	N/A	1851860613	0	0	PEDERSEN, NIKKI L LMFT	8/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127368	N/A	N/A	N/A	N/A	N/A	6635 FLORENCE AVE.	SUITE 101	BELL GARDENS	CA	90201	0001	00	06000	33.96212715	-118.1462995	Los Angeles County
349481	Ordering, Referring, Prescribing	N/A	1851928121	0	0	PENALOZA PACHECO, JUAN F MD	5/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178289	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349525	Ordering, Referring, Prescribing	N/A	1861017873	0	0	POOUDOMSAK, VALERIE I MD	5/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179010	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
349534	Ordering, Referring, Prescribing	N/A	1861041147	0	0	PIATT, NICHOLE LCSW	7/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116293	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	100	LOS ANGELES	CA	90018	1336	00	06000	34.037415	-118.3176815	Los Angeles County
349553	Ordering, Referring, Prescribing	N/A	1861055352	0	0	POTTER, DAVID PHARMD	4/11/2019	Taxonomy not applicable	NA	n/a	000	Unknown	80421	N/A	N/A	N/A	N/A	N/A	5918 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	3229	00	06000	37.696693	-121.9317572	Alameda County
349561	Ordering, Referring, Prescribing	N/A	1861105785	0	0	POTLURI, NEERAJA PHARMD	1/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84358	N/A	N/A	N/A	N/A	N/A	2605 MIDDLEFIELD RD	None	PALO ALTO	CA	94306	2516	00	06000	37.43410933	-122.1303843	Santa Clara County
349583	Ordering, Referring, Prescribing	N/A	1861258725	0	0	POSTELLE, LESLIE NP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029089	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	300	LAWNDALE	CA	90260	0000	00	06000	33.898572	-118.3527775	Los Angeles County
349617	Ordering, Referring, Prescribing	N/A	1861525370	0	0	PENAFIEL, MICHAEL LMFT	11/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52733	N/A	N/A	N/A	N/A	N/A	625 FAIR OAKS AVE	300	SOUTH PASADENA	CA	91030	2630	00	06000	34.117947	-118.1503575	Los Angeles County
349622	Ordering, Referring, Prescribing	N/A	1861532301	0	0	PINSON, LETITIA A MD	3/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G82101	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
349654	Ordering, Referring, Prescribing	N/A	1861591646	0	0	PRATT, CAROLYN K MD	5/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G55706	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	125	OXNARD	CA	93036	8226	00	06000	34.219566	-119.1539365	Ventura County
349656	Ordering, Referring, Prescribing	N/A	1861611386	0	0	PAK, PATRICK PA	5/6/2019	Taxonomy not applicable	NA	n/a	000	Unknown	15188	N/A	N/A	N/A	N/A	N/A	1307 W 6TH STREET	SUITE 113	CORONA	CA	92882	1642	00	06000	33.87790309	-117.589666	Riverside County
349675	Ordering, Referring, Prescribing	N/A	1861651069	0	0	PINEDA, TANIA F LMFT	5/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT147093	N/A	N/A	N/A	N/A	N/A	108 WEST VICTORIA STREET	None	GARDENA	CA	90248	9024	00	06000	33.86509452	-118.2762279	Los Angeles County
349679	Ordering, Referring, Prescribing	N/A	1861682569	0	0	PAL, IOANA PSYD	3/18/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28368	N/A	N/A	N/A	N/A	N/A	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1638	00	06000	33.808185	-118.1850575	Los Angeles County
349681	Ordering, Referring, Prescribing	N/A	1861687345	0	0	PERALES, JOSEPH E LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78176	N/A	N/A	N/A	N/A	N/A	1501 FRUITVALE AVE	None	OAKLAND	CA	94601	2322	00	06000	37.77894489	-122.2252034	Alameda County
349692	Ordering, Referring, Prescribing	N/A	1861708554	0	0	PERRY, KASEY S DDS	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D59560	N/A	N/A	N/A	N/A	N/A	198 N G STREET	None	EMPIRE	CA	95319	5132	00	06000	37.64084134	-120.9011164	Stanislaus County
349715	Ordering, Referring, Prescribing	N/A	1861740136	0	0	PADILLA, EVA M MD	6/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156405	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
349723	Ordering, Referring, Prescribing	N/A	1861747982	0	0	POON, LAYHEARB T LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59608	N/A	N/A	N/A	N/A	N/A	4510 EAST PACIFIC COAST	SUITE 600	LONG BEACH	CA	90804	6914	00	06000	33.78815204	-118.1400821	Los Angeles County
349729	Ordering, Referring, Prescribing	N/A	1861771370	0	0	PAPANI, RAVIKANTH MD	12/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	166936	N/A	N/A	N/A	N/A	N/A	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	00	06000	33.94909549	-118.3481595	Los Angeles County
349732	Ordering, Referring, Prescribing	N/A	1861761983	0	0	PHAM, JULIE K PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65296	N/A	N/A	N/A	N/A	N/A	128 S STATE COLLEGE BLVD	None	ANAHEIM	CA	92806	2921	00	06000	33.840252	-117.889103	Orange County
349740	Ordering, Referring, Prescribing	N/A	1861774812	0	0	PATEL, SANJAY R	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH44827	N/A	N/A	N/A	N/A	N/A	333 EL CAMINO REAL	None	SAN BRUNO	CA	94066	4839	00	06000	37.62052886	-122.411011	San Mateo County
349769	Ordering, Referring, Prescribing	N/A	1861826299	0	0	PORTILLO GONZALEZ, ADRIANA LMFT	5/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85676	N/A	N/A	N/A	N/A	N/A	21455 BIRCH ST	None	HAYWARD	CA	94541	2165	00	06000	37.68159734	-122.0935159	Alameda County
349812	Ordering, Referring, Prescribing	N/A	1861892788	0	0	PADILLA, TATIANA R	9/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96994	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
349817	Ordering, Referring, Prescribing	N/A	1861893901	0	0	POUROMID, KOUSHYAR PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70951	N/A	N/A	N/A	N/A	N/A	10955 MAGNOLIA BLVD	None	NORTH HOLLYWOOD	CA	91601	0000	00	06000	34.16490852	-118.3694715	Los Angeles County
349819	Ordering, Referring, Prescribing	N/A	1861899650	0	0	PRETTAPAPOP, PAUL NP	5/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025321	N/A	N/A	N/A	N/A	N/A	16255 VENTURA BLVD	SUITE 500	ENCINO	CA	91436	2302	00	06000	34.15693902	-118.4876816	Los Angeles County
349851	Ordering, Referring, Prescribing	N/A	1861947228	0	0	PHAM, CATHERINE PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74820	N/A	N/A	N/A	N/A	N/A	30116 EIGENBRODT WAY	None	UNION CITY	CA	94587	1225	00	06000	37.60846354	-122.0715526	Alameda County
349879	Ordering, Referring, Prescribing	N/A	1861990053	0	0	PACKARD, CANDICE A LMFT	7/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125086	N/A	N/A	N/A	N/A	N/A	7412 JOSHUA LANE	None	YUCCA VALLEY	CA	92284	3747	00	06000	34.11779727	-116.4160432	San Bernardino County
349888	Ordering, Referring, Prescribing	N/A	1871004044	0	0	PENDLETON, ROBIN E NP	8/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013006	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	4245	00	06000	40.58349378	-122.3853903	Shasta County
349908	Ordering, Referring, Prescribing	N/A	1871033530	0	0	POWERS, JAMES J NP	4/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005871	N/A	N/A	N/A	N/A	N/A	2121 NILES ST	None	BAKERSFIELD	CA	93305	5007	00	06000	35.37666351	-118.9688275	Kern County
349933	Ordering, Referring, Prescribing	N/A	1871072736	0	0	PEREIRA, MARIANA D	5/1/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	102781	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
349935	Ordering, Referring, Prescribing	N/A	1871073411	0	0	PANGOTTIL, JISHA C NP	6/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009215	N/A	N/A	N/A	N/A	N/A	1501 E HOLT AVE	A	POMONA	CA	91767	5823	00	06000	34.06321709	-117.7205804	Los Angeles County
349954	Ordering, Referring, Prescribing	N/A	1871097287	0	0	PATEL, POOJA H MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163832	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349960	Ordering, Referring, Prescribing	N/A	1871101717	0	0	PETERSON-HOLT, NANCY K LMFT	8/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34388	N/A	N/A	N/A	N/A	N/A	7820 MONTANA ST.	None	LEMON GROVE	CA	91945	2945	00	06000	32.73650961	-117.02971	San Diego County
349972	Ordering, Referring, Prescribing	N/A	1871124719	0	0	PRICE, MIUREL PA-C	2/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA58113	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
349984	Ordering, Referring, Prescribing	N/A	1871147579	0	0	POLACHEK, JOEL R LMFT	2/27/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109146	N/A	N/A	N/A	N/A	N/A	300 S BEVERLY DR	412	BEVERLY HILLS	CA	90212	4808	00	06000	34.06187273	-118.3990929	Los Angeles County
349996	Ordering, Referring, Prescribing	N/A	1871167387	0	0	PHAM, CHARLEEN T PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79909	N/A	N/A	N/A	N/A	N/A	1101 S SANDERSON AVE	None	HEMET	CA	92545	9047	00	06000	33.728832	-117.0066995	Riverside County
350001	Ordering, Referring, Prescribing	N/A	1871185744	0	0	PALACIOS, NATALIA LPCC	7/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14261	N/A	N/A	N/A	N/A	N/A	460 N MAGNOLIA AVE	SUITE 110	EL CAJON	CA	92020	3610	00	06000	32.800266	-116.962389	San Diego County
350053	Ordering, Referring, Prescribing	N/A	1871374488	0	0	PERKINS, RANDALL K PA-C	11/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63656	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	SUITE 108/109	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
350070	Ordering, Referring, Prescribing	N/A	1871600288	0	0	PEKO-RIOS, MARIA MD	7/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54934	N/A	N/A	N/A	N/A	N/A	209 E 7TH ST	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
350082	Ordering, Referring, Prescribing	N/A	1871623751	0	0	PORTER, TERRY LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50119	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
350135	Ordering, Referring, Prescribing	N/A	1871721647	0	0	PERSICHINO, DENISE R DO	1/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9889	N/A	N/A	N/A	N/A	N/A	17053 E. FOOTHILL BLVD.	BUILDING B	FONTANA	CA	92335	9988	00	06000	34.10655148	-117.432828	San Bernardino County
350139	Ordering, Referring, Prescribing	N/A	1871741553	0	0	PEREZ, RUDOLPHO LCSW	10/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91751	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
350175	Ordering, Referring, Prescribing	N/A	1871807016	0	0	PLEITEZ, ERICK A	9/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D59456	N/A	N/A	N/A	N/A	N/A	8787 HALL RD	None	LAMONT	CA	93241	1953	00	06000	35.25969451	-118.908099	Kern County
350177	Ordering, Referring, Prescribing	N/A	1871808576	0	0	PATEL, MANOJ B PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51041	N/A	N/A	N/A	N/A	N/A	16900 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	5904	00	06000	33.881058	-118.1252535	Los Angeles County
350188	Ordering, Referring, Prescribing	N/A	1871824276	0	0	PEREGRINA RAMIREZ, JESSICA LCSW	8/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96326	N/A	N/A	N/A	N/A	N/A	205 39TH ST.	None	RICHMOND	CA	94805	2212	00	06000	37.93301316	-122.3325599	Contra Costa County
350209	Ordering, Referring, Prescribing	N/A	1871856385	0	0	PLUM-SANTOS, LANETTE R LCSW	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100800	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DR	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
350216	Ordering, Referring, Prescribing	N/A	1871861781	0	0	PRECIADO, LAURA M LCSW	4/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88476	N/A	N/A	N/A	N/A	N/A	1499 HUNTINGTON DR	SUITE 101	PASADENA	CA	91030	4552	00	06000	34.10404853	-118.150551	Los Angeles County
350229	Ordering, Referring, Prescribing	N/A	1871877951	0	0	PHAM, THI T PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54716	N/A	N/A	N/A	N/A	N/A	350 N CAPITOL AVE	None	SAN JOSE	CA	95133	1937	00	06000	37.37182239	-121.8445339	Santa Clara County
350232	Ordering, Referring, Prescribing	N/A	1871882704	0	0	PERTZ, SANDRA V MD	6/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129906	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	SUITE 709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
350237	Ordering, Referring, Prescribing	N/A	1871893305	0	0	PAN, CHEN-YIN PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53570	N/A	N/A	N/A	N/A	N/A	4041 N SIERRA WAY	None	SAN BERNARDINO	CA	92407	3816	00	06000	34.16544	-117.2850005	San Bernardino County
350290	Ordering, Referring, Prescribing	N/A	1871969097	0	0	PHAM, ALINA OD	10/8/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15267	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST	SUITE 101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
350292	Ordering, Referring, Prescribing	N/A	1871972315	0	0	POLLARD, SHELLEE G LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18320	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	8TH FLOOR	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
350316	Ordering, Referring, Prescribing	N/A	1881000164	0	0	PHAN, TRUNG V OD	6/18/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT15031	N/A	N/A	N/A	N/A	N/A	610 COTTONWOOD ST	None	WOODLAND	CA	95695	3615	00	06000	38.67351395	-121.7933438	Yolo County
350337	Ordering, Referring, Prescribing	N/A	1881042067	0	0	PHAN, HENRY PHARMD	10/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	CA45144	N/A	N/A	N/A	N/A	N/A	1910 N CAMPUS AVE	None	UPLAND	CA	91784	1667	00	06000	34.13230802	-117.6383398	San Bernardino County
350351	Ordering, Referring, Prescribing	N/A	1881058022	0	0	PILE, ELIZABETH NP	1/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002663	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
350358	Ordering, Referring, Prescribing	N/A	1881063683	0	0	PEREIRA, LUIS LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25389	N/A	N/A	N/A	N/A	N/A	919 1ST ST.	None	SAN FERNANDO	CA	91340	2957	00	06000	34.28328995	-118.4389224	Los Angeles County
350389	Ordering, Referring, Prescribing	N/A	1881104370	0	0	PACE, STEVIE V NP	5/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	202109888NPPP	N/A	N/A	N/A	N/A	N/A	1225 NE 2ND AVE	None	PORTLAND	OR	97232	2003	00	06000	45.53179918	-122.6637358	Multnomah County
350404	Ordering, Referring, Prescribing	N/A	1881128197	0	0	POUDEL, MANOJ K MD	7/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173493	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350408	Ordering, Referring, Prescribing	N/A	1881128668	0	0	PENDLETON, GRACE LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119604	N/A	N/A	N/A	N/A	N/A	16650 SHERMAN WAY	404	VAN NUYS	CA	91406	3782	00	06000	34.20108451	-118.4959755	Los Angeles County
350417	Ordering, Referring, Prescribing	N/A	1881136786	0	0	PENNACHIO, KLARA E LMFT	4/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113128	N/A	N/A	N/A	N/A	N/A	3940-7351 BROAD STREET	None	SAN LUIS OBISPO	CA	93401	7015	00	06000	35.24886415	-120.6432859	San Luis Obispo County
350437	Ordering, Referring, Prescribing	N/A	1881179414	0	0	PINZON, AMBER N LMFT	5/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146721	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
350463	Ordering, Referring, Prescribing	N/A	1881221190	0	0	PANCHAL, HEMALI V MD	3/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176903	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350490	Ordering, Referring, Prescribing	N/A	1881273829	0	0	PATEL, JOY MD	4/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195436	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
350504	Ordering, Referring, Prescribing	N/A	1881314508	0	0	PACHECO, MARISSA NP	8/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022317	N/A	N/A	N/A	N/A	N/A	2400 GLENDALE LN	None	SACRAMENTO	CA	95825	2431	00	06000	38.597355	-121.405212	Sacramento County
350542	Ordering, Referring, Prescribing	N/A	1881627693	0	0	PALTIN, SHARON R MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G66767	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
350567	Ordering, Referring, Prescribing	N/A	1881725406	0	0	PURPUS, DEBBIE LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41800	N/A	N/A	N/A	N/A	N/A	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
350568	Ordering, Referring, Prescribing	N/A	1881724292	0	0	PATEL, ALPA A MD	11/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67355	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
350634	Ordering, Referring, Prescribing	N/A	1881866275	0	0	PRIYANKA, PRIYANKA MD	11/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119376	N/A	N/A	N/A	N/A	N/A	7750 N FRESNO ST	104	FRESNO	CA	93720	2410	00	06000	36.85139259	-119.7836202	Fresno County
350651	Ordering, Referring, Prescribing	N/A	1881924629	0	0	PONTEMAYOR, RUBY JANE U PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57769	N/A	N/A	N/A	N/A	N/A	408 WHITEHALL RD	APT C	ALAMEDA	CA	94501	6100	00	06000	37.75892402	-122.2566606	Alameda County
350694	Ordering, Referring, Prescribing	N/A	1881988467	0	0	PESSEGUEIRO, EVA C MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120619	N/A	N/A	N/A	N/A	N/A	8616 LA TIJERA BLVD	SUITE 200	LOS ANGELES	CA	90045	3944	00	06000	33.95943215	-118.3918599	Los Angeles County
350696	Ordering, Referring, Prescribing	N/A	1881994325	0	0	PALIVOS, CONSTANDINA PHD	11/23/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25179	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
350702	Ordering, Referring, Prescribing	N/A	1881995041	0	0	PRENDERGAST, DECLAN G PHARMD	11/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43386	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD MS	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
350706	Ordering, Referring, Prescribing	N/A	1891011078	0	0	PODSADA, KIMBERLY C NP	2/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0622357	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	STE 600	SANTA MONICA	CA	90404	2131	00	06000	34.02901811	-118.4795396	Los Angeles County
350728	Ordering, Referring, Prescribing	N/A	1881994937	0	0	PATEL, AMIT D PHARMD	11/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	55988	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD.	#99	MISSION VIEJO	CA	92691	6413	00	06000	33.55952733	-117.6645199	Orange County
350735	Ordering, Referring, Prescribing	N/A	1891072153	0	0	PATEL, RINA PHARMD	9/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62381	N/A	N/A	N/A	N/A	N/A	1990 MONUMENT BLVD	None	CONCORD	CA	94520	3800	00	06000	37.95593881	-122.0395891	Contra Costa County
350763	Ordering, Referring, Prescribing	N/A	1891101408	0	0	PEREZ, MARY C LCSW	6/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101750	N/A	N/A	N/A	N/A	N/A	2500 SOUTH C ST	C	OXNARD	CA	93033	4560	00	06000	34.17646093	-119.1812737	Ventura County
350780	Ordering, Referring, Prescribing	N/A	1891132288	0	0	PHAN, TRANG N LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96373	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	None	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
350793	Ordering, Referring, Prescribing	N/A	1891149076	0	0	POOLEY GILLESPIE, CECELIA LCSW	12/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99066	N/A	N/A	N/A	N/A	N/A	150 RAMSEY RD	None	LAYTONVILLE	CA	95454	0868	00	06000	39.6853496	-123.4833802	Mendocino County
350797	Ordering, Referring, Prescribing	N/A	1891161212	0	0	PO, SANDRA JULIA L	2/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99935	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE.	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
350801	Ordering, Referring, Prescribing	N/A	1891160503	0	0	PATEL, CHIRAG NP	11/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95003438	N/A	N/A	N/A	N/A	N/A	1130 COUNTRY CLUB DR	E	MADERA	CA	93638	2691	00	06000	36.97610274	-120.0742439	Madera County
350814	Ordering, Referring, Prescribing	N/A	1891177259	0	0	PEARSALL, CHRISTOPHER C LMFT	1/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137456	N/A	N/A	N/A	N/A	N/A	1001 STONEMAN AVE	None	PITTSBURG	CA	94565	5479	00	06000	38.00374709	-121.8768059	Contra Costa County
350825	Ordering, Referring, Prescribing	N/A	1891183067	0	0	PESQUEIRA, ANA G LCSW	5/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89026	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
350828	Ordering, Referring, Prescribing	N/A	1891186003	0	0	PAZ, ANDREA	3/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83890	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
350862	Ordering, Referring, Prescribing	N/A	1891254884	0	0	PAN, MIN S PA-C	2/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56588	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
350884	Ordering, Referring, Prescribing	N/A	1891308417	0	0	PARK, KEVIN PHARMD	3/9/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82234	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
350890	Ordering, Referring, Prescribing	N/A	1891312104	0	0	PATEL, RUPANGI S PHARMD	8/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82415	N/A	N/A	N/A	N/A	N/A	2345 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92027	8333	00	06000	33.14045456	-117.0453396	San Diego County
350894	Ordering, Referring, Prescribing	N/A	1891328910	0	0	PEREZ, MARGARET E	2/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113537	N/A	N/A	N/A	N/A	N/A	25910 ACERO	STE 160	MISSION VIEJO	CA	92691	2777	00	06000	33.61712389	-117.6780482	Orange County
350930	Ordering, Referring, Prescribing	N/A	1891427290	0	0	PINHASSIAN, TAMARA LPCC	12/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	18280	N/A	N/A	N/A	N/A	N/A	1161BAY BLVD	SUITE B	CHULA VISTA	CA	91911	4321	00	06000	32.6050811	-117.0922508	San Diego County
350933	Ordering, Referring, Prescribing	N/A	1891427845	0	0	PABLOS-VELEZ, XOCHITL PA-C	1/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62283	N/A	N/A	N/A	N/A	N/A	3260 SACRAMENTO ST	None	BERKELEY	CA	94702	2739	00	06000	37.8481184	-122.2779098	Alameda County
350949	Ordering, Referring, Prescribing	N/A	1891458428	0	0	PALOMARES, AXXEL PHARMD	9/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85028	N/A	N/A	N/A	N/A	N/A	3222 UNIVERSITY AVE	None	SAN DIEGO	CA	92104	2010	00	06000	32.74852553	-117.124866	San Diego County
350962	Ordering, Referring, Prescribing	N/A	1891531349	0	0	PLACK, MARTHA NP	7/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031369	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
350963	Ordering, Referring, Prescribing	N/A	1891564613	0	0	PAULINO, MELANIE NP	9/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027095	N/A	N/A	N/A	N/A	N/A	1780 E FLORIDA AVE	None	HEMET	CA	92544	4679	00	06000	33.74770382	-116.9532553	Riverside County
351058	Ordering, Referring, Prescribing	N/A	1891954020	0	0	PASYAR, NEDA	8/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109547	N/A	N/A	N/A	N/A	N/A	2039 FOREST AVE	SUITE 105	SAN JOSE	CA	95128	4817	00	06000	37.32711929	-121.934266	Santa Clara County
351059	Ordering, Referring, Prescribing	N/A	1891959300	0	0	PORTILLO, EILDA	3/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	19764	N/A	N/A	N/A	N/A	N/A	355 CAMPUS DR	STE E	HANFORD	CA	93230	4376	00	06000	36.3271295	-119.6633596	Kings County
351076	Ordering, Referring, Prescribing	N/A	1891998761	0	0	PORTER-LEITE, KIMBERLY A LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34887	N/A	N/A	N/A	N/A	N/A	250 EXECUTIVE PARK BLVD	SUITE 4900	SAN FRANCISCO	CA	94134	3394	00	06000	37.71122789	-122.3917813	San Francisco County
351080	Ordering, Referring, Prescribing	N/A	1902001506	0	0	PRYPCHAN, LIDA D MD	3/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	7701A	N/A	N/A	N/A	N/A	N/A	2521E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
351095	Ordering, Referring, Prescribing	N/A	1902035546	0	0	POYNOR, APRIL LMFT	9/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT82578	N/A	N/A	N/A	N/A	N/A	2231 E. PALMDALE BLVD	SUITE K	PALMDALE	CA	93550	1326	00	06000	34.5801813	-118.0885398	Los Angeles County
351122	Ordering, Referring, Prescribing	N/A	1902097926	0	0	PETERS, LANSDALE J PA-C	12/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	18710	N/A	N/A	N/A	N/A	N/A	437 N EUCLID AVE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
351130	Ordering, Referring, Prescribing	N/A	1902112030	0	0	POON, JOHN S PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63192	N/A	N/A	N/A	N/A	N/A	2500 MERCED STREET	2966	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
351148	Ordering, Referring, Prescribing	N/A	1902151962	0	0	PARIKH, RISHI M MD	2/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132327	N/A	N/A	N/A	N/A	N/A	303 E VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
351167	Ordering, Referring, Prescribing	N/A	1902170467	0	0	PREGO, SUSANA LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90554	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	9999	00	06000	33.782913	-118.192417	Los Angeles County
351171	Ordering, Referring, Prescribing	N/A	1902174816	0	0	PAEZ, ROSALYN A	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57293	N/A	N/A	N/A	N/A	N/A	13231 VICTORY BLVD	None	VAN NUYS	CA	91401	2025	00	06000	34.18670546	-118.42164	Los Angeles County
351221	Ordering, Referring, Prescribing	N/A	1902267859	0	0	PUGH, SHENNEN N LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111268	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	200	CONCORD	CA	94520	4886	00	06000	37.98393807	-122.0466953	Contra Costa County
351253	Ordering, Referring, Prescribing	N/A	1902303191	0	0	PIETRO, KELSEY	5/9/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30015	N/A	N/A	N/A	N/A	N/A	3330 PICO BLVD	SUITE A	SANTA MONICA	CA	90405	2116	00	06000	34.02739419	-118.4541753	Los Angeles County
351261	Ordering, Referring, Prescribing	N/A	1902317662	0	0	PHAM, LINDA PHARMD	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76782	N/A	N/A	N/A	N/A	N/A	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
351270	Ordering, Referring, Prescribing	N/A	1902330020	0	0	PARKER, JESSICA A PHARMD	4/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74504	N/A	N/A	N/A	N/A	N/A	5700 LINDERO CANYON RD	None	WESTLAKE VILLAGE	CA	91362	4063	00	06000	34.15352777	-118.7978196	Los Angeles County
351302	Ordering, Referring, Prescribing	N/A	1902397045	0	0	PHANGRATH, DOUANGCHAY J NP	8/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	766190	N/A	N/A	N/A	N/A	N/A	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	00	06000	36.72031784	-120.060276	Fresno County
351319	Ordering, Referring, Prescribing	N/A	1902439375	0	0	PAZ, JUSTINE LMFT	1/2/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152429	N/A	N/A	N/A	N/A	N/A	400 W PARK AVE	None	SANTA MARIA	CA	93458	6116	00	06000	34.944048	-120.4407685	Santa Barbara County
351324	Ordering, Referring, Prescribing	N/A	1902444573	0	0	PAZ, YESENIA LCSW	8/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117786	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
351325	Ordering, Referring, Prescribing	N/A	1902455827	0	0	PENA, SANDY LCSW	7/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90759	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
351329	Ordering, Referring, Prescribing	N/A	1902459977	0	0	PEREZ-CELIS, ANGIE S DDS	1/31/2025	Taxonomy not applicable	NA	n/a	000	Unknown	DDS111217	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	STE 1504	LOS ANGELES	CA	90017	4006	00	06000	34.05270508	-118.2641005	Los Angeles County
351370	Ordering, Referring, Prescribing	N/A	1902833734	0	0	PATEL, HITESH C DO	5/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50723	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
351377	Ordering, Referring, Prescribing	N/A	1902868268	0	0	PLUMMER, ALICE T MD	10/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C143188	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	1170	00	06000	40.58349378	-122.3853903	Shasta County
351386	Ordering, Referring, Prescribing	N/A	1902881808	0	0	PANADERO, CHARLES V MD	3/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A77796	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
351395	Ordering, Referring, Prescribing	N/A	1902909054	0	0	PORTALES, RAMON DDS PC	5/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS34194	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
351397	Ordering, Referring, Prescribing	N/A	1902918469	0	0	PFANNER, ALISA A LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79996	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY 49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
351425	Ordering, Referring, Prescribing	N/A	1902952898	0	0	PANAGOS, WENDY A LMFT	3/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42231	N/A	N/A	N/A	N/A	N/A	6386 ALVARADO CT	SUITE 310	SAN DIEGO	CA	92120	4905	00	06000	32.77666838	-117.0614255	San Diego County
351443	Ordering, Referring, Prescribing	N/A	1902984628	0	0	POPLAWSKI, DONNA A MD	12/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A56118	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
351448	Ordering, Referring, Prescribing	N/A	1902998578	0	0	PHENGRASAMY, TONY T PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51027	N/A	N/A	N/A	N/A	N/A	1600 OWENS ST	5TH FLOOR	SAN FRANCISCO	CA	94158	2261	00	06000	37.76850146	-122.3949365	San Francisco County
351491	Ordering, Referring, Prescribing	N/A	1912084799	0	0	PELAYO, LUZ LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28632	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
351515	Ordering, Referring, Prescribing	N/A	1912139403	0	0	PHAN, CHAU T PHARMD	11/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	62912	N/A	N/A	N/A	N/A	N/A	1652 B ST	None	HAYWARD	CA	94541	3020	00	06000	37.67963935	-122.0715674	Alameda County
351525	Ordering, Referring, Prescribing	N/A	1912159575	0	0	PRINCE, DARRYL L LMFT	11/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106794	N/A	N/A	N/A	N/A	N/A	3845 N. CLARK ST.	SUITE 201	FRESNO	CA	93726	4812	00	06000	36.788364	-119.785209	Fresno County
351531	Ordering, Referring, Prescribing	N/A	1912183310	0	0	PACHECO, IGNACIO F LCSW	6/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71527	N/A	N/A	N/A	N/A	N/A	200 BROADWAY ST STE 70	None	KING CITY	CA	93930	2866	00	06000	36.2133658	-121.1256124	Monterey County
351534	Ordering, Referring, Prescribing	N/A	1912196056	0	0	PARK, BURN MD	11/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32222	N/A	N/A	N/A	N/A	N/A	1025 WILLOW AVE	None	LA PUENTE	CA	91746	1617	00	06000	34.05410889	-117.9706993	Los Angeles County
351540	Ordering, Referring, Prescribing	N/A	1912198557	0	0	PARKER, JOSHUA A MD	10/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92097	N/A	N/A	N/A	N/A	N/A	2039 FOREST AVENUE	None	SAN JOSE	CA	95128	4817	00	06000	37.32711929	-121.934266	Santa Clara County
351573	Ordering, Referring, Prescribing	N/A	1912260589	0	0	PYLADAKI, EFTHYMIA LMFT	9/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50310	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
351588	Ordering, Referring, Prescribing	N/A	1912287236	0	0	POWERS, CASEY L LCSW	7/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69535	N/A	N/A	N/A	N/A	N/A	339 PAJARO ST.	STE. B	SALINAS	CA	93901	3400	00	06000	36.6725294	-121.6522021	Monterey County
351593	Ordering, Referring, Prescribing	N/A	1912289166	0	0	PATEL, RUPAL D PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52640	N/A	N/A	N/A	N/A	N/A	5055 TELEGRAPH AVE	None	OAKLAND	CA	94609	2040	00	06000	37.8368777	-122.2624355	Alameda County
351630	Ordering, Referring, Prescribing	N/A	1912335480	0	0	PHAN, LISA PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67607	N/A	N/A	N/A	N/A	N/A	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
351633	Ordering, Referring, Prescribing	N/A	1912338450	0	0	PICCOLO, LIESL F NP	7/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022010	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
351673	Ordering, Referring, Prescribing	N/A	1912392713	0	0	PROUM, SUSAN MD	8/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160299	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
351684	Ordering, Referring, Prescribing	N/A	1912393711	0	0	POLITIS, MICHAEL DO	4/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16367	N/A	N/A	N/A	N/A	N/A	3801 3RD ST	BLDG B SUITE 400, FOSTER	SAN FRANCISCO	CA	94124	1409	00	06000	37.74208019	-122.3880422	San Francisco County
351747	Ordering, Referring, Prescribing	N/A	1912511403	0	0	PATOLIA, NISHITA R NP	6/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95015188	N/A	N/A	N/A	N/A	N/A	7526 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92111	1504	00	06000	32.83275147	-117.157122	San Diego County
351809	Ordering, Referring, Prescribing	N/A	1912656836	0	0	PIMENTEL, ESTEBAN PHARMD	3/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85978	N/A	N/A	N/A	N/A	N/A	2048 E AVENIDA DE LOS AR	None	THOUSAND OAKS	CA	91362	1356	00	06000	34.21127806	-118.8412358	Ventura County
351817	Ordering, Referring, Prescribing	N/A	1912683004	0	0	PARIKH, HINAL PA-C	6/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62943	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
351834	Ordering, Referring, Prescribing	N/A	1912922865	0	0	PINA, ANN C	2/7/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0457956	N/A	N/A	N/A	N/A	N/A	1550 N GAREY AVE	None	POMONA	CA	91767	3626	00	06000	34.07356342	-117.7522392	Los Angeles County
351860	Ordering, Referring, Prescribing	N/A	1922115856	0	0	PARIKH, MEGHAL V MD	7/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110325	N/A	N/A	N/A	N/A	N/A	2908 G ST	None	MERCED	CA	95340	0000	00	06000	37.31214885	-120.4693265	Merced County
351866	Ordering, Referring, Prescribing	N/A	1922128511	0	0	PALHAN, SANDHYA J	2/1/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D54427	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
351885	Ordering, Referring, Prescribing	N/A	1922152834	0	0	PELUCE-FUNE, POPPY E LCSW	1/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23689	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
351889	Ordering, Referring, Prescribing	N/A	1922170562	0	0	PERSON, HADISHA LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51776	N/A	N/A	N/A	N/A	N/A	401 E OCEAN AVE	None	LOMPOC	CA	93436	6828	00	06000	34.6389765	-120.4537095	Santa Barbara County
351904	Ordering, Referring, Prescribing	N/A	1922203603	0	0	PAYNE, JONATHAN LMFT	9/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77876	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
351909	Ordering, Referring, Prescribing	N/A	1922210251	0	0	PETERSEN, ERIK J MD	4/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137589	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD.	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
351930	Ordering, Referring, Prescribing	N/A	1922290840	0	0	PADILLA, PAULINA A LCSW	11/25/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61768	N/A	N/A	N/A	N/A	N/A	9101 WHITTIER BLVD.	None	PICO RIVERA	CA	90660	2405	00	06000	34.00074139	-118.0822944	Los Angeles County
351937	Ordering, Referring, Prescribing	N/A	1922302215	0	0	PEREZ, GIANNCARLO PHARMD	1/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53533	N/A	N/A	N/A	N/A	N/A	150 W FOOTHILL BLVD	None	MONROVIA	CA	91016	2171	00	06000	34.15130911	-118.0025994	Los Angeles County
351961	Ordering, Referring, Prescribing	N/A	1922334341	0	0	PHILLIPS, ANNA PHD	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83288	N/A	N/A	N/A	N/A	N/A	1315 FRUITVALE AVE	None	OAKLAND	CA	94601	1916	00	06000	37.77711228	-122.2261217	Alameda County
352022	Ordering, Referring, Prescribing	N/A	1922428622	0	0	PEREZ, NICHOLAS J MD	6/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148494	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
352046	Ordering, Referring, Prescribing	N/A	1922473685	0	0	PATINO, VERONICA M LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106713	N/A	N/A	N/A	N/A	N/A	120 S STATE COLLEGE BLVD	STE 150	BREA	CA	92821	5837	00	06000	33.92111797	-117.8828786	Orange County
352057	Ordering, Referring, Prescribing	N/A	1922482538	0	0	PATEL, MITUL N	4/5/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	71492	N/A	N/A	N/A	N/A	N/A	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
352064	Ordering, Referring, Prescribing	N/A	1922489715	0	0	PHAN, MARIE ELOISE T PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71605	N/A	N/A	N/A	N/A	N/A	3501 STOCKDALE HWY	2326	BAKERSFIELD	CA	93309	2150	00	06000	35.35408422	-119.0424307	Kern County
352066	Ordering, Referring, Prescribing	N/A	1922493402	0	0	POPPE, CHRISTA LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97711	N/A	N/A	N/A	N/A	N/A	2227 CHALLENGER WAY	207	SANTA ROSA	CA	95407	5418	00	06000	38.4250533	-122.7524648	Sonoma County
352120	Ordering, Referring, Prescribing	N/A	1922569698	0	0	PETERSON, ANDREA NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020812	N/A	N/A	N/A	N/A	N/A	4120 PRESCOTT RD	None	MODESTO	CA	95356	8418	00	06000	37.69891977	-121.0317078	Stanislaus County
352135	Ordering, Referring, Prescribing	N/A	1922589522	0	0	PARIKH, HIRAL G PHARMD	8/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76968	N/A	N/A	N/A	N/A	N/A	200 N WINCHESTER BLVD	None	SANTA CLARA	CA	95050	6501	00	06000	37.329138	-121.950268	Santa Clara County
352156	Ordering, Referring, Prescribing	N/A	1922643295	0	0	PHIFER, KRISTEN OD	10/15/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34451	N/A	N/A	N/A	N/A	N/A	1131 W 6TH ST	None	ONTARIO	CA	91762	1121	00	06000	34.084404	-117.6717015	San Bernardino County
352192	Ordering, Referring, Prescribing	N/A	1922763697	0	0	PAZ CALDERON, DANIELA LCSW	12/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127682	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
352198	Ordering, Referring, Prescribing	N/A	1922804426	0	0	POTTUKALAM, MINU J NP	10/15/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032599	N/A	N/A	N/A	N/A	N/A	14860 ROSCOE BLVD	300	PANORAMA CITY	CA	91402	4665	00	06000	34.2214515	-118.4573205	Los Angeles County
352221	Ordering, Referring, Prescribing	N/A	1932128121	0	0	PAULEKAS, MARK MD	5/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43159	N/A	N/A	N/A	N/A	N/A	801 17TH ST	None	MODESTO	CA	95354	1243	00	06000	37.64374164	-120.9915923	Stanislaus County
352226	Ordering, Referring, Prescribing	N/A	1932163441	0	0	PARRILLA, RENEE M	2/5/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA13760	N/A	N/A	N/A	N/A	N/A	2633 16TH STREET	None	BAKERSFIELD	CA	93301	3348	00	06000	35.37232854	-119.0327985	Kern County
352263	Ordering, Referring, Prescribing	N/A	1932257490	0	0	PIERRE, JUDITH PA-C	8/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63238	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
352277	Ordering, Referring, Prescribing	N/A	1932294576	0	0	PATTERSON, SUZANNAH W	6/20/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	58402	N/A	N/A	N/A	N/A	N/A	760 HARRISON STREET	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
352304	Ordering, Referring, Prescribing	N/A	1932368388	0	0	PINEDA, ANNARHEEN S PSY	7/19/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27194	N/A	N/A	N/A	N/A	N/A	1140 MAIN ST	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
352364	Ordering, Referring, Prescribing	N/A	1932487006	0	0	PARASHAR, ADITI MD	5/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139276	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
352375	Ordering, Referring, Prescribing	N/A	1932512647	0	0	PAEK, AGELINA	5/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	100231	N/A	N/A	N/A	N/A	N/A	4881 TELEGRAPH AVE	None	BERKELEY	CA	94609	2009	00	06000	37.83557035	-122.2627452	Alameda County
352380	Ordering, Referring, Prescribing	N/A	1932523081	0	0	POTTENGER, MAXINE MD	7/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165796	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
352387	Ordering, Referring, Prescribing	N/A	1932528965	0	0	PARUNGAO, JODI MD	6/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157212	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	94545	0870	00	06000	39.68781544	-123.4842982	Mendocino County
352413	Ordering, Referring, Prescribing	N/A	1932567815	0	0	PRAT, ELIZABETH LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78722	N/A	N/A	N/A	N/A	N/A	17800 WOODRUFF AVE	#F	BELLFLOWER	CA	90706	7079	00	06000	33.87127861	-118.1172501	Los Angeles County
352416	Ordering, Referring, Prescribing	N/A	1932568144	0	0	PALMER, MARTIN K	4/6/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	101000	N/A	N/A	N/A	N/A	N/A	847 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
352418	Ordering, Referring, Prescribing	N/A	1932570009	0	0	PHAN, CONNIE K	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71986	N/A	N/A	N/A	N/A	N/A	1801 E MARCH LN	B280	STOCKTON	CA	95210	6629	00	06000	38.00315652	-121.2868715	San Joaquin County
352432	Ordering, Referring, Prescribing	N/A	1932585437	0	0	PARRISH, SCOTT PHARMD	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48865	N/A	N/A	N/A	N/A	N/A	8850 FOOTHILL BLVD	None	RANCHO CUCAMONGA	CA	91730	3305	00	06000	34.108308	-117.612144	San Bernardino County
352433	Ordering, Referring, Prescribing	N/A	1932566031	0	0	PRASEK, LAUREN M NP	5/23/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95089757	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	7207	00	06000	34.06633051	-118.4452686	Los Angeles County
352438	Ordering, Referring, Prescribing	N/A	1932592011	0	0	PHONXANASINH, TERRY PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72357	N/A	N/A	N/A	N/A	N/A	7155 24TH ST	None	SACRAMENTO	CA	95822	4494	00	06000	38.496231	-121.482207	Sacramento County
352453	Ordering, Referring, Prescribing	N/A	1932616034	0	0	PARK, PAUL LMFT	8/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141218	N/A	N/A	N/A	N/A	N/A	6301 BEACH BLVD	SUITE 245	BUENA PARK	CA	90621	2840	00	06000	33.86880928	-117.9983013	Orange County
352463	Ordering, Referring, Prescribing	N/A	1932629656	0	0	PRIVETTE, THEA A LMFT	2/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124467	N/A	N/A	N/A	N/A	N/A	101 WIKIUP DR	None	SANTA ROSA	CA	95403	1375	00	06000	38.50788547	-122.7587646	Sonoma County
352476	Ordering, Referring, Prescribing	N/A	1932657830	0	0	PEAVY, MARGARET G LCSW	12/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99187	N/A	N/A	N/A	N/A	N/A	1255 KENDALL RD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
352494	Ordering, Referring, Prescribing	N/A	1932671344	0	0	PSOTER, MARIKA MSW LCSW	9/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103778	N/A	N/A	N/A	N/A	N/A	104 S C ST	SUITE A	LOMPOC	CA	93436	6924	00	06000	34.638645	-120.4514709	Santa Barbara County
352584	Ordering, Referring, Prescribing	N/A	1932883147	0	0	PREDAZZI, MICAELA NP	8/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026775	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	5908	00	06000	34.95019447	-120.4147816	Santa Barbara County
352594	Ordering, Referring, Prescribing	N/A	1932960549	0	0	PHILLIPS, SHANTELL NP	7/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026235	N/A	N/A	N/A	N/A	N/A	5959 GREENBACK LN	STE 500	CITRUS HEIGHTS	CA	95621	4700	00	06000	38.681397	-121.322682	Sacramento County
352669	Ordering, Referring, Prescribing	N/A	1942385471	0	0	PARK, KWANG S MD	10/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A37469	N/A	N/A	N/A	N/A	N/A	1224 VINE ST.	None	LOS ANGELES	CA	90038	1216	00	06000	34.093332	-118.326603	Los Angeles County
352688	Ordering, Referring, Prescribing	N/A	1942459607	0	0	PARKS, PAT PA-C	12/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56397	N/A	N/A	N/A	N/A	N/A	635 N FAIRBANKS CT	None	CHICAGO	IL	60611	5435	00	06000	41.893956	-87.62025198	Cook County
352695	Ordering, Referring, Prescribing	N/A	1942460506	0	0	POURMEHR, SHARONA LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51789	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD.	2000	LOS ANGELES	CA	90010	2151	00	06000	34.06170677	-118.302787	Los Angeles County
352752	Ordering, Referring, Prescribing	N/A	1942583299	0	0	POWERS, VAN	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65472	N/A	N/A	N/A	N/A	N/A	2900 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2302	00	06000	38.547882	-121.454955	Sacramento County
352811	Ordering, Referring, Prescribing	N/A	1942656376	0	0	PAUL, NATALIE R LMFT	7/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120232	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	None	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
352812	Ordering, Referring, Prescribing	N/A	1942665252	0	0	PALMA, JUSTINE N NP	8/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003453	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	220	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
352818	Ordering, Referring, Prescribing	N/A	1942665609	0	0	PATEL, ANUP	11/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71165	N/A	N/A	N/A	N/A	N/A	101 TOWN CENTER PARKWAY	None	SANTEE	CA	92071	5802	00	06000	32.84028083	-116.9886045	San Diego County
352855	Ordering, Referring, Prescribing	N/A	1942731906	0	0	POP, PATRICIA MD	8/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157715	N/A	N/A	N/A	N/A	N/A	922 THE ALAMEDA	SUITE 400	SAN JOSE	CA	95126	1136	00	06000	37.33156314	-121.9078492	Santa Clara County
352864	Ordering, Referring, Prescribing	N/A	1942740899	0	0	PHONG, KENNETH T NP	9/12/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	819828	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	7404	00	06000	34.06633051	-118.4452686	Los Angeles County
352969	Ordering, Referring, Prescribing	N/A	1952008054	0	0	PHAN, VAN DDS	7/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108579	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	C AND D	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
352975	Ordering, Referring, Prescribing	N/A	1952029589	0	0	PELAYO, ALBERTO PHARMD	8/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86440	N/A	N/A	N/A	N/A	N/A	101 N BEACH BLVD	None	LA HABRA	CA	90631	4468	00	06000	33.9322713	-117.9680281	Orange County
352982	Ordering, Referring, Prescribing	N/A	1952060212	0	0	PATEL, VISHAL PHARMD	10/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	61642	N/A	N/A	N/A	N/A	N/A	15141 WHITTIER BLVD	SUITE 115	WHITTIER	CA	90603	2160	00	06000	33.94810044	-118.0039419	Los Angeles County
353006	Ordering, Referring, Prescribing	N/A	1952314205	0	0	PURAY, MERLA MD	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A98668	N/A	N/A	N/A	N/A	N/A	3175 COLLINS DR	None	MERCED	CA	95348	3133	00	06000	37.32106749	-120.4764781	Merced County
353018	Ordering, Referring, Prescribing	N/A	1952381550	0	0	PIERMAN, DENISHA A PA-C	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57586	N/A	N/A	N/A	N/A	N/A	290 N WAYTE LN	None	FRESNO	CA	93701	2124	00	06000	36.74643429	-119.7837416	Fresno County
353019	Ordering, Referring, Prescribing	N/A	1952372732	0	0	PATEL, UMESH BHAI P	5/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	38358	N/A	N/A	N/A	N/A	N/A	1240 S MAGNOLIA AVE	None	ANAHEIM	CA	92804	5116	00	06000	33.815583	-117.9757915	Orange County
353062	Ordering, Referring, Prescribing	N/A	1952463648	0	0	PATEL, URVI R OD	2/28/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11941	N/A	N/A	N/A	N/A	N/A	1700 S BRADLEY RD	None	SANTA MARIA	CA	93454	8001	00	06000	34.92801184	-120.4200671	Santa Barbara County
353065	Ordering, Referring, Prescribing	N/A	1952476913	0	0	PEREZ, DIANA LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64563	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
353094	Ordering, Referring, Prescribing	N/A	1952558454	0	0	PHAM, LANCHI DMD	1/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	57639	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
353135	Ordering, Referring, Prescribing	N/A	1952650038	0	0	PORTER, JENNIFER A PSYD	12/8/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26841	N/A	N/A	N/A	N/A	N/A	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	00	06000	34.15365596	-118.1370318	Los Angeles County
353176	Ordering, Referring, Prescribing	N/A	1952723736	0	0	PLASCENCIA, CINDY LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113536	N/A	N/A	N/A	N/A	N/A	1012 N MAIN ST	STE 101	RAMONA	CA	92065	0000	00	06000	33.04181722	-116.8689096	San Diego County
353185	Ordering, Referring, Prescribing	N/A	1952747875	0	0	PROOSASELTS, YULIYA E MD	6/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133675	N/A	N/A	N/A	N/A	N/A	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	00	06000	32.75537928	-117.1416551	San Diego County
353189	Ordering, Referring, Prescribing	N/A	1952748204	0	0	PEREZ, ANTHONY J PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59504	N/A	N/A	N/A	N/A	N/A	29910 MURRIETA HOT SPRIN	None	MURRIETA	CA	92563	3814	00	06000	33.5525995	-117.139571	Riverside County
353233	Ordering, Referring, Prescribing	N/A	1952808149	0	0	PICKRELL, DANIEL MD	6/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22996	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	0000	00	06000	40.5857177	-122.3870781	Shasta County
353240	Ordering, Referring, Prescribing	N/A	1952825788	0	0	PARKER, LAUREN C LMFT	10/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126128	N/A	N/A	N/A	N/A	N/A	970 CAMERADO DR	None	CAMERON PARK	CA	95682	7636	00	06000	38.68796248	-120.9882223	El Dorado County
353249	Ordering, Referring, Prescribing	N/A	1952835423	0	0	PERRIN-DUDENHOEFFER, SARAH DO	8/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20685	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
353254	Ordering, Referring, Prescribing	N/A	1952838799	0	0	PHILLIPPI, ROSANNA M	6/20/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	29652	N/A	N/A	N/A	N/A	N/A	76270 HIGH SCHOOL STREET	None	COVELO	CA	95428	0000	00	06000	39.79231672	-123.2558669	Mendocino County
353263	Ordering, Referring, Prescribing	N/A	1952851370	0	0	PATEL, MRUGESH N PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75676	N/A	N/A	N/A	N/A	N/A	645 SAN ANTONIO RD	None	MOUNTAIN VIEW	CA	94040	1303	00	06000	37.40220238	-122.1130454	Santa Clara County
353269	Ordering, Referring, Prescribing	N/A	1952854663	0	0	PEREZ, GUADALUPE M LMFT	1/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144189	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
353295	Ordering, Referring, Prescribing	N/A	1952869752	0	0	PRATAP, YASHWEENI LMFT	8/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT148903	N/A	N/A	N/A	N/A	N/A	301 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
353334	Ordering, Referring, Prescribing	N/A	1952971848	0	0	PHAM, QUYNH N OD	3/28/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35114	N/A	N/A	N/A	N/A	N/A	1555 S. GAREY AVENUE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
353380	Ordering, Referring, Prescribing	N/A	1962059121	0	0	PERINO, LINDSEY N LCSW	4/29/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107914	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	None	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
353381	Ordering, Referring, Prescribing	N/A	1962074799	0	0	PHAM, TRUNG K PHARMD	6/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84474	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
353394	Ordering, Referring, Prescribing	N/A	1962123380	0	0	PACLIBON, MIRIAM LY V NP	12/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023723	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
353398	Ordering, Referring, Prescribing	N/A	1962136598	0	0	PUREWAL, PARWINDER PHARMD	2/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	82705	N/A	N/A	N/A	N/A	N/A	3555 ROUND BARN CIR	None	SANTA ROSA	CA	95403	1757	00	06000	38.478717	-122.729715	Sonoma County
353403	Ordering, Referring, Prescribing	N/A	1962163667	0	0	PFISTER, ROBIN OT	1/5/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	14761	N/A	N/A	N/A	N/A	N/A	3575 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3212	00	06000	37.78122373	-122.4579478	San Francisco County
353415	Ordering, Referring, Prescribing	N/A	1962148932	0	0	PANG, EMILY L LCSW	11/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127517	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
353428	Ordering, Referring, Prescribing	N/A	1962406645	0	0	PASCUAL, ANNE GRACE STEPHANIE MD	1/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A78868	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
353431	Ordering, Referring, Prescribing	N/A	1962405084	0	0	PISTONE, DANIEL N MD	5/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C132973	N/A	N/A	N/A	N/A	N/A	19531 MCLANE ST	STE B	PALM SPRINGS	CA	92262	3019	00	06000	33.90666798	-116.5523429	Riverside County
353437	Ordering, Referring, Prescribing	N/A	1962428912	0	0	PATEL, VARSHA H MD	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50538	N/A	N/A	N/A	N/A	N/A	2813 S. MAIN ST	None	CORONA	CA	92882	5942	00	06000	33.84741266	-117.570694	Riverside County
353457	Ordering, Referring, Prescribing	N/A	1962525972	0	0	PIERCE, FRANKLIN DDS	11/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS38902	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	0000	00	06000	40.5857177	-122.3870781	Shasta County
353477	Ordering, Referring, Prescribing	N/A	1962573964	0	0	PENA, SIERRA MD	2/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C193631	N/A	N/A	N/A	N/A	N/A	1250 PEACH ST	STE B	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.28647825	-120.6599674	San Luis Obispo County
353486	Ordering, Referring, Prescribing	N/A	1962555078	0	0	PENSE, NOELLE M LMFT	5/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53876	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	STE 201-12	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
353488	Ordering, Referring, Prescribing	N/A	1962594523	0	0	PETRILLA, TERESA A PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47044	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2485	00	06000	38.12828446	-122.24821	Solano County
353492	Ordering, Referring, Prescribing	N/A	1962599522	0	0	PANGULURI, SANDHYA MD	1/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52988	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
353499	Ordering, Referring, Prescribing	N/A	1962617407	0	0	PURCELL, RAYMOND M JR NP	6/18/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	404097	N/A	N/A	N/A	N/A	N/A	1801 PANORAMA DR	None	BAKERSFIELD	CA	93305	1219	00	06000	35.407539	-118.972026	Kern County
353539	Ordering, Referring, Prescribing	N/A	1962693713	0	0	PALOMARES, SALVADOR L LMFT	6/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47403	N/A	N/A	N/A	N/A	N/A	501 KEARNEY ST #D	None	EL CERRITO	CA	94530	3520	00	06000	37.90264358	-122.3024948	Contra Costa County
353553	Ordering, Referring, Prescribing	N/A	1962720698	0	0	PATEL, YERA B PHARMD	5/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50861	N/A	N/A	N/A	N/A	N/A	932 S EUCLID ST	None	ANAHEIM	CA	92802	1523	00	06000	33.81900658	-117.9413125	Orange County
353558	Ordering, Referring, Prescribing	N/A	1962736587	0	0	PARTIDA-CANDIA, VANESSA LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90871	N/A	N/A	N/A	N/A	N/A	1650 LAS PLUMAS AVE	K	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
353570	Ordering, Referring, Prescribing	N/A	1962746230	0	0	PARKS, CHRISTOPHER J LPCC	3/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	10162	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO S STE	STE 201	SAN DIEGO	CA	92108	3505	00	06000	32.76094819	-117.1611994	San Diego County
353590	Ordering, Referring, Prescribing	N/A	1962771907	0	0	PATEL, VRUNDA K PHARMD	5/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66315	N/A	N/A	N/A	N/A	N/A	15940 QUANTICO ROAD	SUITE 100	APPLE VALLEY	CA	92307	1300	00	06000	34.54090735	-117.2706402	San Bernardino County
353597	Ordering, Referring, Prescribing	N/A	1962782581	0	0	PATEL, DHARINI	1/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	57957	N/A	N/A	N/A	N/A	N/A	2304 COLUMBUS ST	None	BAKERSFIELD	CA	93306	2608	00	06000	35.39764435	-118.9670636	Kern County
353606	Ordering, Referring, Prescribing	N/A	1962787093	0	0	PHAM, TRUNG PHARMD	9/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	CA46349	N/A	N/A	N/A	N/A	N/A	522 N ORANGE ST	None	REDLANDS	CA	92374	0001	00	06000	34.060041	-117.182552	San Bernardino County
353608	Ordering, Referring, Prescribing	N/A	1962788851	0	0	PANG, VITH PHARMD	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56333	N/A	N/A	N/A	N/A	N/A	3540 MT DIABLO RD	None	LAFAYETTE	CA	94549	3814	00	06000	37.89207305	-122.1192741	Contra Costa County
353622	Ordering, Referring, Prescribing	N/A	1962814038	0	0	PHAM, THOMAS M	9/15/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105242	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
353642	Ordering, Referring, Prescribing	N/A	1962832261	0	0	PAEZ, YENISS A LCSW	11/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98231	N/A	N/A	N/A	N/A	N/A	5420 N. FIGUEROA ST.	None	LOS ANGELES	CA	90042	4118	00	06000	34.10779213	-118.196385	Los Angeles County
353648	Ordering, Referring, Prescribing	N/A	1962834812	0	0	POULSEN, RAUL	7/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173593	N/A	N/A	N/A	N/A	N/A	540 N FIRST ST	None	SAN JOSE	CA	95112	5319	00	06000	37.34571835	-121.8975601	Santa Clara County
353687	Ordering, Referring, Prescribing	N/A	1962894550	0	0	PEMBROKE, DANIELLE PHARMD	9/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49591	N/A	N/A	N/A	N/A	N/A	730 LONG BEACH BLVD	C	LONG BEACH	CA	90813	4480	00	06000	33.775965	-118.189283	Los Angeles County
353731	Ordering, Referring, Prescribing	N/A	1962983536	0	0	PERKINS, NYSHAE LMFT	8/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120581	N/A	N/A	N/A	N/A	N/A	1214 EDDINGTON ST.	None	UPLAND	CA	91786	3440	00	06000	34.11371778	-117.6352691	San Bernardino County
353732	Ordering, Referring, Prescribing	N/A	1962985572	0	0	PEREZ, JESSICA E LCSW	1/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85619	N/A	N/A	N/A	N/A	N/A	954 N. VERMONT AVENUE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
353736	Ordering, Referring, Prescribing	N/A	1962990200	0	0	PETELIN, ARMA LMFT	3/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137559	N/A	N/A	N/A	N/A	N/A	1074 EAST AVE	STE A4	CHICO	CA	95926	1005	00	06000	39.76099443	-121.8353929	Butte County
353753	Ordering, Referring, Prescribing	N/A	1972013746	0	0	PERRY, ALEXANDRIA E LMFT	9/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128015	N/A	N/A	N/A	N/A	N/A	58471 29 PALMS HWY	102	YUCCA VALLEY	CA	92284	5818	00	06000	34.13270029	-116.3881647	San Bernardino County
353754	Ordering, Referring, Prescribing	N/A	1972012581	0	0	PASHEA, STACY M NP	10/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	849995	N/A	N/A	N/A	N/A	N/A	29 BAYWOOD AVENUE	None	SAN MATEO	CA	94401	1516	00	06000	37.56478204	-122.3289243	San Mateo County
353757	Ordering, Referring, Prescribing	N/A	1972018059	0	0	PON, CYNTHIA PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76277	N/A	N/A	N/A	N/A	N/A	6819 WATT AVE	None	NORTH HIGHLANDS	CA	95660	3203	00	06000	38.690892	-121.383558	Sacramento County
353802	Ordering, Referring, Prescribing	N/A	1972090306	0	0	PARSONS, MEKRAE NP	6/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008290	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
353851	Ordering, Referring, Prescribing	N/A	1972229854	0	0	PERDOMO, ANA NP	10/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022990	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR.	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
353887	Ordering, Referring, Prescribing	N/A	1972371425	0	0	PORTER, NICOLE LCSW	10/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110131	N/A	N/A	N/A	N/A	N/A	13000 NEW AIRPORT ROAD	None	AUBURN	CA	95603	9596	00	06000	38.94036707	-121.0798907	Placer County
353902	Ordering, Referring, Prescribing	N/A	1972608008	0	0	PHAM, XUAN T OD	5/11/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11435	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400 STE 100	SALINAS	CA	93906	3136	00	06000	36.696987	-121.633164	Monterey County
353915	Ordering, Referring, Prescribing	N/A	1972625861	0	0	PEOPLES, GERALDINE M NP	1/18/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9531	N/A	N/A	N/A	N/A	N/A	220 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3795	00	06000	37.78184696	-122.4142203	San Francisco County
353957	Ordering, Referring, Prescribing	N/A	1972705911	0	0	PITTS, CRYSTAL A LMFT	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78392	N/A	N/A	N/A	N/A	N/A	96 WASHOE BLVD	None	MARKLEEVILLE	CA	96120	9321	00	06000	38.79429819	-119.7533368	Alpine County
353997	Ordering, Referring, Prescribing	N/A	1972775278	0	0	PELAYO, NANCY LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53787	N/A	N/A	N/A	N/A	N/A	1816 S FIGUEROA ST	None	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
354012	Ordering, Referring, Prescribing	N/A	1972806776	0	0	PADDEN, KEVIN P LPCC	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	10168	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	C	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
354032	Ordering, Referring, Prescribing	N/A	1972850170	0	0	PURI, MUHAMMAD REHAN A MD MPH	11/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159451	N/A	N/A	N/A	N/A	N/A	7349 MILLIKEN AVE	None	RANCHO CUCAMONGA	CA	91730	7435	00	06000	34.120971	-117.5557455	San Bernardino County
354102	Ordering, Referring, Prescribing	N/A	1972943603	0	0	PATEL, PRANJAL R MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144145	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
354106	Ordering, Referring, Prescribing	N/A	1972947638	0	0	PATHAK, VIBHA OT	7/21/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	9572	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
354109	Ordering, Referring, Prescribing	N/A	1972949287	0	0	PUSKOOR, AKHILDEEP V MD	5/30/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155027	N/A	N/A	N/A	N/A	N/A	420 34TH STREET	None	BAKERSFIELD	CA	93301	2284	00	06000	35.39052148	-119.0070765	Kern County
354160	Ordering, Referring, Prescribing	N/A	1982008314	0	0	PHAM, QUYNH-CHI M LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW84876	N/A	N/A	N/A	N/A	N/A	615 W CIVIC CENTER DR	200	SANTA ANA	CA	92701	4006	00	06000	33.75157048	-117.8744355	Orange County
354190	Ordering, Referring, Prescribing	N/A	1982066734	0	0	PARIKH, AMIT MD	4/11/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161326	N/A	N/A	N/A	N/A	N/A	808 W 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
354216	Ordering, Referring, Prescribing	N/A	1982105474	0	0	POTTER, AMBER D NP	1/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008282	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
354222	Ordering, Referring, Prescribing	N/A	1982122503	0	0	PIELERT, MADELINE LCSW	1/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106625	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVE	100	SOUTH SAN FRANCIS	CA	94080	9571	00	06000	37.64441633	-122.4219331	San Mateo County
354232	Ordering, Referring, Prescribing	N/A	1982137519	0	0	PARK, ANDREW C MD	2/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160795	N/A	N/A	N/A	N/A	N/A	8605 SANTA MONICA BLVD	700497	WEST HOLLYWOOD	CA	90069	4109	00	06000	34.088062	-118.3791834	Los Angeles County
354233	Ordering, Referring, Prescribing	N/A	1982133906	0	0	PEREZ, MARIA NP	6/9/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012973	N/A	N/A	N/A	N/A	N/A	810 CAPP ST	None	SAN FRANCISCO	CA	94110	3225	00	06000	37.75351083	-122.417474	San Francisco County
354242	Ordering, Referring, Prescribing	N/A	1982155289	0	0	PIMENTEL, NERMAN PT	11/30/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT299595	N/A	N/A	N/A	N/A	N/A	12100 VALLEY BLVD	109A	EL MONTE	CA	91732	3161	00	06000	34.06130355	-118.0164048	Los Angeles County
354290	Ordering, Referring, Prescribing	N/A	1982232245	0	0	POSSANI, SADAF NP	11/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95014019	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
354303	Ordering, Referring, Prescribing	N/A	1982257416	0	0	PORRAS, VANESSA M LMFT	6/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133001	N/A	N/A	N/A	N/A	N/A	8530 LA MESA BLVD	#306	LA MESA	CA	91942	0966	00	06000	32.76873337	-117.0134248	San Diego County
354312	Ordering, Referring, Prescribing	N/A	1982277471	0	0	PALMA, LIBNA Z OD	5/31/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35129	N/A	N/A	N/A	N/A	N/A	1300 W OCEAN AVE	None	LOMPOC	CA	93436	5678	00	06000	34.63907053	-120.473361	Santa Barbara County
354321	Ordering, Referring, Prescribing	N/A	1982285698	0	0	PATEL, NEEDHEE MD	12/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8516	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
354343	Ordering, Referring, Prescribing	N/A	1982384327	0	0	PANJAITAN, GABRIELLA LMFT	7/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147821	N/A	N/A	N/A	N/A	N/A	600 N ARROWHEAD	SUITE 300	SAN BERNARDINO	CA	92401	1164	00	06000	34.110486	-117.2896755	San Bernardino County
354374	Ordering, Referring, Prescribing	N/A	1982721361	0	0	PENA, AURORA LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48107	N/A	N/A	N/A	N/A	N/A	222 PAUL SCANNELL DR	None	SAN MATEO	CA	94402	4061	00	06000	37.51168342	-122.3375282	San Mateo County
354445	Ordering, Referring, Prescribing	N/A	1982839239	0	0	PHILLIPS, LAURA LCSW	5/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25312	N/A	N/A	N/A	N/A	N/A	33122 VALLE RD	None	SAN JUAN CAPISTRA	CA	92675	4859	00	06000	33.47960493	-117.6694529	Orange County
354460	Ordering, Referring, Prescribing	N/A	1982867669	0	0	PARSA, KAMRAN H MD	10/2/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	11025	N/A	N/A	N/A	N/A	N/A	38420 5TH STREET WEST	STE E	PALMDALE	CA	93551	4430	00	06000	34.58015195	-118.1384596	Los Angeles County
354495	Ordering, Referring, Prescribing	N/A	1982951786	0	0	PEREZ-GOMEZ, BRISEIDA LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74218	N/A	N/A	N/A	N/A	N/A	813 E 4TH PL	None	LOS ANGELES	CA	90013	1805	00	06000	34.04412628	-118.2359868	Los Angeles County
354503	Ordering, Referring, Prescribing	N/A	1982961587	0	0	PHAN, YVONNE V PHARMD	2/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62551	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
354563	Ordering, Referring, Prescribing	N/A	1992055263	0	0	PERMENTER, LAUREN E LCSW	6/3/2018	Taxonomy not applicable	NA	n/a	000	Unknown	83870	N/A	N/A	N/A	N/A	N/A	1172 N MACLAY AVE	None	SAN FERNANDO	CA	91340	1328	00	06000	34.29582554	-118.4241314	Los Angeles County
354591	Ordering, Referring, Prescribing	N/A	1992091870	0	0	PYLES, KAREN J LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92333	N/A	N/A	N/A	N/A	N/A	2415 UNIVERSITY AVENUE	None	EAST PALO ALTO	CA	94303	1148	00	06000	37.47232529	-122.139568	San Mateo County
354658	Ordering, Referring, Prescribing	N/A	1992195127	0	0	PATEL, NISHA D	8/31/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64070	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	STE 225	VENTURA	CA	93004	1382	00	06000	34.29321532	-119.1597424	Ventura County
354695	Ordering, Referring, Prescribing	N/A	1992266100	0	0	PITCHER, CHAD DO	7/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19904	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	0000	00	06000	40.5857177	-122.3870781	Shasta County
354770	Ordering, Referring, Prescribing	N/A	1992424188	0	0	PAYNE, MACY C LCSW	3/18/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW129358	N/A	N/A	N/A	N/A	N/A	3737 MARCONI AVE	None	SACRAMENTO	CA	95821	5303	00	06000	38.618109	-121.3764615	Sacramento County
354790	Ordering, Referring, Prescribing	N/A	1992466593	0	0	PARK, PETER PHARMD	12/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85798	N/A	N/A	N/A	N/A	N/A	26521 AGOURA ROAD	None	CALABASAS	CA	91302	1958	00	06000	34.14393164	-118.6996508	Los Angeles County
354792	Ordering, Referring, Prescribing	N/A	1992490544	0	0	PUENTE MORENO, JOSE G MD	9/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P22	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
354800	Ordering, Referring, Prescribing	N/A	1992538565	0	0	PATEL, SHAMA NP	8/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031788	N/A	N/A	N/A	N/A	N/A	17822 BEACH BLVD	STE. 300	HUNTINGTON BEACH	CA	92647	7102	00	06000	33.70331388	-117.9890471	Orange County
354810	Ordering, Referring, Prescribing	N/A	1992742381	0	0	PONZIO, SHEILA MD	10/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68671	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LANE	L	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
354814	Ordering, Referring, Prescribing	N/A	1992752216	0	0	PADILLA, AMELIA GRACE G PHARMD	5/28/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50321	N/A	N/A	N/A	N/A	N/A	823 S. MAIN ST. STE 102	None	CORONA	CA	92882	3409	00	06000	33.87244032	-117.5668207	Riverside County
354882	Ordering, Referring, Prescribing	N/A	1992899041	0	0	PAL, JAYANTA KUMAR MD	3/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C158290	N/A	N/A	N/A	N/A	N/A	1101 MARINA VILLAGE PKWY	None	ALAMEDA	CA	94501	3579	00	06000	37.78594823	-122.2729465	Alameda County
354911	Ordering, Referring, Prescribing	N/A	1992961197	0	0	PARK, STACY L LCSW	1/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23522	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	SUITE 100	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County